Cytologic detection of human papillomavirus infection

In recent years there has been a dramatic increase in the incidence of human papillomavirus infection of the female genital tract. Since the primary diagnosis of this condition is almost invariably based on cytologic observations, the diagnostic criteria are of paramount importance. The diagnosis is usually based on the presence of koilocytes, or balloon cells, and dyskeratotic cells. Although these cells remain fundamental to the diagnosis, it is important to recognize other possible cytologic manifestations of the disease. Follow-up studies indicate clearly that any woman with cytologic evidence of HPV infection has a greatly increased risk of developing cervical intraepithelial neoplasia. Morphologic attempts to quantify this risk are unreliable. The studies described and quoted in this paper would suggest that all women with the cytologic changes of HPV infection, with or without evidence of cervical intraepithelial neoplasia, should be managed with extreme caution.