Lesions of the uterine cervix encompass a broad morphologic spectrum ranging from chronic inflammatory and reactive changes to cervical intraepithelial neoplasia and invasive carcinoma. Persistent infection with high-risk human papillomavirus is the central etiologic event in most cervical precancers and cancers, and cervical carcinogenesis is understood as a multistep process influenced by viral persistence, host response, and time-dependent progression [1-3]. Classical natural history studies and later systematic reviews have shown that lower-grade lesions frequently regress, whereas higher-grade cervical intraepithelial neoplasia carries a substantially greater risk of persistence and progression to invasive disease [4-6]. Although cytology, human papillomavirus testing, and colposcopy play major roles in screening and triage, histopathological examination of cervical biopsy tissue remains the definitive method for lesion confirmation and grading [7-9]. This is particularly important because management decisions differ across non-neoplastic lesions, low-grade dysplasia, high-grade intraepithelial lesions, and invasive malignancy. Contemporary classification systems have also refined the morphologic categorization of cervical neoplasia and strengthened the integration of histology with pathogenetic understanding, especially for squamous and glandular lesions associated with or independent of human papillomavirus infection [10,11]. The histopathological pattern of cervical biopsies varies across institutions and populations according to age structure, symptom profile, referral practices, screening coverage, and underlying burden of cervical cancer. Previous biopsy-based studies have consistently reported chronic cervicitis as the predominant non-neoplastic lesion and squamous cell carcinoma as the leading malignant diagnosis, while the frequency of cervical intraepithelial neoplasia differs across centers [12-14]. Correlation between clinical suspicion, colposcopic assessment, and tissue diagnosis is therefore essential in routine gynecologic practice, especially in resource-constrained settings where women often present after symptoms have become persistent or alarming [7,9,13]. Retrospective pathology audits are useful because they provide a realistic picture of the lesions actually encountered in day-to-day diagnostic practice and help identify the proportion of cases requiring closer surveillance or definitive treatment. However, region-specific data from many secondary and tertiary care hospitals in India remain limited in the published literature. Against this background, the present study was undertaken in the Department of Pathology, KIMS, Amalapuram, Andhra Pradesh, India, to analyze the age distribution, clinical indications, and histopathological spectrum of cervical biopsy lesions, and to determine the relative burden of non-neoplastic, premalignant, and malignant cervical lesions in the study population.

Study design and setting This retrospective descriptive study was carried out in the Department of Pathology, Konaseema Institute of Medical Sciences (KIMS), Amalapuram, Andhra Pradesh, India. The study period extended from July 2019 to December 2019. The investigation was based on cervical biopsy specimens received in the pathology laboratory during the defined study interval. The study was designed to assess the pattern of lesions encountered in routine histopathology practice rather than to estimate community prevalence. Accordingly, all interpretations were made within the context of biopsy-based hospital data. The retrospective audit design was considered appropriate for documenting the morphologic spectrum of disease and for generating clinically meaningful baseline information for local service planning and academic reporting. Study population and sample size A total of 50 cervical biopsy specimens constituted the study sample. These represented all eligible cervical biopsy samples received during the study period for which the paraffin blocks, histopathology slides, and pathology records were available for review. Inclusion criteria comprised cervical punch biopsies and small cervical tissue biopsies submitted to the department with adequate clinical information and preserved tissue architecture sufficient for diagnosis. Specimens with severely autolyzed tissue, inadequate material, or missing essential histopathology records were excluded. Because the objective of the study was descriptive profiling of lesions received during the specified period, no separate sample size calculation was applied. Data collection and histopathological evaluation Data were retrieved from pathology requisition forms, laboratory registers, archived reports, and available hematoxylin and eosin stained sections. Patient age and clinical indication for biopsy were recorded. Each case was reviewed and categorized on histomorphological grounds into non-neoplastic, premalignant, or malignant lesions. Non-neoplastic lesions included chronic nonspecific cervicitis, chronic cervicitis with squamous metaplasia, koilocytic change suggestive of human papillomavirus effect, endocervical polyp, and nabothian cyst. Premalignant lesions were grouped as cervical intraepithelial neoplasia grade I, grade II, and grade III or carcinoma in situ, while malignant lesions were classified according to the established morphologic diagnosis recorded on histopathology, such as squamous cell carcinoma and adenocarcinoma. The classification approach was aligned with accepted principles of cervical lesion grading and contemporary pathologic categorization of cervical tumors [4,10,11]. Histopathology was treated as the reference standard for lesion confirmation, consistent with recommendations in cervical diagnostic pathways [7-9,13]. Study variables and statistical analysis The primary study variables were age group, clinical indication for cervical biopsy, detailed histopathological diagnosis, and broad lesion category. Age was grouped into clinically relevant intervals to facilitate descriptive interpretation. Data were entered into a structured spreadsheet and analyzed using descriptive statistics. Continuous data were summarized as mean +/- standard deviation, while categorical data were expressed as frequencies and percentages. Findings were presented in tables to allow clear display of demographic distribution, clinical indications, detailed lesion spectrum, and broad categorization of cervical pathology. Because the study objective was descriptive in nature, no inferential statistical testing was undertaken. Ethical considerations Patient confidentiality was maintained throughout the study. Data were anonymized at the time of extraction from departmental records, and no patient-identifying information was included in the analysis or reporting. The work was undertaken as a retrospective review of archived pathology material and records after obtaining institutional and departmental permission in accordance with local academic practice.

