Morphological diagnosis of HPV lesions and cervical intraepithelial neoplasia (CIN) is highly reproducible.
OBJECTIVE
to assess the value of individual histological criteria in the diagnosis of cervical HPV lesions.


METHODS
138 women referred for colposcopic evaluation (due to abnormal PAP smears) were subjected to cervical punch biopsy. The biopsies were classified as no HPV lesion, CIN 1, or CIN 2-3 by two observers independently. Kappa tests were used for interobserver agreement of the diagnosis. The presence of binucleation, multinucleation, abnormal mitosis. koilocytosis, spindle koilocytosis and dyskeratosis was similarly assessed.


RESULTS
the Kappa statistic was 0.638 (CI 95% 0.533-0.743), showing substantial inter-observer agreement. Abnormal mitosis and multi-nucleation were the two most powerful discriminators between CIN 2-3 and CIN 1. Koilocytosis proved to be the single most powerful discriminator between CIN 1 lesions and non-HPV lesions.


CONCLUSIONS
the results advocate the use of histology as the gold standard in diagnosing cervical precancerous lesions. The classical criteria can be also used to differentiate low-grade lesions, which has practical implications by avoiding the unnecessary treatment of minor abnormalities.
Roteli-Martins
C M
CM
Department of Gynecology UNICAMP, São Paulo, Brazil. ceciliaroteli@iname.com
Derchain
S F
SF
Martinez
E Z
EZ
Siqueira
S A
SA
Alves
V A
VA
Syrjänen
K J
KJ
D001706:Biopsy; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D015588:Observer Variation; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000473:pathology* / Q000821:virology; D011446:Prospective Studies; D015203:Reproducibility of Results; D014412:Tumor Virus Infections / Q000473:pathology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology*