Cytologic Detection of Condylomas and Cervical Intraepithelial Neoplasia of the Uterine Cervix with Histologic Correlation

ABSTRACT

Human papillomavirus (HPV) has been implicated as an important etiologic factor in cervical carcinoma. This study evaluates the efficacy of cytology as a screening tool in the detection of cervical lesions with koilocytotic features. Cervical smears and biopsies from 100 women seen between January 1983 and January 1986 were reviewed. The histologic categories consisted of (1) koilocytotic lesions (flat condylomas) with minimal cellular atypia, (2) CIN I, II, III, with surface koilocytes showing cellular atypia (atypical koilocytosis), (3) CIN III with a contiguous lesion as defined in categories 1 and 2, (4) negative biopsies. Histologically, 6 patients showed flat condylomas with minimal cellular atypia, 88 showed CIN with atypical koilocytosis, 4 had CIN HI with a contiguous CIN I with atypical koilocytosis, and 2 showed negative biopsies. Cytologically in all cases of flat condyloma with minimal cellular atypia (6/6), CIN I with atypical koilocytosis (56/56), and CIN III with a contiguous condylomatous lesion (4/4), both koilocytes and, in the last two categories, dysplastic cells were identified in the cervical smears. In 8/11 cases of CIN II and 12/21 cases of CIN III with atypical koilocytosis, smears showed both atypical koilocytes and dysplastic cells. In the remaining 12 patients, however, there was cytologic underestimation of the histologic diagnosis of CIN, particularly when the lesion was focal. The data suggest that although cytology does detect a high percentage of cervical lesions with koilocytotic features (86% in this study), it may not detect focal CIN II and III lesions associated with condylomatous lesions in the same biopsy specimen. Therefore, it is proposed that all women with cytologic evidence of koilocytosis on cervical smears should have a colposcopic examination.