Objective: Human papillomavirus (HPV) is the leading cause of cervical cancer, but approximately 5% of cervical cancers are reported to be HPV-independent, especially in adenocarcinomas. These subtypes are reported to have poorer prognosis, and clinical attention is required. Recent guidelines on cervical cancer screening endorse a shift in practice to primary HPV screening rather than conventional cytology test. This study aimed to evaluate the accuracy of cytology test in HPV-independent cervical adenocarcinoma and compared the accuracy of the test with HPV-associated cervical cancers. Methods: This study included patients who were diagnosed with cervical cancer and started primary treatment in our institution from January 2019 to May 2021. Patients with rare histology or those who had not performed cytology test before diagnosis were excluded. Pathologic report of cervical biopsy and the results of most recent cytology test prior to diagnosis were investigated. Histologic subtype of cervical cancer was divided according to 2020 WHO Female Genital Tumors classification. The results of cytology test were dichotomized into ‘normal’ and ‘abnormal’. Results: Among total of 426 patients, squamous cell carcinoma was 68.5% (292/426), adenocarcinoma was 30.1% (128/426), and adenosquamous carcinoma was 1.4 % (6/426). In adenocarcinoma, 75% (96/128) of the cases were HPV-associated, and remaining 25% (32/128) was HPV-independent. Among HPV-associated adenocarcinoma, usual-type was the most common type (81.2%, 77/96). In HPV-independent adenocarcinoma, there were 25 (78.1%) cases of gastric-type, 6 (18.8%) cases of clear cell-type, and one (3.1%) mesonephric-type adenocarcinoma. In all cases, patients with HPV-associated cancer had abnormal cytology test result in 84.8% (334/394), with false-negative rate of 15.2% (60/394). When considering only adenocarcinoma, false-negative rate of cytology test was 21.9% (21/96). In patients with HPV-independent adenocarcinoma, 46.9% (15/32) had abnormal cytology test result, with false-negative rate of 53.12% (17/32). Conclusions: The false-negative rate of cytology test was higher in HPV-independent cervical cancer patients than in HPV-associated cervical cancer patients. In addition to the limitation of primary HPV test, cervical cytology test also is not accurate for screening HPV-independent adenocarcin