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Cervical cancer is the third most common cancer after breast and colorectal cancers worldwide, and the second most common gynecological malignancy after endometrial cancer. Cervical cancer screening was first described by Papanicolaou in 1941 using the PAP smear test. The incidence of invasive cervical cancer clearly reduced with the common use of PAP smear in developed countries. The basic methods used for diagnosis of premalignant lesions of the cervix are determination with colposcopy, biopsy and HPV DNA typing. Cervical premalignant lesions cannot be observed with the naked eye, other than exophytic or papillary lesions of condyloma acuminatum. Condyloma acuminatum are simultaneously LSIL. LSIL and HSIL differentiation cannot be made with colposcopy. Due to better repeatability and interobserver compliance, the World Health Organization (WHO) recommends a 2-layer HSIL/LSIL system. In the 3-layer CIN system, CIN1 is equivalent to LSIL, while CIN3 equivalent is HSIL. The lesions are frequently encountered in routine biopsies, and in some cases, differential diagnosis may be difficult. Basal cell hyperplasia, atrophy, reactive and repair-induced atypia and immature squamous metaplasia may mimic precancerous lesions. Although histomorphology is gold standard, P16 and Ki-67 are beneficial immunohistochemical ancillary testes. However, it should be kept in mind that p16 can be positive in LSIL, and negative in HSIL.

The Challenge of Pathological Diagnosis for Precancerous Cervical Lesions