Role of colposcopy in the diagnosis of human papillomavirus infection of the uterine cervix

Among 6706 women screened by cytology, only 9 (0.13%) showed evidence of human papillomavirus infection (HPVI). In 133 women examined by colposcopy for abnormal cytology or/and suspected lesions on the cervix, 41 (30.8%) showed subclinical papillomavirus infection (SPI) while 17.4% and 5.3% showed HPVI by histopathology and cytology, respectively. The conformation rate between colposcopy and pathology was 69.6%. Sixty-nine specimens out of 133 colposcopy guided biopsies were assayed by HPV-DNA dot hybridization with 6B/11, 16, 18 probes to detect the presence of HPV-DNA in the cervical specimens. Thirty-nine (56.5%) gave a positive result. The colposcopic predictive value of positive result for HPVI was 76.7%. The difference between colposcopy (59%) and pathology (20.5%) is statistically significant (P less than 0.01). These results suggest that colposcopy is superior to cytology and histopathology for the detection of SPI in the cervix. In colposcopy HPV-DNA positive women, aceto-while-epithelium was most common (28.2%). As it is difficult to differentiate SPI from cervical intraepithelial neoplasia especially the Grade I lesion by colposcopy, discrimination criteria are proposed together with the chief colposcopic features of SPI.