Colposcopy in the Era of Primary HPV Screening: Current Status, Challenges, and Perspectives on Standardization

Abstract

Synopsis: Since April 2024, primary human papillomavirus (HPV) testing has been introduced nationwide in Japan, marking a major turning point in the role of colposcopy as the definitive diagnostic procedure in cervical cancer screening. Conventional colposcopy, however, has long faced challenges due to its inherent subjectivity, including persistent difficulties in diagnostic accuracy, quality assurance (QA), and the standardization of training and education. In this context, the International Federation for Cervical Pathology and Colposcopy (IFCPC) is developing a new international standard, IFCPC 2026, which represents the first major revision since the 2011 Barcelona terminology. This updated classification is anticipated to introduce a refined framework for squamous lesions, a systematic approach to glandular lesions, and a redefinition of the spatial mapping concept of lesion distribution based on Lugol's iodine staining. In this review, we outline the central features of IFCPC 2026, with particular emphasis on quantitative assessment using the Swede score, concordance with international QA indicators, and the significance of emerging educational systems that utilize web-based learning and international certification programs. Finally, we discuss future directions for next-generation colposcopy in the era of primary HPV screening. Standardization of diagnostic accuracy, quality assurance, and training systems will help establish consistent clinical standards across Japan and provide a foundation for next-generation cervical cancer screening in the era of primary HPV testing.Key words: uterine cervix, colposcopy, education, HPV primary screening, quality assurance