Advertisement

Cervical Cytology or Colposcopy in the Identification of Cervical Intraepithelial Neoplastic Changes in Human Immunodeficiency Virus Positive Patients in an African Population?

  • T. K. Nyengidiki
  • G. Bassey
  • L. Sapira-Odu
  • N. Inimgba
  • B. Athanasius
  • N. C. Orazulike
Original Article
  • 32 Downloads

Abstract

Background

Effective screening methods for early detection of cervical premalignant lesions among women with human immunodeficiency virus are needful since cervical cancer is one of the AIDS-defining malignancies.

Aim

To determine whether cervical cytology is superior to colposcopy as screening test among women infected with human immunodeficiency virus.

Method

A cross-sectional study was conducted at the cancer screening centre of the University of Port Harcourt Teaching Hospital from June to August 2015. Ninety-one women attending the infectious disease clinic were recruited. A pre-structured questionnaire was used to obtain information on sociodemographic characteristics. Cervical cytology, colposcopy and colposcopically directed biopsy were carried out on each patient. The data collated analysed, validity determined, and the degree of agreement of the two test screening methods was determined using Kappa statistical analysis.

Results

The mean age of the respondents was 36.92 ± 6.68 years with age range of 20–58 years. Among the 91 subjects analysed, the prevalence of cervical intraepithelial neoplasia was 40.7% from histological analysis. The sensitivity, specificity, positive predictive value and negative predictive value cytology were 21.62, 79.63, 42.11 and 59.72% while colposcopy had 72.97, 57.41, 54.0 and 75.61%, respectively. The Kappa value for cytology (κ = 0.014; p value = 0.885) as against that for colposcopy (κ = 0.288; p value = 0.004).

Conclusion

The prevalence of cervical intraepithelial neoplasia among HIV-positive women was high. Colposcopy is superior to the traditional cervical cytology as screening test for the identification of cervical intraepithelial neoplastic changes in acquired immunodeficiency-positive patients in Nigeria. There is fair degree of agreement of colposcopy  with histological diagnosis among these patients.

Keywords

Pap test Colposcopy Histology Correlation Sensitivity Specificity Cervical intraepithelial neoplasia 

Notes

Acknowledgements

Special thanks to Mr Gbarabe O, the laboratory scientist, in the department of Anatomical Pathology in the University of Port Harcourt Teaching Hospital, who processed the specimens; Matron Solomon and Mr Hart who are in charge of the colposcopy room of the cancer screening centre of the hospital and Dr Mrs Okaefor for the statistical analysis.

Compliance with Ethical Standards

Conflict of interest

None.

