title: Polymerase chain reaction-assisted evaluation of low and high grade squamous intraepithelial lesion cytology and reappraisal of the Bethesda System.
abstract: Between January 1991 and 1992, 5,652 cervical smears from 4,918 women were classified according to the traditional Papanicolaou/cervical intraepithelial neoplasia (CIN) categories and to the recently developed Bethesda System. Koilocytosis without atypia was identified in 3.7% (183 cases), CIN 1 in 1.8% (87 cases) and high grade squamous intraepithelial lesions (SILs) (CIN 2 and 3) in 1.9% (93 cases) (total, 363/4,918 = 7.4%). Human papillomavirus (HPV)-directed polymerase chain reaction analysis with general primers and subsequent hybridization with HPV 16/18 probe cocktail was carried out in 35% of cases with koilocytosis and dysplasia of any degree (127/363 cases). Seventy-five percent (95 cases) were positive in contrast to a detection rate of 30.8% (53/172 cases) for nonsuspicious smears. While low grade SILs were HPV positive in 67% (koilocytosis only) and 75% (CIN 1), high grade SILs harbored HPV in 87%. The rate of HPV 16/18 infections varied from 71.9% in low grade SILs to 88.9% in high grade SILs. Our results point to the questionable value of koilocytosis as a specific marker of HPV infection and call for confirmatory tests prior to classifying cervical smears suggestive of HPV infection in the low grade SIL category.
authors.affiliation: Department of Gynecological Pathology and Electron Microscopy, University of Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kühler-Obbarius
authors.forename: K
authors.initials: K
authors.lastname: Milde-Langosch
authors.forename: T
authors.initials: T
authors.lastname: Löning
authors.forename: H E
authors.initials: HE
authors.lastname: Stegner
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000737:chemistry / Q000145:classification* / Q000473:pathology*; D002584:Cervix Uteri / Q000737:chemistry / Q000382:microbiology / Q000473:pathology; D004273:DNA, Neoplasm / Q000032:analysis / Q000235:genetics; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D004848:Epithelium / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000145:classification / Q000473:pathology; D016133:Polymerase Chain Reaction; D014412:Tumor Virus Infections / Q000145:classification / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000737:chemistry / Q000145:classification* / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000737:chemistry / Q000145:classification* / Q000473:pathology*
chemical_list: D004273:DNA, Neoplasm; D004279:DNA, Viral