Background
Cervical smear cytology and colposcopic biopsy histology are prone to error at both collection and interpretation stages, leading to a large number of discordant cases.

Aims
Investigation of five‐year outcomes for women who have cervical cytology that is discordant and higher grade than histology results.

Materials and Methods
A retrospective cohort study was carried out for 111 women with cervical cytology discordant and higher grade than histology, after cytopathological review, over a three‐year period. Five‐year follow‐up data were reviewed to identify the highest level of pathology seen within five years from the discordance.

Results
Women with atypical squamous cells with possible high‐grade change (ASC‐H) cytology and negative biopsy (n = 28) had a 46% chance of high‐grade histological disease within 5 years; with cervical intraepithelial neoplasia grade 1 (CIN1) histology (n = 20), this was reduced to 30%. With high‐grade cytology and negative histology (n = 23), 48% had high‐grade disease within five years, including one case of invasive disease; with CIN1 histology 50% had high‐grade disease within five years.

Conclusions
This study demonstrates a 30–50% chance of high‐grade disease within five years, in the setting of ASC‐H or high‐grade cytology with a negative or low‐grade colposcopic biopsy. This highlights that in the setting of cytology and histology discordance, at least one of the tests indicating high‐grade pathology warrants the need for treatment or close ongoing surveillance.