Background: Cervical cancer remains a significant health burden globally, and early diagnosis of precancerous lesions is paramount in prevention. Colposcopy-directed biopsy has been considered the gold standard to evaluate abnormal cervical cytology, but the correlation of colposcopic impression with histopathological examination has to be revalidated regularly in order to optimize screening programs. This study will correlate colposcopic findings and scoring indices with biopsy results to identify features that predict high-grade cervical lesions. Methods: 90 women with suspicious cervical findings or abnormal cytology were included in this cross-sectional study, who had received colposcopy and colposcopy-guided biopsy at a tertiary care hospital from July, 2023 to June, 2024. Colposcopic images were captured by routine procedure after acetic acid and Lugol's iodine staining. Reid Colposcopic Index and Swede Score were calculated for each case. Biopsy samples were obtained from the area of abnormality and were histopathologically graded as negative/inflammatory, LSIL (CIN 1), or HSIL (CIN 2-3). Data were analyzed in SPSS, including correlation coefficients, and logistic regression analysis was carried out. Results: Out of 90 patients, 38 (42.2%) had HSIL and 34 (37.8%) had LSIL, and 18 (20.0%) had negative/inflammatory findings on histopathology. Colposcopy was 81.6% sensitive and 76.9% specific for HSIL detection (AUC=0.85). There were high correlations between the Reid Index and histopathology (r=0.68) and the Swede Score and histopathology (r=0.72). Swede Score ≥8 (AOR=17.3, 95% CI 3.1-95.8), lesion involving ≥2 quadrants (AOR=7.39, 95% CI 2.07-26.3), and atypical vessels (AOR=8.25, 95% CI 1.33-51.2) were independent predictors of HSIL. Conclusion: Colposcopy has exceptional diagnostic accuracy in the detection of high-grade cervical precancerous lesions, and standardized scoring systems significantly improve predictive performance. These findings support colposcopy-directed biopsy as a safe technique for diagnosis in screening programs for cervical cancer.