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Updated: Apr 25, 2026
Ex Vivo Infection of Human Lymphoid Tissue and Female Genital Mucosa with Human Immunodeficiency Virus 1 and Histoculture
Published on: October 12, 2018
Interobserver variability of cervical cytology in HIV-infected women
I Heard1,2, V Potard3,4,5, C Bergeron6
1Centre National de Référence des papillomavirus humains, Institut Pasteur, Paris, France.
Insights
Liquid-based cytology (LBC) shows better reproducibility than conventional Pap tests for interpreting cervical specimens in women with human immunodeficiency virus (HIV). LBC also yielded fewer unsatisfactory results, making it the preferred method.
Area of Science:
- Gynecologic pathology
- Cytopathology
- Infectious disease epidemiology
Background:
- Human immunodeficiency virus (HIV)-infected women are at increased risk for human papillomavirus (HPV) related cervical abnormalities.
- Accurate and reproducible cytological interpretation is crucial for effective management of cervical pathology in this population.
Purpose of the Study:
- To assess the inter-pathologist reproducibility of conventional cytology versus liquid-based cytology (LBC) for cervical specimens from HIV-infected women.
- To evaluate the impact of LBC on the rate of unsatisfactory cervical cytology results.
Main Methods:
- A blinded, paired comparison of conventional Papanicolaou (Pap) tests and LBC preparations from HIV-infected women.
- Two pathologists independently interpreted a random sample of Pap tests and LBCs using the Bethesda System 2001.
- Inter-observer agreement was quantified using unweighted and Cicchetti-Allison-weighted kappa statistics.
Main Results:
- Liquid-based cytology (LBC) demonstrated significantly higher inter-observer agreement (kappa = 0.82) compared to conventional Pap tests (kappa = 0.69) (P = 0.009).
- LBC resulted in a significantly lower percentage of unsatisfactory specimens compared to conventional cytology.
- Overall agreement was 84% for LBC and 78% for conventional Pap tests.
Conclusions:
- Liquid-based cytology (LBC) offers superior reproducibility for cervical specimen interpretation in HIV-infected women compared to conventional cytology.
- LBC reduces the rate of unsatisfactory results, improving the reliability of cervical cancer screening in this high-risk group.
- LBC is recommended as the preferred method for cervical cytology in HIV-infected women due to its enhanced performance characteristics.
Objectives:
Our objectives were to determine the reproducibility of cytological specimen interpretation between two pathologists in human immunodeficiency virus (HIV)-infected women (from the VIHGY, ANRS CO17 study of human papillomavirus genital pathology among HIV-positive women) and to analyse the improvement, if any, between conventional and liquid-based cytology (LBC) interpretations.
Materials And Methods:
A sample of all abnormal and 40% of randomly selected normal Papanicolaou (Pap) tests was randomly ordered and read blindly by a second pathologist using the revised Bethesda terminology 2001. For both conventional and liquid-based preparations, unweighted and Cicchetti-Allison-weighted kappa and their 95% confidence intervals (CIs) were calculated. Kappa values were then compared using the Altman rule to classify the reproducibility of cytological specimen interpretation.
Results:
Two hundred and seventy-seven conventional Pap tests were reviewed, including 79 abnormal and 10 unsatisfactory results. Overall agreement between the two observers was 78%, with an estimated Cicchetti-Allison-weighted kappa of 0.69 (95%CI, 0.61-0.77). The corresponding values for the 268 LBCs, including 123 abnormal and two unsatisfactory results, were 84% and 0.82 (95%CI, 0.76-0.87), respectively. The reproducibility of LBC interpretations was significantly higher than that of conventional preparations (P = 0.009) and, for both laboratories, the percentages of unsatisfactory results were significantly lower for LBC.
Conclusion:
In HIV-infected women in the combination antiretroviral therapy era, the strength of agreement was better for LBCs than for conventional preparations, with a lower percentage of unsatisfactory results. When available, LBC should be preferred because of its higher reproducibility.
