STRINGENT CRITERIA FOR HISTOLOGICAL DIAGNOSIS OF KOILOCYTOSIS FAIL TOELIMINATE OVERDIAGNOSIS OF HUMAN-PAPILLOMAVIRUS INFECTION AND CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE-1

Overdiagnosis of HPV infection in cervical biopsies results in increas ed health care costs and unnecessary surgical procedures. Stringent cr iteria for histological diagnosis of koilocytosis were evaluated, usin g molecular detection of HPV DNA (polymerase chain reaction and Southe rn blot hybridization) as gold standard. Colposcopic biopsy specimens from 511 patients were studied, including 76 with referral diagnoses o f negative cervix and 241 with CIN 1 or koilocytosis. Referral diagnos es for low-grade lesions failed to distinguish between HPV-infected an d uninfected patients. False-positive rate for prediction of HPV infec tion was 74.8%. Biopsy specimens reevaluated using stringent diagnosti c criteria showed increasing prevalence of HPV infection among patient s whose biopsy specimens showed negative (43.7%), minimal (52.4%), or definite (69.5%) features of koilocytosis (P = .001). Similarly, subje cts infected with high viral load or oncogenic HPV infection were more likely to be identified (P = .004 and .04, respectively). Despite inc reased 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 spontan eously regress, patients with histological diagnosis of CIN 1 or HPV i nfection should be observed for a period of several months before defi nitive ablative treatment is undertaken. Copyright (C) 1998 by W.B. Sa unders Company.