Correlação entre criterios morfologicos, citologicos e histologicos e presença do DNA do papilomavirus humano em biopsias cervicais uterinas detectado por meio da tecnica de reação em cadeia da polimerase

Abstract

Human papillomavirus (HPV) is associated to uterine cervical intraepithelial neoplasia (CIN) and has an important role in cevical cancer. Subjective differences in evaluation lead to disagreement among examiners in relation to the cytological and histological diagnosis of HPV infection, which can lead to changes in clinic manegement. The aim of the present study was to test the histological and cytological criteria used for detection of HPV in uterine cervix, by comparing to the presence of viral DNA as detected by PCR. By cytological screening, 107 women with atypia were submitted to colposcopy, when new samples were collected for cytology and PCR and suspicious images were biopsied. The PCR assay was performed with primers MY09/11 and GP05/06+ and, as control, beta-globin was amplified. For cytological analysis, 101 samples were selected (6 excluded due to fixation artifacts) and 61 biopsies taken.DNA extraction was not possible in 8 cases. Parakeratosis, acanthosis, koilocytotic atypia, binucleation, dyskeratosis and number of mitoses were assessed histologically; and clear perinuclear halos, irregularly distributed chromatin, hyperchromatic nuclei, increased nuclear-cytoplasmic ratio, irregular nuclear outline, binucleation (in superficial and immature cells), indian files, formation of syncytia with atypia (in immature cells only) and dyskeratosis were examined in cytological preparations. The histological diagnoses were: 11 chronic cervicitis (CC); 36 CIN (13 CIN I; 10 CIN II; 13 CIN III) and 14 suggestive of HPV (SHPV). HPV was found in 37.5% of CC, 77.4 % of CIN (91.7% of CIN I, 66.7% of CIN II and 70% of CIN III) and 64.3% of SHPV.Among the histological criteria, the most highly correlated to HPV were koilocytotic atypia (positive predictive value or PPV = 72.7%) and binucleation (PPV = 77.1%).However, specificity was low: 29.4% and 52.9% respectively. Taken together, koilocytotic atypia, dyskeratosis and binucleation showed PPV of 72.4%. They could be used as markers of HPV infection, but false positive results were found in 27.6%.Among cytological criteria associated to immature cells for detection of CIN III, formation of syncytia with atypia had the highest PPV (69.2%), followed by irregularly distributed chromatin (62.5%).The negative predictive values (NPV) for HPV-DNA involving superficial or immature cells were low (about 40%). PPV were relatively high, ranging from 50% to 93.9%