Screening for cervical abnormalities in women with anogenital warts in an STD clinic: an inappropriate use of colposcopy

Is colposcopy warranted in women with external anogenital warts?

OBJECTIVES.: To determine the prevalence of cervical dysplasia, diagnosed cytologically (squamous intraepithelial lesion [SIL]) or histologically (cervical intraepithelial neoplasia [CIN]), in women with external anogenital warts, and to determine the discriminating risk factors between those with and without cervical dysplasia. MATERIALS AND METHODS.: Chart review of women referred to colposcopy for external anogenital warts from 1990 to 1999. Human papillomavirus risk factors predictive for cervical dysplasia were assessed by logistic and Cox regression models. RESULTS.: There were 496 patients in this study. The prevalence of SIL by cytology was 20%: 18% low-grade squamous intraepithelial lesion and 2% high-grade squamous intraepithelial lesion. The combination of Pap smear and colposcopically directed biopsy identified dysplasia (SIL or CIN) in 30%, 4% of which were high-risk lesions (high-grade squamous intraepithelial lesion or CIN 2,3). Colposcopy performed much better than the Pap test alone in detecting CIN 2,3 lesions; 16 of 18 cases of CIN 2,3 diagnosed on biopsy had Pap smear results of low-grade squamous intraepithelial lesion or less, 7 of which were normal. Two thirds of those diagnosed with CIN 2,3 were aged 25 years and older. No differences in human papillomavirus infection risk factors were found between women with and without cervical dysplasia. CONCLUSIONS.: The high prevalence of CIN 2,3 in women with external anogenital warts warrants evaluation with colposcopy, particularly in women aged 25 years and older.

MIB-1 immunostaining is a beneficial adjunct test for accurate diagnosis of vulvar condyloma acuminatum

The histopathologic diagnosis of vulvar condyloma acuminatum is often based on architectural features that are not specific for human papillomavirus (HPV) infection. Because HPV-associated lesions show increased cellular proliferation, the authors evaluated the usefulness of MIB-1 immunostaining as an aid in the differential diagnosis of cases equivocal for condyloma. The MIB-1 immunostaining pattern was correlated with HPV DNA detection in condyloma acuminatum (CON-A; n = 15), "consistent with condyloma" (c/w CON-A; n = 26), fibroepithelial polyp (FEP; n = 14), and squamous papilloma (n = 10). HPV was detected in 100% of the CON-A cases, and all cases demonstrated MIB-1-positive nuclei in the upper two thirds of the epithelial thickness. With this definition of MIB-1 positivity, there was complete concordance between MIB-1 positivity and HPV detection for all cases (kappa = 0.88). Of the cases c/w CON-A, 17 of 26 (65%) were positive for both MIB-1 and HPV, and could be reclassified as CON-A, whereas 35% were identified as an overdiagnosis based on negative results. In addition, two cases of FEP were MIB-1 and HPV positive, and thus were identified as an underdiagnosis. These results suggest significant overdiagnosis of cases equivocal for condyloma, and indicate that MIB-1 immunostaining is a beneficial adjunctive test when the morphologic features are suggestive but not diagnostic for CON-A.