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Colposcopic Characteristics of High-Risk Human Papillomavirus-Related Cervical Lesions

Louwers, Jacqueline A. MD1,2; Kocken, Mariëlle MD2,3; van der Bijl, Joyce C. MSc1,2; Berkhof, Johannes PhD4; Snijders, Peter J.F. PhD2; Meijer, Chris J.L.M. MD, PhD2; Verheijen, René H.M. MD, PhD5

Journal of Lower Genital Tract Disease: January 2010 - Volume 14 - Issue 1 - pp 49-55
doi: 10.1097/LGT.0b013e3181b0fb8e
Original Articles
Spanish Translation

Objective. Because high-risk human papillomavirus (hrHPV) is the necessary factor in the development of high-grade cervical lesions, knowing the colposcopic differences between hrHPV-positive and hrHPV-negative lesions could be of value. We have evaluated whether there are colposcopic differences between lesions testing hrHPV-positive or hrHPV-negative.

Materials and Methods. This study was conducted as a retrospective case-control study. We designed a scoring system for colposcopic criteria that might be of relevance to distinguish hrHPV-positive from hrHPV-negative lesions. Colposcopic images were analyzed from patients at the VU University Medical Center Amsterdam, the Netherlands, in whom a GP5+/6+ polymerase chain reaction hrHPV test had been performed within a month of the colposcopic examination (n = 507).

Results. Visibility of the transformation zone (corrected for age), a (very) coarse and irregular punctation pattern, and a large lesion (>25% of the visible cervix) were more often associated with a positive hrHPV test status (p =.001, odds ratio [OR] = 2.29, 95% CI = 1.41-3.73; p =.036, OR 2.37, 95% CI = 1.08-5.19; and p =.044, OR = 1.78, 95% CI = 1.08-2.94, respectively). After correction for histologic diagnosis, the difference between hrHPV-positive and hrHPV-negative lesions for visibility of the transformation zone and lesion size remained statistically significant (OR = 2.44, 95% CI = 1.35-4.41 and OR = 1.92, 95% CI = 1.04-3.54, respectively).

Conclusions. This study indicates that visibility of the transformation zone, (very) coarse punctation pattern, and larger lesion size were the main colposcopic features associated with a hrHPV-positive test status.

At colposcopic examination visibility of the transformation zone, punctation pattern and a larger lesion size were associated with hrHPV presence.

Departments of 1Obstetrics and Gynecology and 2Pathology, VU University Medical Center, Amsterdam, 3Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, 4Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, and 5Department of Women and Baby, Surgical and Oncological Gynecology, Utrecht University Medical Center, Utrecht, the Netherlands

Reprint requests to: Jacqueline A. Louwers, MD, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. E-mail:

©2010The American Society for Colposcopy and Cervical Pathology