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

Abstract EN

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.