Objective: This study aimed to compare the diagnostic value of R-way, the 2011 International Federation for Cervical Pathology and Colposcopy (IFCPC), and Reid colposcopy evaluation system for high-grade squamous intraepithelial lesions and cervical cancer (HSIL+). Methods: A total of 987 cases were referred for vaginal microscopic examination, using R-way system, IFCPC and Reid examination, and diagnostic capabilities of the methods for detecting HSIL+ were compared. Results: Using cervical biopsy or conization as the gold standard, in total 170 women (17.2%) had histologically confirmed HSIL+ including 36 women (3.6%) with invasive cervical cancer. The sensitivity for HSIL+ using the three different colposcopy evaluation methods were 74.7% (127/170), 78.2% (133/170) and 62.9% (107/170) for IFCPC, R-way and Reid. Consistency with histopathology was 69.00%, 75.28% and 55.32%, Kappa values were 0.517, 0.599 and 0.310, respectively. Based on HSIL, sensitivity, specificity, PPV and NPV of IFCPC and R-way pair for HSIL+ were better than those of Reid. McNemar test results revealed significant differences between R-way and IFCPC and between Reid and IFCPC for HSIL+ (\chi{}^2 = 19.558, \chi{}^2 = 17.876, P 0.001); however, the consistency rate was better for R-way and IFCPC than for Reid and IFCPC (Kappa = 0.826 vs 0.127, agreement rate: 94.6% vs 70.62%). Conclusion: All three evaluation methods can be used for colposcopy diagnosis of HSIL+, and the diagnostic value of IFCPC and R-way is better than Reid. There is good agreement between R-way colposcopy evaluation and histopathology. Considering the characteristics of easy operation, the R-way evaluation system is worthy of popularization and application in primary hospitals.