Sensitivity of the cytologic diagnosis of cervical condyloma in comparison with HPV-DNA hybridization studies.

The cytologic diagnosis of cervical condyloma is based on criteria developed over the last 10 years. It has now become possible to document the presence of human papilloma virus (HPV) DNA directly in cervical swabs by the highly sensitive technique of DNA filter hybridization in situ. The purpose of this article is to evaluate critically the empirically established cytologic criteria of condyloma by comparing them with HPV-DNA hybridization studies in the same material. The results of this study indicate that "classic" koilocytosis and dyskeratocytosis are not highly sensitive criteria for the presence of HPV infection, identifying only 15% of the HPV-DNA-positive cases correctly. In an attempt to improve the sensitivity of the cytologic diagnosis of HPV infections, a panel of nine "nonclassic" criteria was evaluated. The five most valuable signs were "mild koilocytosis," mild dyskeratocytosis," hyperchromatic nuclei, bi- and multinucleation, and cleared cytoplasm. Using these criteria in combination, statistically discriminant analysis could correctly identify 84% of the HPV-positive group.