[Human papillomaviruses in uterine cervix pathology: clinical implications, detection and type]

Recently, intense interest has been focused on the relation between HPV infection and the precancerous and cancerous lesions of the uterine cervix, as documented in numerous publications on the subject. We carried out a prospective anatomoclinical study on 224 women (HPV positive) in the René Huguenin Centre, from April 1984 to December 1988. Among these patients, cytology, colposcopy and biopsy, where necessary, were performed, concurrently with the detection of HPV on cervical smears using a molecular hybridization method (G Orth). We analysed the anatomo-clinical results and propose practical implications, in taking the evolution of the patients into account. These patients were followed up and treated when necessary for cervical intra-epithelial neoplasia (CIN) or carcinoma, associated or unassociated with HPVs (oncogene in 70% of cases). 24% of the patients where infected by an HPV, without any lesion. This virus disappeared spontaneously during the follow-up period. It can be concluded therefore that HPV infection, even oncogene, does not necessarily carry on CIN. Among CIN 1-2, associated or unassociated with HPV, the adequate treatment cured the patients and the virus disappeared. In some cases, a simple follow-up showed spontaneous regression of the lesion and the virus--CIN 3 was removed when necessary with a systematic pathological examination of the endocervix and the surgical sample limits. In a few cases, the virus persisted without lesion. HPV infection did not modify our protocol in the invasive carcinoma. These observations are available in a Centre with a well-trained anatomo-clinical team. In our opinion, the major priority involved in the recognition of cervical HPV infection is to perform a more systematic colposcopy (even for normal smears with subtle atypia), allowing the detection of early precancerous lesion, clinically occult. On the other hand, the oncogene HPV notion has caused us to take more aggressive action regarding treatment of some CIN 1-2, but may not be of benefit to the patient. We remain convinced that the CIN, with or without HPV, or not oncogene with HPV, must only be treated based on the clinical extension and the pathological gravity of the lesions.