Colposcopic patterns and their histopathologic correlation

White epithelium, mosaicism, punctation and atypical vessels are internationally used colposcopic terms describing an atypical transformation zone. Other morphologic findings are surface contour, clarity of demarcation, and tone of whiteness with or without atypical vessels. In the State University of New York at Buffalo affiliate hospitals, 665 cervical and vaginal atypical colposcopic patterns of 552 patients were matched with their histologic findings. Mosaicism, punctation, and white epithelium correlated with the histologic diagnosis of vaginal intraepithelial neoplasia and cervical intraepithelial neoplasia in 43%, 55% and 42% of the cases, respectively. When white epithelium accompanied the mosaicism or punctuation, the incidence of histologically confirmed vaginal and cervical intraepithelial neoplasia rose to 66% and 68%, respectively. In patients with prenatal DES exposure, mosaicism rarely (17%) correlated with the histologic findings of vaginal and cervical intraepithelial neoplasia. Overall, there was a great variability in the correlation depending on the specific colposcopy abnormalities.