Correlating Papanicolaou Smear, Colposcopic Impression, and Biopsy: Results from the Women's Interagency HIV Study.
OBJECTIVE
To determine associations among cervical cytology, colposcopy, and biopsy in HIV-seropositive women.


METHODS
HIV-seropositive women and uninfected comparison women in a multicenter prospective cohort study underwent colposcopy for protocol indications. Women were eligible if they had a cervix, satisfactory cytology, and colposcopy between October 1994 and September 1999. Cytology, colposcopic impression, and biopsy were compared using equivalent categorizations. Kappa statistics with bootstrap sampling assessed strength of associations.


RESULTS
Colposcopy was performed in 978/1370 HIV-seropositive women and in 154/224 seronegative women. Biopsies were performed on 603 (44%) seropositive women at least once during 1015 colposcopy visits and on 82 (37%) seronegative women at 116 visits. The positive predictive value of cytology was 72% for seropositive women and 60% for seronegative women. The positive predictive value of colposcopy was 71% for seropositive women and 55% for seronegative women.


CONCLUSIONS
The correlation between either cervical cytology or colposcopic impression and colposcopic biopsy was poor.
Massad
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*Division of Gynecologic Oncology, Cook County Hospital and Rush Medical College, Chicago, Illinois †Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD ‡National Institute for Child Health, Bethesda, MD §Departments of Medicine and Epidemiology, University of California, San Francisco, San Francisco, CA ‖Department of Obstetrics & Gynecology, Downstate Medical Center, Brooklyn, NY ¶Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY **Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, CA ††Department of Pathology, George Washington University Medical Center, Washington, DC ‡‡National Cancer Institute, Bethesda, MD.
Schneider
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Watts
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Darragh
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Abulafia
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Salzer
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Muderspach
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Sidawy
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Melnick
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