Human papillomavirus detection in cervical lesions nondiagnostic for cervical intraepithelial neoplasia: correlation with papanicolaou smear, colposcopy, and occurrence of cervical intraepithelial neoplasia

Article Abstract:

The human papillomavirus (HPV) is a common sexually transmitted viral infection that is associated with cervical cancer. Although some women display overt signs and symptoms of HPV infection, other patients may not know they have the infection until a routine Pap smear indicates abnormal cells on the cervix. A Pap smear that is suggestive of HPV infection will prompt an investigation to determine whether there is evidence of a precancerous or cancerous condition. To examine the cervix, a colposcope, a microscope placed a few inches from the vagina, is used to magnify the vagina and the cervix. Areas of tissue appearing white when a mild acid is applied to the surface can be removed for biopsy. The proper treatment of patients with cells which appear suspicious but are not atypical when biopsy samples are analyzed is unclear. These "borderline" cases, which are not considered cervical intraepithelial neoplasia (CIN, a precancerous condition), may indicate that the cells obtained during sampling were inadequate, in an inactive stage, or were not affected by HPV infection at all. The meaning of an abnormal Pap smear and suspicious lesions visualized by colposcopy without CIN confirmation was studied. Of the 59 women who had biopsies that were not confirmed as CIN, 20 women were found to have DNA (genetic material) from HPV, and were classified as HPV DNA-positive. The HPV DNA-positive group had a lower (30 percent) chance of having a normal Pap smear while the HPV DNA-negative women had a greater (61 percent) chance of having a normal Pap smear, at the time of biopsy. For the women who were reexamined at follow-up, 12 of the 17 women (71 percent) having HPV DNA-positive tests had a biopsy that proved CIN at another location on the cervix, either at the time the biopsy was done or 3 to 12 months later. The rate of confirmed CIN was significantly higher among women testing positive for HPV DNA than among the women testing negative for HPV DNA. Most of the women who tested negative had no abnormal Pap or colposcopic results at the time of the follow-up. Therefore, it appears likely that a suspicious lesion that is HPV DNA-positive without diagnosis of CIN will change into CIN in the future. Conversely, HPV DNA-negative lesions are less likely to develop into CIN. (Consumer Summary produced by Reliance Medical Information, Inc.)

Papillomavirus infections, Cervix uteri, Precancerous conditions, Pap test

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Paired Papanicolaou smears in the evaluation of atypical squamous cells

Article Abstract:

A study of 360 women was done to assess the value of performing several (paired) Papanicolaou (Pap) smears, a test for cervical cancer, in the follow-up of atypical squamous cells in cervical smear samples. The patients were evaluated by paired Pap smears which were repeated, and by colposcopy, an examination of the uterus and vagina. Fifty-six percent of the patients had negative results in both of the paired Pap smears. Cervical intraepithelial neoplasia, the abnormal growth of cells within the lining layer of the cervix, was diagnosed in 16 percent of all patients and in 10 percent of those with negative/negative repeat smears. The presence of atypical squamous cells in a Pap smear is abnormal. Microscopic examination of tissue samples should be performed when atypical squamous cells appear in a Papanicolaou smear.

Squamous cell carcinoma

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The significance of a negative Papanicolaou smear with hyperkeratosis or parakeratosis

Article Abstract:

It is of unclear significance why some Papanicolaou (Pap) smears, tests for cancer cells in the female genital tract, which have negative results for cancer nevertheless reveal a diagnosis of hyperkeratosis (overproduction of the so-called horny layer of the skin) or parakeratosis, another disorder of the skin. The investigators examined the uteruses and vaginas (colposcopy) of 170 women with negative Pap smears who had either hyperkeratosis or parakeratosis (detected on slides under a microscope). The results indicate that detecting cells of hyperkeratosis or parakeratosis on a Pap smear does not correspond with an increased detection of cancer of the cervix.

Keratosis

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