Colposcopic diagnosis of HPV cervical lesions

The colposcopic criteria for abnormal epithelium are leukoplakia, a white area detected after the application of acetic acid or iodine-negative areas not reacting to the acetic acid test. However, white epithelium and iodine-negative areas are not specific for abnormal tissue, condyloma or intraepithelial neoplasia. The lack of specificity of colposcopic findings has motivated the distinction between minor and major grade abnormalities in the recently proposed new colposcopic terminology. Metaplasia and dysplasia cannot be distinguished by colposcopy. All criteria proposed so far lack specificity and reproducibility. Thus, it is at present considered that colposcopy is not a diagnostic method, but an investigative technique that allows the evaluation of the extent of the lesion and localization of the squamo-columnar junction. As for the distinction between condyloma and high-grade intraepithelial neoplasia, all criteria proposed so far also lack reproducibility. Moreover, condyloma is often found at the periphery of high-grade CIN, rendering such a distinction meaningless. The only features specific of HPV infection without dysplasia are condyloma acuminatum and, to a lesser extent, non-acetowhite microcapillary surfaces. Finally, it has been shown that there is no colposcopic sign specific of HPV types.