PATIENTS WITH VARIOUS TYPES OF HUMAN PAPILLOMAVIRUS - COVARIATION ANDDIAGNOSTIC RELEVANCE OF CYTOLOGICAL FINDINGS IN PAPANICOLAOU SMEARS

Human papillomavirus (HPV) infection in the genital tract is associate d with a number of cytological changes which are accepted as standard criteria for a cytological diagnosis. We evaluated the covariation and diagnostic accuracy of these criteria in 210 patients, i.e. l50 cases who were positive for HPV types 6, 11, 16, 18, 31, 33 or 35, and 60 c ases who were HPV-negative by simultaneous Southern blot analysis. Thi s was done by re-examining cervical smears obtained at the same time, without knowing the results of the Southern blot analysis, for the pre sence of koilocytosis, dyskeratosis-parakeratosis, nuclear smudging, h yperchromasia, binucleation, multinucleation, karyorrhexis and macrocy tosis. We found that all these cytological changes correlated with the presence of an HPV infection. However, analysis of variance showed th at koilocytosis, dyskeratosis-parakeratosis and karyorrhexis were of p articular diagnostic value, while the other features provided little o r no additional information. By omitting these features and making the diagnosis when two out of three of the key criteria, i.e. koilocytosi s, dyskeratosis-parakeratosis and karyorrhexis were present, we diagno sed HPV infection with a specificity of 100% in 36% of the 150 cases, which were positive by Southern blot analysis. The various HPV types p roduced different morphological patterns which may reflect differences in action on the host cell. In the individual patient, however, such differences 111 cytology do not provide a sound basis for distinguishi ng between viral types.