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

Human Pathology
M A AbadiA S Kadish

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 le...Continue Reading

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Citations

Jun 26, 2007·Gynecologic Oncology·Mark H EinsteinCarolyn D Runowicz
Sep 7, 2017·Applied Immunohistochemistry & Molecular Morphology : AIMM·Kien T Mai
Sep 24, 2009·British Journal of Cancer·J S LawsonN J Whitaker
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Jan 5, 2002·The American Journal of Surgical Pathology·Edyta C PirogChristina Isacson
Oct 7, 2000·The American Journal of Surgical Pathology·E C PirogC Isacson
Jun 24, 2003·International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists·Arnold-Jan KruseStanley J Robboy
Feb 4, 2009·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Mark H EinsteinRobert D Burk

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