title: Cytologic correlates of cervical papillomavirus infection.
abstract: A fundamental question in Papanicolaou smear screening is the specificity of cytologic criteria for the recognition of genital human papillomavirus (HPV) infection. To address this problem, we conducted a two-phase study of routinely screened women to determine the efficiency with which cytologic findings identified the presence of HPV DNA, focusing on the criteria for identifying smears as "atypical." In phase 1, 25 of 290 (8.6%) smears were designated atypical, but only 3 (12%) of the samples contained HPV nucleic acids. Four of five (80%) smears designated as diagnostic of HPV/cervical HPV infection were associated with HPV nucleic acids. By applying more stringent criteria for the diagnosis of atypical in phase 2, only 3 of 166 (1.8%) were identified as atypical. Of these, two (67%) contained HPV nucleic acids. The criteria that most efficiently correlated with HPV nucleic acids included prominent nuclear enlargement with either multiple nuclei or nuclear hyperchromatism. On review of the 19 HPV-positive and 20 control HPV-negative smears originally diagnosed as cytologically negative, the above criteria identified an additional 3 cytologically atypical/positive smears versus none (0 of 20) in the control group. This study supports the concept that cytologic abnormalities suggesting "subtle" HPV infection may be extremely difficult to distinguish from non-HPV-related changes, and that criteria used to imply "suggestive but not diagnostic for HPV infection" should be continually reevaluated. The potential role of HPV DNA analysis in Papanicolaou smear interpretation is discussed.
authors.affiliation: Department of Pathology, University of Virginia Medical Center, Charlottesville 22908.
authors.forename: B E
authors.initials: BE
authors.lastname: Ward
authors.forename: B
authors.initials: B
authors.lastname: Burkett
authors.forename: C
authors.initials: C
authors.lastname: Petersen
authors.forename: M L
authors.initials: ML
authors.lastname: Nuckols
authors.forename: C
authors.initials: C
authors.lastname: Brennan
authors.forename: L M
authors.initials: LM
authors.lastname: Birch
authors.forename: C P
authors.initials: CP
authors.lastname: Crum
mesh_terms: D000328:Adult; D015139:Blotting, Southern; D002584:Cervix Uteri / Q000382:microbiology / Q000473:pathology*; D015344:DNA Probes, HPV; D005260:Female; D006801:Humans; D009693:Nucleic Acid Hybridization; D065006:Papanicolaou Test; D027383:Papillomaviridae; D014412:Tumor Virus Infections / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000382:microbiology / Q000473:pathology*; D014626:Vaginal Smears
chemical_list: D015344:DNA Probes, HPV