Research
Oncology
Visual appearance of the uterine cervix: correlation with human papillomavirus detection and type

https://doi.org/10.1016/j.ajog.2007.02.047Get rights and content

Objective

Infection with carcinogenic human papillomaviruses (HPVs) is necessary for cervical precancer and cancer, but the effects of type-specific HPV infection on cervical appearance are poorly understood.

Study Design

Twenty expert colposcopists evaluated a total of 939 digitized cervigrams that were obtained during the ASCUS (atypical squamous cells of undetermined significance)-LSIL (low-grade squamous intraepithelial lesion) Triage study after the application of 5% acetic acid. Each reviewer rated the number and severity of lesions in 112 pictures that were matched on histologic diagnoses and HPV typing results so that ≥2 reviewers rated each image. We used standard tests of association and correlation to relate HPV type and visual appearance.

Results

Pairs of reviewers were significantly (P < .05) more likely to agree that a definite lesion was present when HPV DNA was found, particularly HPV16, regardless of histologic diagnosis. However, the link between infection status and visual appearance was weak for each individual reviewer. Interestingly, many women with multiple HPV infections had no visible lesions and vice versa.

Conclusion

HPV16 causes more definite visual abnormalities than other HPV types, regardless of eventual histologic diagnosis. Otherwise, the associations between HPV infection and lesion recognition are weak.

Section snippets

Study design and population

This was a substudy of the ASCUS (atypical squamous cells of undetermined significance)-LSIL (low-grade squamous intraepithelial lesion) Triage study (ALTS). The design of ALTS and characteristics of the population have been described previously.14 The study was approved by the National Cancer Institute and local institutional review boards. Briefly, 5060 women were enrolled because they had received a community-based cytologic diagnosis of ASCUS (n = 3488) or LSIL (n = 1572). They were

Results

Digitized pictures of the uterine cervix of 939 women that were evaluated at enrollment of ALTS were selected for review; the mean age of the subjects was 26.2 ± 7.8 (SD) years, and the median age was 24 years (range, 18-73 years). The result of the cytologic evaluation that referred the patient to the study was ASCUS in 577 women (61.5%) and LSIL in 362 women (38.8%). All the participants had a polymerase chain reaction result: 222 women (23.6%) had a negative HPV test result; 115 women

Comment

To our knowledge, this is the first study to explore systematically the relationship between type-specific HPV infection and visual changes of the uterine cervix. HPV infection is the necessary cause of cervical cancer, and we had hypothesized that colposcopic impression at the most basic level (lesion vs no lesion) would be associated strongly with molecular evidence of infection. Previous reports suggested that there is some level of tropism of some HPV types for infecting preferentially the

Acknowledgment

Affiliations of the NIH-ASCCP Research Group: Lori Boardman, Obstetrician Gynecologist, Department of Obstetrics and Gynecology, Women and Infants’ Hospital, Providence, RI; Peter Cartwright, Obstetrician Gynecologist, Department of Obstetrics and Gynecology Duke University, NC; Philip Castle, Investigator, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Charles Dunton, Gynecologist Oncologist, Division of Gynecologic Oncology, Lankenau Hospital,

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  • Cited by (0)

    This is an ancillary study of the National Cancer Institute (NCI) funded ASCUS-LSIL Triage Study (ALTS). The results do not necessarily reflect the opinions of NCI or the ALTS Investigators.

    Cite this article as: Jeronimo J, Massad S, Schiffman M, et al. Visual appearance of the uterine cervix: correlation with human papillomavirus detection and type. Am J Obstet Gynecol 2007;197:47.e1-47.e8.

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