Abnormal "low grade" transformation zone: current diagnostic gold standard

The aim of this work was to examine different methods of investigation in the diagnosis of the abnormal "low grade" transformation zone of the portio. Over a period of one year 41 patients subjected to colposcopic examination underwent exo-endocervical sampling for oncologic evaluation and for detection of viral and bacterial infections (HPV, HSV, adenovirus, mycoplasmas and chlamydia trachomatis), as well as portio biopsy. A 65.8% correlation was found between cytology and the HPV-DNA test results, while histology and the presence of the HPV virus agreed in 51.4% of cases. In those cases in which minimal histological alterations were found (koilocytosis) a high percentage of HPV negativity was found. In discordant negative cytologic tests that were however positive for HPV by PCR, the genotypes identified were always 6 and 11.

Cervix; Colposcopy; Cytology; Histology; Genital infections; Mycoplasma; HPV; HSY; Adenovirus; Chlamydia trachomatis

[1] Hilgarth M., Menton M.: "The colposcopic screening". Eur. J. Obstet. Gynaecol. Repr. Biol., 1996, 65, 65.

[2] Pete I., Toth V., Bosze P.: "The value of colposcopy in screening cervical carcinoma". Eur. J. Gynaecol. Oncol., 1997, 2, 120.

[3] Richart R. M., Barron B. A.: "A follow-up study of patients with cervical dysplasia". Am. J. Obstet. Gynaecol., 1969, 105, 386.

[4] Reid R., Crum C. P., Herschman B. R., Fu Y. S., Braun L., Shah K. V., Agronow S. J., Stanhope C. R.: "Genital warts and cervical cancer". Cancer, 1984, 53, 943.

[5] Namkoong S.: "Clinical application of HPV typing in cervical cancer". Intern. J. Gynaecol. Obstet., 1995, 49 suppl., 59.

[6] Trofatter K. F.: "Diagnosis of human papillomavirus genital tract infection". Am. J. Med., 1997, 102, 21.

[7] Darron B. R., Fife K. H.: "Human papillomavirus infection of the genital tract". Med. Clin. North Am., 1990, 74 (6), 1455.

[8] Koutsky L.: "Epidemiology of genital human papillomavirus infection". Am. J. Med., 1997, 102, 3.

[9] Rozendaal L., Walboomers J. M. M., Van der Linden J. C., Voorhost F. J., Kenemans P., Helmerhost TH. JM et al.: "PCRbased high risk HPV test in cervical cancer screening gives objective risk assessment of women with cytomorphologically normal cervical smears". Int. J. Cancer, 1996, 68, 766.

[10] Mossetti C., De Palo G., Remotti G., Marchionni M., De Vigiliis G., Montanari G. et al.: "Proposal for a colposcopic classification'. The cervix and low.female genital tract, 1987, 5, 25.

[11] Jensen J. S., Uldurn S. A., Sondergard-Andersen J., Vuust J., Lind K.: "Polymerase chain reaction for detection of mycoplasma genitalium in clinical samples". J. Clin. Microhiol., 1991, 29, 46.

[12] Lan J., Wallboomers J.M., Roosendaal R., Van Doornum G. J. J., Maclaren D.M .,M eijer C. J. L.M .,V an der Brule A. J. C.: "Direct detection and genotyping of C. Trachomatis in cervical scrapes by using PCR and restriction fragment polymorphism analysis". J Clin. Microb/ol., 1993, 31, 1060.

[13] Contorni M., Leoncini P.:'Typing of human HPV-DNA by restnction endonuclease mapping of PCR products". J. Virol. Methods, 1993, 41, 29.

[14] Ting Y.,M anosM .: "Detection and typing of genital human papillomaviruses". In: !mis M. A., Gelfand D. H.. Sninsky J. J., White T. J. (eds.): "PCR Protocols: a Guide to Methods and Applications". City Academic Press, 1990, 356.

[15] Bernard H. U., Chan S. Y.. Manos M. M., Ong C. K., Villa L. L., Delius H. et al.: "Identification and assessment of known and novel human papillomaviruses by polymerase chain reaction amplication, restriction fragment length polymorphisms, nucleotide sequence, and phylogenetic algorithms". J. Infect. Dis., 1994, 170, 1077.

[16] Kimura H., Shibata M., Kuzushima K., Nishikawa K., Nishiyama Y.,M orishima T.: "Detection and direct typing of herpes simplex virus by polymerase chain reaction". Med. Microbiol. lmmunol., 1990, 179, 77.

[17] Schneider A., Zahm D. M., Greinke C., Kirchmayr R., Nindl J.: "Different detectability of high risk HPV in smears from incident and prevalent high-grade squamous intra-epithelial lesions of the cervix". Gynaecol. Oncol., 1997, 65, 399.