Visual appearance of the uterine cervix: correlation with human papillomavirus detection and type

Infection with carcinogenic human papillomaviruses (HPVs) is necessary for cervical precancer and cancer, but the effects of type-specific HPV infection on cervical appearance are poorly understood.

Twenty expert colposcopists evaluated a total of 939 digitized cervigrams that were obtained during the ASCUS (atypical squamous cells of undetermined significance)-LSIL (low-grade squamous intraepithelial lesion) Triage study after the application of 5% acetic acid. Each reviewer rated the number and severity of lesions in 112 pictures that were matched on histologic diagnoses and HPV typing results so that > or = 2 reviewers rated each image. We used standard tests of association and correlation to relate HPV type and visual appearance.

Pairs of reviewers were significantly (P < .05) more likely to agree that a definite lesion was present when HPV DNA was found, particularly HPV16, regardless of histologic diagnosis. However, the link between infection status and visual appearance was weak for each individual reviewer. Interestingly, many women with multiple HPV infections had no visible lesions and vice versa.

HPV16 causes more definite visual abnormalities than other HPV types, regardless of eventual histologic diagnosis. Otherwise, the associations between HPV infection and lesion recognition are weak.