A total of 50 cervical biopsy specimens received in the pathology department during the study period were included in the retrospective analysis. The age of the patients ranged from 24 to 68 years, with a mean age of 43.8 +/- 10.9 years. The highest number of biopsies was observed in the 41-50 year age group, accounting for 32.0% of cases, followed by the 31-40 year age group at 28.0%. Women aged 51 years and above constituted 24.0% of the study population. The age-wise distribution of cases is shown in Table 1. Table 1. Age-wise distribution of study participants [N = 50] Age group [years] Number of cases Percentage 21-30 8 16.0 31-40 14 28.0 41-50 16 32.0 51-60 9 18.0 >60 3 6.0 Total 50 100.0 The most common clinical indication for cervical biopsy was white vaginal discharge, seen in 14 cases (28.0%), followed by abnormal uterine bleeding in 11 cases (22.0%), postcoital bleeding in 8 cases (16.0%), and unhealthy cervix on per speculum examination in 7 cases (14.0%). Other indications included cervical erosion, prolapse with suspicious cervical changes, and visible cervical growth. The spectrum of clinical presentation is presented in Table 2. Histopathological examination showed that non-neoplastic lesions constituted the majority of cervical biopsies, accounting for 34 cases (68.0%). Among these, chronic nonspecific cervicitis was the most common lesion, identified in 16 cases (32.0%), followed by chronic cervicitis with squamous metaplasia in 9 cases (18.0%). Koilocytic change suggestive of human papillomavirus effect was observed in 4 cases (8.0%), while endocervical polyp and nabothian cyst accounted for 3 cases (6.0%) and 2 cases (4.0%), respectively. Premalignant lesions accounted for 10 cases (20.0%), of which cervical intraepithelial neoplasia grade I was the most frequent diagnosis. Malignant lesions were identified in 6 cases (12.0%), and squamous cell carcinoma formed the predominant malignant subtype. The detailed histopathological spectrum is shown in Table 3. Table 2. Clinical indications for cervical biopsy [N = 50] Clinical indication Number of cases Percentage White vaginal discharge 14 28.0 Abnormal uterine bleeding 11 22.0 Postcoital bleeding 8 16.0 Unhealthy cervix 7 14.0 Cervical erosion 4 8.0 Prolapse with cervical changes 3 6.0 Visible cervical growth 3 6.0 Total 50 100.0 Table 3. Histopathological spectrum of cervical biopsy lesions [N = 50] Histopathological diagnosis Number of cases Percentage Chronic nonspecific cervicitis 16 32.0 Chronic cervicitis with squamous metaplasia 9 18.0 Koilocytic changes / HPV effect 4 8.0 Endocervical polyp 3 6.0 Nabothian cyst 2 4.0 CIN I 5 10.0 CIN II 3 6.0 CIN III / carcinoma in situ 2 4.0 Keratinizing squamous cell carcinoma 4 8.0 Non-keratinizing squamous cell carcinoma 1 2.0 Adenocarcinoma 1 2.0 Total 50 100.0 Table 4. Broad categorization of cervical lesions [N = 50] Lesion category Number of cases Percentage Non-neoplastic lesions 34 68.0 Premalignant lesions 10 20.0 Malignant lesions 6 12.0 Total 50 100.0 When lesions were broadly categorized, non-neoplastic lesions formed the largest group (68.0%), followed by premalignant lesions (20.0%) and malignant lesions (12.0%), as shown in Table 4. Age-wise assessment indicated that non-neoplastic lesions were predominantly encountered in women aged 31-50 years, whereas premalignant and malignant lesions were relatively more frequent in women older than 40 years. Most malignant lesions were observed in patients aged 51 years and above. Overall, the results indicate that inflammatory and reactive conditions represented the bulk of cervical biopsy diagnoses in this setting, while a substantial minority of cases demonstrated epithelial dysplasia and invasive malignancy requiring closer clinical attention.

