Predictive determinants of CIN II + lesions in women over 65 years old: the contribution of HPV, colposcopy, and double immunostaining techniques.

BACKGROUND

Cervical intraepithelial neoplasia grade II or higher (CIN II+) is hard to diagnose in women over 65 years of age since age-related anatomical changes take place, and there is a paucity of data. The aim of the study was to identify predictive clinical, virological, colposcopic, and immunohistochemical predictors of CIN II + lesions in this less studied population.

METHODS

We retrospectively analyzed 364 postmenopausal women aged ≥ 65 years who underwent colposcopy due to abnormal cytology and/or positive human papillomavirus (HPV) test results. Data included HPV test results, cytology, colposcopic findings, biopsy results, and p16/Ki67 dual immunostaining. Univariate logistic regression was used to determine risk factors associated with CIN II+.

RESULTS

CIN II + lesions were detected in 6.0% of the patients (n = 22). 100% of the CIN II + cases were p16/Ki67 positive and 0% were in negative-staining cases (p < 0.001). CIN II + prevalence was significantly higher among HPV-positive women (9.9%) compared with HPV-negative women (0.7%) (p < 0.001). Among HPV genotypes, HPV 18 was associated with the highest CIN II + rate (20%). Being sexually active (OR: 4.847; p = 0.002), persistent HPV infection (OR: 1.512; p = 0.013), HPV positivity (OR: 16.602; p = 0.006), HPV 18 infection (OR: 5.042; p = 0.033), and pathologic colposcopic findings (OR: 5.503; p = 0.007) were all significantly associated with CIN II + lesions.

CONCLUSION

In women aged ≥ 65 years, CIN II + lesions are strongly linked to HPV positivity, persistent infection, high-risk types such as HPV 18, dual p16/Ki67 positivity, and abnormal colposcopy. This argues for individualized, multimodal cervical screening in elderly women, combining HPV genotype-based risk stratification, biomarker triage (p16/Ki-67), and clinical factors to improve detection and reduce unnecessary procedures.