Cervical Cytology or Colposcopy in the Identification of Cervical Intraepithelial Neoplastic Changes in Human Immunodeficiency Virus Positive Patients in an African Population?
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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.
To determine whether cervical cytology is superior to colposcopy as screening test among women infected with human immunodeficiency virus.
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.
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).
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.
KeywordsPap test Colposcopy Histology Correlation Sensitivity Specificity Cervical intraepithelial neoplasia
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
- 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
- 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.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
- 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
- 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
- 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
- 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
- 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
- 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.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
- 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.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.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
- 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.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.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