Human papillomavirus in women. A three-year experience in a county hospital colposcopy clinic.
The human papillomavirus (HPV) has been associated with cervical dysplasia and carcinoma. This report summarizes the authors' experience with HPV-related problems over three years, 1987-89, while managing 1,644 women at a county hospital colposcopy clinic. Probes for HPV DNA were not used, and the diagnoses were made with cytologic and histologic criteria alone. The percentage of patients referred to the clinic with HPV found on routine Papanicolaou smears rose significantly, from 3 in 1987 to 18 in 1989. Fifteen percent of those referred because of HPV on a Papanicolaou smear were found to have cervical intraepithelial neoplasia (CIN) grade II or III after they were evaluated at the clinic. Of the 367 cases of biopsy-proven cervical HPV, only 33 (9%) were recorded on Papanicolaou smears performed immediately before the biopsy, and 140 (38%) also had concomitant, biopsy-proven CIN, grade II or III. Of the 195 instances in which the colposcopic impression was simple HPV without CIN, 46 (24%) had high-grade CIN on biopsy. We conclude that the proportion of patients with HPV-associated problems is increasing, that the Papanicolaou smear is not sensitive in detecting cervical HPV infections, that patients with HPV changes found on Papanicolaou smears should be evaluated with colposcopy and that lesions that appear colposcopically to be simple HPV should undergo biopsy to rule out the presence of high-grade CIN.
Cartwright
P S
PS
Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN 37232.
Dao
A H
AH
Reed
G W
GW
D001706:Biopsy; D002278:Carcinoma in Situ / Q000453:epidemiology* / Q000473:pathology; D003127:Colposcopy; D005260:Female; D006766:Hospitals, County; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D013714:Tennessee / Q000453:epidemiology; D014412:Tumor Virus Infections / Q000453:epidemiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014626:Vaginal Smears