Value of Morphological Criteria in Diagnosing Cervical HPV Lesions Confirmed by in situ Hybridization and Hybrid Capture Assay

The present study evaluated the value of morphological criteria (binucleation, multinucleation, koilocytosis, spindle koilocytes, abnormal mitosis and dyskeratosis) in the diagnosis of cervical human papillomavirus (HPV) lesions confirmed by in situ hybridization (ISH) and hybrid capture (HC) assay. Colposcopic punch biopsies from a series of 138 women with abnormal Pap smears were examined on light microscopy and in situ hybridization (DAKO widespectrum cocktail probe)for HPV-induced morphological changes and HPV DNA, respectively. Cervical swabs were analyzed for HPV DNAof the oncogenic types using Hybrid Capture. CIN 2 and CIN 3 were found in 44 biopsies, CIN1 in 62, and no evidence of HPVin 32 cases. HPV was detected by ISH in 51/138 (37%) cases and by HCin 66/138 (48%) lesions. With both tests, HPVDNAdetection increased parallel with lesion severity, up to 70% and 59% in CIN 2/3 by HC and ISH, respectively OR4.6 (1.7–12.1) and 10.1 (3.0–33.8). Among the histological criteria, multinucleation, binucleation and abnormal mitoses were significantly associated with HPVDNA detection. Multinucleation proved to be the strongest predictor of HPV DNA-positivity. Binucleation, abnormal mitosis, koilocytosis and spindle koilocytes were also reliable criteria of HPVlesions. Minor nuclear atypia, and “mild koilocytosis” were of no value in making this diagnosis.