To estimate the probability of histologically confirmed cervical high-grade intraepithelial lesions and cancer (HGIL+) among women referred for colposcopy after ASC - H cytology, and to determine whether this probability differs when ASC - H is reported as triage after a positive primary HPV test.

We conducted a retrospective two-center study including women referred for colposcopy following ASC - H cytology between 2018 and 2024. ASC - H was classified as either a primary screening result or triage after positive HPV testing. Clinical, cytological, colposcopic, and histological data were extracted. The primary outcome was histologically confirmed HGIL+, defined as high-grade cervical or vaginal intraepithelial lesion and/or cervical cancer diagnosed on biopsy and/or LLETZ specimen.

Overall, 421 colposcopies performed after ASC - H cytology were included. ASC - H was reported as a primary screening result in 185 cases (43.9%) and as triage after positive HPV testing in 236 cases (56.1%). HGIL+ was diagnosed in 213 women (50.6%), including 202 cervical HGIL, five vaginal HGIL, and six cervical cancers. The HGIL+ rate did not differ significantly between primary cytology and HPV-positive triage: 102/185 (55.1%) versus 111/236 (47.0%) ( p = 0.099). The HGIL+ rate varied significantly with age and was the lowest in women older than 50 years: 45.5% before 30 years, 56.3% between 30 and 50 years, and 40.5% after 50 years ( p = 0.017).

The probability of HGIL+ among women referred after ASC - H cytology was approximately 50%. This probability was not significantly modified by HPV-positive triage context but appeared lower in women older than 50 years.