Pathology of the cervix

An increasing number of cervical neoplasia studies implicate human papillomavirus (HPV) in the carcinogenic process, perhaps as a necessary factor but not the sole factor. Many different HPV types infect the cervix and the pattern of types is complex, even in women with a normal cervix or a low-grade cervical intraepithelial neoplasia lesion. Although certain types (eg, HPV 18) are particularly likely to be associated with more aggressive cervical cancer types, the results regarding the prognostic value of specific HPV types are still equivocal. Studies of latent HPV infection have yielded varying results, but an HPV detection rate of 31% in swabs from women attending a student health service has been reported. To solve many of the questions raised about HPV in relation to cervical pathology, it is evident that there is a need for large, prospective studies. It is also likely that the continuing development and improvement of serologic assay and a further understanding of the immune response to HPV may prove to be of major importance in the diagnosis and treatment of cervical neoplastic lesions.