Colposcopy in assessment of the natural history of prospectively followed-up human papillomavirus (HPV) lesions in the uterine cervix.

Abstract

As a part of the long-term prospective follow-up study conducted in our clinic since 1981 for women with cervical HPV (Human papillomavirus) infections (either with or without cervical intra-epithelial neoplasia, HPV-CIN and HPV-NCIN, respectively) the colposcopic data on 292 consecutive patients with a mean follow-up of 16 months are reported. The results are based on 786 colposcopies performed at 6-month intervals according to conventional methods. Colposcopic findings are categorized into one of the following patterns: normal, warty, punctate, mosaic, leukoplakia, and combination. Colposcopic pattern bore an excellent correlation to the natural history (clinical course) of the HPV lesions, in that colposcopy was normal in 75% of the regressing lesions, in 38% of the persistors, and in only 16% of the progressors. The percentage of regression increased parallel with the frequency of normal pattern during the follow-up. Leukoplakia and combination were the two most frequent (55.7%) patterns in progressor lesions, as compared with only 12.9% in regressors and in 33.2% of the persistors. The same was true of the 15 lesions progressing into carcinoma in situ (CIS), and treated by cone. In the progressor lesions, an abnormal colposcopy pattern was disclosed in 65-100%, as compared with 14-35% only in the regressors. The present study provides evidence that colposcopy is an applicable and relatively accurate diagnostic method for assessing cervical HPV lesions. Colposcopy also seems to have some prognostic value in the follow-up of these lesions, as shown by the fact that normal colposcopic pattern is frequently associated with regression, whereas leukoplakia and combination are encountered more frequently than others in HPV lesions with CIN, shown to be more prone to progress during the follow-up.