References

  1. 1.
    Kallings LO. The first postmodern pandemic: 25 years of HIV/AIDS. J Intern Med. 2008;263(3):218–43.CrossRefPubMedGoogle Scholar
  2. 2.
    WHO—HIV Department. Core epidemiology slides, HIV/AIDS estimates, November 2013. Available at: http://www.who.int/hiv/data/en/WHO/Data and Statistics. Accessed 28 Feb 2017
  3. 3.
    Anorlu R. Cervical cancer: the sub-saharan African perpective. Reprod Health matters. 2008;16(32):41–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Mishra GA, Pimple SA, Shastri SS. An overview of prevention and early detection of cervical cancers. Indian J Med Paediatr Oncol. 2011;32(3):125–32.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sankaranarayanan R, Budukh AM, Raikumah R. Effective screening programs for cervical cancer in low and middle income developing countries. Bull World Organ. 2001;79:954–62.Google Scholar
  6. 6.
    Sharma S, Sharma A, Sinha U, Roshan C. Comparative study of evolution of sensitivity and specificity of cytology and colposcopy for detection of precancerous lesions of the cervix. J Evol Med Dent Sci. 2013;12(50):9697–701.Google Scholar
  7. 7.
    Singh V, Sehgal A, Luthra UK. Screening for cervical cancer by direct inspection. Br Med J. 1992;304:534–5.CrossRefGoogle Scholar
  8. 8.
    Walboomers JMM, Jacobs MV, Manos MM. Human papilloma virus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Thomax Cox J. The development of cervical cancer and its precursors: what is the role of human Papilloma virus. Curr Opin Obstet Gynaecol. 2006;18(supp1):S5–13.Google Scholar
  10. 10.
    Massad LS, Evans CT, Strickler HD. Outcome after negative colposcopy among human immunodeficiency virus- infected women with borderline cytologic abnormalities. Obstet Gynaecol. 2005;106(3):525–32.CrossRefGoogle Scholar
  11. 11.
    Cardillo M, Hagan R, Abadi J, Abadi MA. CD4 T-cell count, viral load and squamous intraepithelial lesions in women infected with HIV. Cancer. 2001;93(2):111–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Davis AT, Charkraborty H, Flowers L, Mosunjac MB. Cervical dysplasia in women infected with HIV: a correlation with viral load and CD4 count. Gynaecol Oncol. 2001;80(3):350–4.CrossRefGoogle Scholar
  13. 13.
    Ahdieh L, Munoz A, Vlahor D. Cervical neoplasia and repeated positivity of HPV in HIV seropositive and negative women. Am J Epidemiol. 2000;151(12):1148–57.CrossRefPubMedGoogle Scholar
  14. 14.
    Holschneider CH. Premalignant and malignant disorders of the uterine cervix. In: DeCherney AH, Nathan L, Goodwin TM, Laufer N, editors. Current diagnosis and treatment, obstetrics and gynaecology. 10th ed. New York: McGraw-Hill medical publishing division; 2007. p. 833–54.Google Scholar
  15. 15.
    Pimple SA, Amin G, Goswami S, Shastri SS. Evaluation of colposcopy vs cytology as secondary test to triage women found positive on visual inspection test. Indian J Cancer. 2010;47:308–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Bappa LA, Yakasai AI. Colposcopy: the scientific basis. Ann Afr Med. 2013;12:86–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Katz DL, Elmore JG, Wild DMG, Lucan SC. Studying the Accuracy and Usefulness of Screening and Diagnostic Tests. In: Jekel’s Epidemiology, Biostatistics, Preventive Medicine and Public Health, textbook. 4th ed. Philadelphia: Sauders Publishers; 2014. pp. 82–7.Google Scholar
  18. 18.
    Bassey G, Jeremiah I, Ikimalo JI, Fiebai PO, Athanasius BP. Abnormal cervical cytology among HIV-positive women in Nigeria. Int J Gynaecol Obstet. 2014;125(2):103–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Nyengidiki TK. Screening methods for gynaecological cancers. In: Darwish A, editor. Contemporary gynaecologic practice. Janeza Trdine: InTech Publishers; 2015. p. 127–41.Google Scholar
  20. 20.
    Atashili J, Adimora AA, Ndumbe PM, Komey GM, Rinas AC, Myers E, et al. High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroun: is targeted screening feasible? Cancer Epidemiol. 2012;36(3):263–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Agaba PA, Thacher TD, Ekwempu CC, Idoko JA. Cervical dysplasia in Nigerian women infected with HIV. Int J Gynaecol Obstet. 2009;107(2):99–102.CrossRefPubMedGoogle Scholar
