Cervical intraepithelial neoplasia treatment in Human Immunodeficiency Virus-positive women.
We set out to consider the level of agreement between referral and treatment pathology and to investigate the effectiveness of standard surgical treatment for cervical intraepithelial neoplasia (CIN) in Human Immunodeficiency Virus (HIV)-positive women. This was a case-note review of all women who underwent treatment for CIN between 1995 and 2004. Information on the referral and follow-up smear and biopsy results and the status of the excision margins at treatment were collected. A total of 71 women had at least one large loop excision of the transformation zone (LLETZ) for CIN. Agreement between the referral smear and biopsy was poor (kappa = 0.20) and between the referral and treatment pathology was only fair (kappa = 0.37). Ten treatment samples showed no histological evidence of CIN and were excluded from analysis of the presence of CIN at the resection margins. In only 32.8% of treatment samples were both margins clear of CIN. A high pre-LLETZ CD4 count was strongly associated with clear margins. A total of 55.6% patients had CIN at follow-up, despite both margins being clear. The follow-up smear/biopsy had decreased by >or=1 grade of CIN in only 50.8% patients. Our results show a high degree of discrepancy between cytology/biopsy and LLETZ histology in HIV-positive women. Additionally, there is often incomplete clearance of CIN at the resection margins emphasing the need for close follow-up after surgery.
Department of Primary Care, Royal Free and University College Medical Schools, London, UK. s.shah@pcps.ucl.ac.uk
S
S
Shah
H
H
Montgomery
J C
JC
Crow
C J
CJ
Smith
A
A
Moore
C A
CA
Sabin
H
H
Evans
M A
MA
Johnson
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001707:Biopsy, Needle; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods*; D015897:Comorbidity; D019092:Conization / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006679:HIV Seropositivity; D006801:Humans; D007150:Immunohistochemistry; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*