Can Pap Smear and Biopsy Results for Warts Be Misleading?

Is it possible for a cauliflower slice report to be inaccurate?

Hello doctor, during my Pap smear examination, the first doctor informed me that I had warts (the biopsy report also indicated this).
However, the second doctor I consulted said it was not the case, and the third doctor also said it was not, but later the biopsy report confirmed it.
I also underwent HPV testing, which showed that types 16 and 18 were negative, but other 12 high-risk HPV types were positive (my Pap smear result was normal).

1.
Can the HPV report accurately test for the presence of wart types (6, 11) as positive or negative?
2.
Is it possible for the biopsy report to be incorrect, given that the doctors said it was not?
3.
If I have already started treatment for warts, at what stage of treatment could it be proven that it is not warts?

Xiao Yang, 30~39 year old female. Ask Date: 2023/01/07

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, it is difficult to make a determination.
I recommend discussing the report and clinical findings with your treating physician.
Thank you! Wishing you peace and health.
Dr.
Chang

Reply Date: 2023/01/07

More Info

When it comes to the diagnosis and management of warts, particularly those caused by Human Papillomavirus (HPV), the interpretation of Pap smear and biopsy results can indeed be complex and sometimes misleading. Let's break down your questions and concerns regarding HPV testing, the accuracy of biopsy results, and the treatment of warts.

1. HPV Testing and Wart Types: The HPV test you underwent detected high-risk types of HPV, specifically types 16 and 18, which are associated with cervical cancer, but it did not identify low-risk types such as 6 and 11, which are responsible for the majority of genital warts (also known as condylomata acuminata). The standard HPV tests are designed to detect high-risk strains that can lead to cervical cancer, and they do not typically include testing for low-risk types. Therefore, it is possible to have low-risk HPV types present without them being detected in a standard HPV test. If you suspect you have warts, it is essential to consult with your healthcare provider about the possibility of low-risk HPV types being present, even if they are not detected in the current testing.

2. Accuracy of Biopsy Results: Biopsy results can sometimes be subject to interpretation, and discrepancies can occur between different healthcare providers. While it is uncommon for a biopsy to be incorrect, it is not impossible. Factors such as the quality of the sample, the experience of the pathologist, and the specific characteristics of the lesions can influence the results. If you have received conflicting opinions regarding the presence of warts, it may be beneficial to seek a second opinion from a dermatopathologist or a specialist in sexually transmitted infections who can review your case comprehensively.

3. Treatment and Confirmation of Diagnosis: If you have already begun treatment for warts, the effectiveness of the treatment can help confirm the diagnosis. Treatments for genital warts include topical therapies (like imiquimod or podophyllin), cryotherapy, laser therapy, or surgical removal. If the warts respond to treatment and resolve, it is a strong indication that they were indeed caused by HPV. However, if the lesions persist or recur after treatment, further evaluation may be necessary. Follow-up examinations and possibly repeat biopsies can help clarify the diagnosis.

In summary, the relationship between HPV types and the presence of warts can be nuanced. Low-risk HPV types may not be detected in standard testing, and biopsy results can vary based on interpretation. If you are undergoing treatment, monitoring the response to that treatment will be crucial in determining the nature of the lesions. It is always advisable to maintain open communication with your healthcare provider and to seek clarification on any concerns you may have regarding your diagnosis and treatment plan. Regular follow-ups and possibly additional testing may be warranted to ensure comprehensive care.

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