  22. 22.
    Getinet M, Gelaw B, Sisay A, Mahmoud EA, Abate A. Prevalence and predictors of Pap smear cervical epithelial cell abnormality among HIV positive and negative women attending gynaecological examination in cervical cancer screening centre at DebreMarkos referral hospital, East Gojjam, Northwest Ethiopia. BMC Clin Pathol. 2015;15:16–20.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Koss LG. The Papanicolaou test for cervical cancer detection: a triump and a tragedy. J Am Med Assoc. 1989;261:737–43.CrossRefGoogle Scholar
  24. 24.
    Basu PS, Sankaranarayanan R, Mandal R, Roy C, Das P. Visual inspection of cervix with acetic acid and cytology in the early detection of cervical neoplasia in Kolkatta-India. Int J Cancer. 2003;13(5):626–32.CrossRefGoogle Scholar
  25. 25.
    Singh SL, Dastur NA, Nanavatti MS. Comparison of colposcopy and Pap smear: sensitivity, specificity and predictive values. BHJ 2000;43(3):447–51.Google Scholar
  26. 26.
    Gopal M, Joshi SP, Pukale R, Shamashoor. Colposcopic findings in unhealthy cervix and its comparison with cytology and histopathology. J Evol Med Dent Sci. 2013;2(26):4663–71.Google Scholar
  27. 27.
    Padmini CP, Indira N, Chaitra R, Priyanca D, Girish BC, et al. Cytological and colposcopic evaluation of unhealthy cervix. J Evid Based Med Healthc. 2015;2(41):6920–7.CrossRefGoogle Scholar
  28. 28.
    Chaudhary RD, Inamdar SA, Hariharan C. Correlation of diagnostic efficacy of unhealthy cervix by cytology, colposcopy and histopathology in women of rural areas. Int J Reprod Contracept Obstet Gynaecol. 2014;3(1):213–8.CrossRefGoogle Scholar
  29. 29.
    Joshi C, Kujur P, Thakur N. Correlation of Pap smear and colposcopy in relation to histopathological findings in detection of premalignant lesions of cervix in a tertiary care centre. Int J Sci Stud. 2015;3(8):55–60.Google Scholar
  30. 30.
    Kohli B, Arya SB, Goel JK, Sinha M, Kar J, Tapasvi I. Comparison of Pap smear and colposcopy in detection of premalignant lesions of the cervix. J South Asian Feder Menopause Soc. 2014;2(1):5–8.Google Scholar
  31. 31.
    Ramesh G, Sudha R, Jayashree AK, Padmini J. Colposcopic evaluation of the unhealthy cervix. J Clin Diagnos Res. 2012;6(6):1026–8.Google Scholar
  32. 32.
    Boicea A, Patrascu A, Surlin V, Iliescu D, Schenker M, Chiutu L. Correlations between colposcopy and histologic results from colposcopically directed biopsy in cervical precancerous lesions. Rom J Morphol Embryol. 2012;53(3):735–41.PubMedGoogle Scholar
  33. 33.
    Akhter S, Bari A, Hayat Z. Variability study between Pap smear, colposcopy and cervical histological findings. JPMA. 2015;65(12):1295–9.Google Scholar
  34. 34.
    Jean RA, Pangaja P, Charles H, Denose JJ, Keerti S, Ann D, et al. Accuracy of pap smear screening in HIV positive women. Clin Infect Dx. (CID). 2006;42(12):562–8.Google Scholar
  35. 35.
    Reshmie AR, Nittaya P, Surasith C, Ferdinard WN, Pat T, Tippawan P, et al. Cervical and anal HPV infections: cytological and histological abnormalities in HIV infected women in Thailand. J Virus Erad. 2015;1(2):96–102.Google Scholar
  36. 36.
    Sujha S, Justin T, Donatus UE, James CG, Timothy JW, Chandrica R. Cost of cervical cancer treatment, implications for providing coverage for low income women under Medicaid expansion for cancer care. Women Health Issues. 2010;20(6):400–6.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2017

Authors and Affiliations

  • T. K. Nyengidiki
    • 1
  • G. Bassey
    • 1
  • L. Sapira-Odu
    • 1
  • N. Inimgba
    • 1
  • B. Athanasius
    • 2
  • N. C. Orazulike
    • 1
  1. 1.Department of Obstetrics and GynaecologyUniversity of Port Harcourt Teaching HospitalPort HarcourtNigeria
  2. 2.Department of Anatomical PathologyUniversity of Port Harcourt Teaching HospitalPort HarcourtNigeria

Personalised recommendations