Utility of cervicography in HIV-infected and uninfected adolescents.
OBJECTIVE
To compare cytology with cervicography in HIV-infected and uninfected adolescent females.


METHODS
At the time of analysis, 334 girls aged 13-19 years from 13 U.S. cities were participating in a prospective study of HIV infection. All subjects had cytology and a Cervigram (cervicography) performed at two consecutive visits 6 months apart, referred to as visit (V) 1 and 2. Cervigrams were sent to the parent company for diagnosis and were categorized as: "negative" or "positive" (compatible with low-grade or high-grade squamous intraepithelial lesions [SIL]). Cytology was considered abnormal if the subject had SIL at either V1 or V2. Sensitivity, specificity, and positive predictive value (PPV) of the Cervigram were calculated compared with repeat Papanicolaou (Pap) smears.


RESULTS
Two consecutive adequate Pap smears were available for analysis in 200 adolescents; 51% (95% CI, 43-59) of the 142 HIV-positive youth and 19% (95% CI, 9-29) of the 58 HIV-negative youth had SIL on at least one Pap smear (p < .001). A positive Cervigram was observed in 44% (95% CI, 36-53) of the HIV-infected group and 29% (95% CI, 17-41) of the HIV-uninfected group (p =.06). For the HIV-infected group, the sensitivity, specificity, and PPV of the Cervigram to detect SIL were 58% (95% CI, 45-71), 69% (95%CI, 57-80), and 64% (95%CI, 52-77), respectively. For the HIV-uninfected group, the sensitivity, specificity, and PPV were 64% (95% CI, 31-89), 80% (95% CI, 65-90), and 44% (95% CI, 19-68), respectively. The combined sensitivity, using both the Pap smear and Cervigram result from V1 to detect SIL, was 82% (95% CI, 71-91 for HIV+ and 48-98 for HIV-) in both groups. However, the PPV based the performance of the Cervigram in Pap smear-negative women as 33% (95% CI, 17-53) and 15% (95% CI, 2-45) for the HIV-infected and uninfected group, respectively (p = not significant [ns]).


CONCLUSIONS
Although the sensitivity of a single Pap smear increased significantly when the Cervigram was used as an adjunct, the low PPV in both HIV-infected and uninfected groups, suggests that cervicography has a limited utility for precancer and cervical cancer screening in high-risk adolescent populations.
Moscicki
Anna-Barbara
AB
Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. annam@itsa.ucsf.edu
Durako
Stephen J
SJ
Ma
Yong
Y
Darragh
Teresa
T
Vermund
Sten H
SH
D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D005069:Evaluation Studies as Topic; D005260:Female; D015658:HIV Infections / Q000473:pathology*; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D065006:Papanicolaou Test; D010781:Photography / Q000379:methods* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears / Q000592:standards* / Q000706:statistics & numerical data