The present retrospective analysis demonstrates that cervical biopsies received in routine pathology practice most commonly show non-neoplastic pathology, with chronic nonspecific cervicitis as the leading diagnosis. The largest age cluster in this series was 41-50 years, indicating that symptomatic cervical pathology requiring tissue diagnosis was concentrated in middle-aged women. This pattern is consistent with previous biopsy-based studies in which inflammatory lesions predominated overall, while invasive malignancy constituted a smaller but clinically important subset [12,14]. The biopsy profile observed here therefore reflects the spectrum of disease encountered in symptomatic or clinically suspicious women rather than screened population prevalence. White vaginal discharge and abnormal uterine bleeding were the leading clinical indications for biopsy in the present study. This finding is understandable because chronic cervicitis, metaplastic changes, and low-grade epithelial abnormalities frequently present with nonspecific gynecologic complaints and an unhealthy cervix on examination. It also underscores the practical importance of tissue diagnosis, since similar presenting symptoms can be associated with benign inflammation, human papillomavirus related epithelial change, or more serious dysplastic lesions. Previous work has shown that agreement between colposcopic impression and final pathology is only moderate, reinforcing the need to rely on histopathological examination for definitive categorization of suspicious cervical lesions [7-9,13]. Premalignant lesions accounted for one-fifth of all biopsies in this series, with cervical intraepithelial neoplasia grade I forming the largest subgroup. This is clinically relevant because cervical intraepithelial neoplasia represents the precursor continuum from which a proportion of cervical cancers arise. Evidence from natural history studies indicates that lower-grade lesions often regress, whereas the risk of persistence and progression increases with lesion severity, particularly for CIN III [4-6]. The greater concentration of premalignant and malignant lesions in women above 40 years in the present study is therefore biologically plausible and compatible with the effect of persistent high-risk human papillomavirus infection over time [1-3]. Malignant lesions constituted 12.0% of cases, and squamous cell carcinoma was the predominant invasive tumor. This aligns with established knowledge that most cervical malignancies are squamous in origin and are linked to high-risk human papillomavirus associated carcinogenesis [1-3,10,11]. The presence of a smaller number of adenocarcinoma cases is also in line with the known but lower frequency of glandular cervical malignancies in routine practice. The diagnostic value of pathology review in such cases is considerable because histologic subtype, depth of invasion, and degree of epithelial abnormality influence treatment planning and referral pathways. Overall, the findings of the present study are comparable with earlier hospital-based reports that documented cervicitis as the most common non-neoplastic lesion and squamous cell carcinoma as the commonest malignant lesion [12,14]. From a service perspective, the study highlights the continued importance of biopsy evaluation in institutions where women frequently present with symptoms rather than through organized screening. Retrospective audits of pathology material can guide clinicians and administrators by showing how many cases fall into inflammatory, precancerous, and malignant categories. Such evidence supports stronger clinical surveillance, timely gynecologic referral, and reinforcement of cervical cancer screening and early detection strategies in the local population [7-9]. Limitations This study was limited by its retrospective design, single-center setting, and relatively small sample size. Clinical variables such as parity, screening history, cytology findings, colposcopic impression, and human papillomavirus status were not uniformly available in the archived records. Follow-up data were also absent, so lesion progression, regression, treatment response, and long-term outcomes could not be assessed.

This retrospective analysis of cervical biopsies at KIMS, Amalapuram showed that inflammatory and reactive lesions constituted the majority of diagnoses, with chronic nonspecific cervicitis as the predominant lesion. Nevertheless, one in five biopsies demonstrated premalignant change and more than one in ten showed invasive malignancy, emphasizing the continued importance of cervical biopsy in symptomatic women and clinically suspicious cases. Premalignant and malignant lesions were more frequent in older age groups, while squamous cell carcinoma remained the leading malignant diagnosis. Histopathological examination continues to provide essential confirmation, grading, and risk stratification, and remains central to early detection, appropriate referral, and timely management of cervical lesions in routine gynecologic practice.

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