Stringent criteria for histological diagnosis of koilocytosis fail to eliminate overdiagnosis of human papillomavirus infection and cervical intraepithelial neoplasia grade 1

M. A. Abadi, G. Y F Ho, Robert D. Burk, S. L. Romney, A. S. Kadish

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Overdiagnosis of HPV infection in cervical biopsies results in increased health care costs and unnecessary surgical procedures. Stringent criteria for histological diagnosis of koilocytosis were evaluated, using molecular detection of HPV DNA (polymerase chain reaction and Southern blot hybridization) as gold standard. Colposcopic biopsy specimens from 511 patients were studied, including 76 with referral diagnoses of negative cervix and 241 with CIN 1 or koilocytosis. Referral diagnoses for low-grade lesions failed to distinguish between HPV-infected and uninfected patients. False-positive rate for prediction of HPV infection was 74.8%. Biopsy specimens reevaluated using stringent diagnostic criteria showed increasing prevalence of HPV infection among patients whose biopsy specimens showed negative (43.7%), minimal (52.4%), or definite (69.5%) features of koilocytosis (P = .001). Similarly, subjects infected with high viral load or oncogenic HPV infection were more likely to be identified (P = .004 and .04, respectively). Despite increased predictive value of stringent diagnostic criteria, significant number of patients diagnosed as having CIN 1/koilocytosis (34.0%) did not in fact have HPV infection. Because most low- grade lesions spontaneously regress, patients with histological diagnosis of CIN 1 or HPV infection should be observed for a period of several months before definitive ablative treatment is undertaken.

Original languageEnglish (US)
Pages (from-to)54-59
Number of pages6
JournalHuman Pathology
Volume29
Issue number1
DOIs
StatePublished - 1998

Fingerprint

Cervical Intraepithelial Neoplasia
Papillomavirus Infections
Infection
Biopsy
Referral and Consultation
Unnecessary Procedures
DNA-Directed DNA Polymerase
Southern Blotting
Viral Load
Cervix Uteri
Health Care Costs
Medical Overuse
Polymerase Chain Reaction

Keywords

  • Cervical intraepithelial neoplasia
  • Human papillomavirus
  • Koilocytosis
  • Overdiagnosis
  • Squamous intrepithelial lesion

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Stringent criteria for histological diagnosis of koilocytosis fail to eliminate overdiagnosis of human papillomavirus infection and cervical intraepithelial neoplasia grade 1. / Abadi, M. A.; Ho, G. Y F; Burk, Robert D.; Romney, S. L.; Kadish, A. S.

In: Human Pathology, Vol. 29, No. 1, 1998, p. 54-59.

Research output: Contribution to journalArticle

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abstract = "Overdiagnosis of HPV infection in cervical biopsies results in increased health care costs and unnecessary surgical procedures. Stringent criteria for histological diagnosis of koilocytosis were evaluated, using molecular detection of HPV DNA (polymerase chain reaction and Southern blot hybridization) as gold standard. Colposcopic biopsy specimens from 511 patients were studied, including 76 with referral diagnoses of negative cervix and 241 with CIN 1 or koilocytosis. Referral diagnoses for low-grade lesions failed to distinguish between HPV-infected and uninfected patients. False-positive rate for prediction of HPV infection was 74.8{\%}. Biopsy specimens reevaluated using stringent diagnostic criteria showed increasing prevalence of HPV infection among patients whose biopsy specimens showed negative (43.7{\%}), minimal (52.4{\%}), or definite (69.5{\%}) features of koilocytosis (P = .001). Similarly, subjects infected with high viral load or oncogenic HPV infection were more likely to be identified (P = .004 and .04, respectively). Despite increased predictive value of stringent diagnostic criteria, significant number of patients diagnosed as having CIN 1/koilocytosis (34.0{\%}) did not in fact have HPV infection. Because most low- grade lesions spontaneously regress, patients with histological diagnosis of CIN 1 or HPV infection should be observed for a period of several months before definitive ablative treatment is undertaken.",
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