Citation: Ple¸ s, L.; Radosa, J.-C.; Sima, R.-M.; Chicea, R.; Olaru, O.-G.; Poenaru, M.-O. The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions. Diagnostics 2022, 12, 1947. https://doi.org/10.3390/ diagnostics12081947 Academic Editor: Lukasz Wicherek Received: 18 June 2022 Accepted: 10 August 2022 Published: 12 August 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). diagnostics Article The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions Liana Ple¸ s 1,2 , Julia-Carolina Radosa 3 , Romina-Marina Sima 1,2, *, Radu Chicea 4 , Octavian-Gabriel Olaru 1,2 and Mircea-Octavian Poenaru 1,2 1 Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania 2 Bucur Maternity, Saint John Hospital, 012361 Bucharest, Romania 3 Department for Gynaecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany 4 Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania * Correspondence: romina.sima@umfcd.ro Abstract: Introduction: Cervical cancer (CC) is the third most common cancer in the world, and Romania has the highest incidence of cervical cancer in Europe. The aim of this study was to evaluate the correlation between cytology, colposcopy, and pathology for the early detection of premalignant cervical lesions in a group of Romanian patients. Methods: This observational type 2 cohort study included 128 women from our unit, “Bucur” Maternity, who were referred for cervical cancer screening. Age, clinical diagnosis, cytology results, colposcopy impression, and biopsy results were considered. Colposcopy was performed by two experienced examiners. The pathological examination was performed by an experienced pathologist. Results: The cytology found high-grade squamous intraepithelial lesions in 60.9% of patients, low-grade squamous intraepithelial lesions in 28.1%, atypical squamous cells for which a high-grade lesion could not be excluded in 9.4%, and atypical squamous cells of undetermined significance, known as repeated LSIL, in 1.6%. The first evaluator identified low-grade lesions in 56.3%, high-grade lesions in 40.6%, and invasion in 3.1% of patients. The second evaluator identified low-grade lesions in 59.4%, high-grade lesions in 32.0%, and invasion in 8.6% of patients. The pathological exam identified low-grade lesions in 64.1%, high-grade lesions in 25%, and carcinoma in 14% of patients. The colposcopic accuracy was greater than the cytologic accuracy. Conclusions: Colposcopy remains an essential tool for the identification of cervical premalignant cancer cells. Standardization of the protocol provided an insignificant interobserver variability and can serve as support for further postgraduate teaching. Keywords: colposcopy; cervical cancer; screening; biopsy; accuracy; audit 1. Introduction Cervical cancer (CC) is the third most common cancer in the world, and Romania has the highest incidence of cervical cancer in Europe [1,2]. Programs designed to reduce cervical cancer morbidity and mortality are based on the early detection of premalignant lesions. Improved cervical cytology and human papillomavirus (HPV) screening methods have decreased cervical cancer incidence [3,4]. A recent report indicated the high reliability of novel droplet digital PCR in molecularly characterizing premalignant uterine cervical lesions by detecting viral DNA belonging to different HPV genotypes [5]. However, in Romania, many patients are still diagnosed with late-stage cervical cancer despite the consistent introduction of national health programs for early detection that have been implemented in recent years [6,7]. In Romania, procedures such as HPV testing, colposcopy, and biopsy are used to diagnose abnormally classified cervical lesions, as proposed by the American Society for Colposcopy and Cervical Pathology (ASCCP) [8]. Although most practitioners follow Diagnostics 2022, 12, 1947. https://doi.org/10.3390/diagnostics12081947 https://www.mdpi.com/journal/diagnostics