OBJECTIVE: This study was performed to compare the agreement of colposcopic impressions to predict the severity of disease at directed biopsy results. METHOD: We reviewed 537 patients who had abnormal Papanicolaou tests suggestive of over the benign cellular change in cytology and colposcopically directed biopsy at the Department of Obstetrics and Gynecology, College of Medicine, KyungHee University from March, 1991 to May, 2001. Among them, 44 patients were excluded because of unsatisfactory colposcopy. Colposcopist assessed border, coloration, topography, vascular change to grade cervical lesion severity. Pap smear was stratified as benign cellular change, HPV(koilocytosis)/CIN I, CIN II, CIN III and cancer purposely to compare with biopsy results. CoIposcopic impression was stratified as squamous metaplasia, low-grade lesion, high-grade lesion, and cancer by combination of colposcopic grading system of modified Colposcopic index(Reid and Scalazi, 1985) and Coppleson's grading method. RESULT: The results of cytology, colposcopic impressions were analyzed with regard to the histologic findings of the biopsy specimen. The accuracy rate, agreement with degress xl degree, underestimation, overestimation of cytology were 55.4%, 91.2%, 18.3%, 26.4%, respectively. Also, the accuracy rate, sensitivity, specificity, positive predictive value, negative predictive value of colposcopic impression were 75.6%, 94.6%, 82.7%, 84.3%, 89.7%, respectively. Overestimation rate, underestimation rate of colposcopic impression were 15.2%, 8.4%, respectively. And likelihood ratio of colposcopy of normal cervix, low-grade SIL, high-grade SIL were 0.11, 3.25, 12.57, respectively. CONCLUSION: These results suggested that colposcpic impressions is very useful for the diagnosis and differentiation of the various cervical lesions. And the colposcopy shows a larger appreciable difference when distinguishing high-grade SIL and cancer from low-grade SIL than when distinguishing low-grade SIL from normal cervix and inflammation.