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PAP Test Versus Colposcopy for Cervical Cancer Screening in HIV-Seropositive Women: A Case-Control Study
Shalini Singh1,2, Swati Agrawal1, Anju Seth3
1Obstetrics and Gynaecology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India.
Purpose:
The prevalence of pre-invasive lesions (PIL) of cervix in human immunodeficiency virus (HIV)-seropositive women ranges from 12.5 to 69%. Although Papanicolaou (PAP) test is the recommended screening method, it has concerns owing to high false-negative cytology in HIV-infected women and is associated with high attrition rates. The current study aims to compare the role of routine colposcopy with PAP test at initial visit for screening of pre-invasive lesions of cervix in HIV-seropositive women.
Methods:
A cross-sectional study of 120 HIV-seropositive women aged 25-50 years and screened for PIL of cervix by PAP test and colposcopy simultaneously was conducted. Colposcopy-directed biopsy was taken if SWEDE score was ≥ 5, and the results were compared with PAP report as well as the histopathology findings.
Results:
Out of the 120 women screened, abnormal colposcopy was found in 22 women (18.3%) out of which 12 (54.54%) were positive for PIL of cervix on biopsy as well. Abnormal PAP test was found in 6 women (5%), and all had abnormal colposcopy and histopathological findings suggestive of PIL as well. There were 6 women with PIL of cervix who would have been missed if only PAP test was to be used as the screening modality.
Conclusion:
Colposcopy was superior in detection of PIL of cervix in HIV-seropositive women. Therefore, the authors conclude that colposcopy should be incorporated as a primary screening tool for pre-invasive lesions of cervix in HIV-seropositive women.
