The predictive value of cytologic testing in women with the human immunodeficiency virus who have low-grade squamous cervical lesions: a substudy of a randomized, phase III chemoprevention trial.
OBJECTIVE
The purpose of this study was to determine whether the progression of low-grade squamous intraepithelial lesions of the cervix in women with the human immunodeficiency virus can be predicted reliably by standard cytologic testing.


METHODS
As part of a previously reported trial, 288 biopsy specimens were collected from 117 women with the human immunodeficiency virus. These specimens underwent central and local interpretation, which were compared and correlated with cytologic results. Ninety-two subjects had matched cytologic/histologic pairs at study termination, which were compared to determine whether cytologic testing was predictive of progression.


RESULTS
Of the central histologic interpretations, 26 of 288 interpretations (9%) differed from local results, 97 of 246 cytologic/histologic pairs (39%) were discordant, and 21 subjects had progression to high-grade squamous intraepithelial lesions by histologic evidence. Cytologic testing showed high-grade squamous intraepithelial lesions in 4 of 21 specimens (sensitivity, 19%). The remaining cytologic specimens were either low-grade squamous intraepithelial lesions or were normal.


CONCLUSIONS
This substudy of pathologic results from a randomized clinical trial suggests that, although the risk of progression of low-grade squamous intraepithelial lesions is low, follow-up cytologic testing is unreliable. Colposcopic evaluation with directed biopsies should be continued.
Robinson
William R
WR
Harrington Cancer Center/Texas Tech University, Amarillo 79106, USA. wrobinson@harringtoncc.org
Luck
Mindy B
MB
Kendall
Michelle A
MA
Darragh
Teresa M
TM
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000517:prevention & control; D002584:Cervix Uteri / Q000473:pathology*; D017326:Clinical Trials, Phase III as Topic; D003127:Colposcopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000517:prevention & control; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000517:prevention & control
D000970:Antineoplastic Agents; D015474:Isotretinoin