Statement of caution in the interpretation of papillomavirus-associated lesions of the epithelium of uterine cervix

The recent discovery that papillomaviruses are associated with many of the morphologic abnormalities of the squamous epithelium of the uterine cervix previously classified as various forms of cervical intraepithelial neoplasia (dysplasia, carcinoma in situ, CIN) has created a great deal of confusion among pathologists and gynecologists. The facts are as follows: 1. The human papillomavirus-associated lesions (koilocytic atypia, warty atypia, 'flat' or 'inverted' condylomas, subclinical papillomavirus infection) are the most common abnormalities of cervical epithelium in young women but may occur at any age. 2. In a significant proportion of women these lesions have been shown to be associated with other forms of cervical intraepithelial neoplasia and, in some, with invasive carcinoma. 3. At this time, the behavior of papillomavirus-associated lesions cannot be predicted on morphologic grounds, as is also true of other forms of intraepithelial neoplasia. For these reasons, it is the opinion of the undersigned that these lesions should be reported according to the degree of morphologic abnormality, within the framework of the customary reporting system used for precancerous epithelial lesions of the uterine cervix, such as dysplasia, carcinoma in situ, or CIN. The presence of the virus-associated component may be mentioned as a part of the microscopic diagnosis but should not modify the clinical approach to these lesions. Women bearing the virus-associated lesions should receive the same clinical and colposcopic evaluation, treatment, and follow-up as usually administered to women with conventional forms of cervical intraepithelial neoplasia, until more data on the natural history of these lesions are obtained.