Correlating Pap Smear Results and Colposcopy-Directed Large Loop Excision of the Transformation Zone Histopathology in HIV-Infected and HIV-Uninfected Women: A Case-Control Study in South Africa. (22nd July 2013)

• Record Type: Journal Article
• Authors: van Bogaert, Louis-J.
• Other Names: Nakayama Kentaro Academic Editor.
• Is Part Of: Journal of cancer research. Volume 2013(2013)
• Publication Date: 2013-07-22
• Subjects: Cancer -- Research -- Periodicals; Cancer -- Research; Neoplasms; Periodicals; 616.994
• DOI: 10.1155/2013/801047
• Languages: English
• ISSNs: 2356-7201

Abstract

Abstract : Background . In low-resource settings (LRS) with high HIV/AIDS and cervical cancer rates, new screening strategies face many logistic hurdles. Since cytology is there to stay, at least in the median-term future, it is important to assess to what extent HIV-HPV coinfection impacts the accuracy of screening methods and strategies. Methods . We audited the correlation between cytological diagnosis of minimal abnormality (≤ CIN1), CIN2+, or cancer and the histological diagnosis of colposcopy-directed large loop excision of the transformation zone of 399 HIV-uninfected controls and 389 HIV-infected cases. Results . The average age at diagnosis of CIN2+ of the cases was 4.2 years younger than controls (P < 0.0001 ). The endpoint used to assess the accuracy of cytology was minimal cytological abnormality (≤CIN1/LGSIL). The sensitivity, specificity, and negative and positive predictive values were 92.7, 18.5, 45.1, and 77.9%, respectively. The overall ratio of discordance/concordance between cytology and histology was similar in both groups. Conclusion . In LRS, where rapid-HPV testing is not yet part of screening algorithms, a cytological diagnosis of minimal abnormality requires visual inspection and treatment of visualized lesions especially in HIV-infected women aged≤ 30 years. The cytological endpoint of accuracy should be set low to avoid false negative smears.