COLPOSCOPIC BIOPSIES VERSUS LOOP ELECTROSURGICAL EXCISION PROCEDURE CONE HISTOLOGY IN HUMAN IMMUNODEFICIENCY VIRUS-POSITIVE WOMEN

OBJECTIVE: To compare the discrepancy between colposcopically directed punch biopsy and excisional cone biopsy in human immunodeficiency-pos itive (HIV+) vs. HIV-negative (HIV-) women. STUDY DESIGN: We performed a case-control analysis of Women treated with excisional cone biopsy after an abnormal colposcopic punch biopsy. Punch and cone biopsy hist ology were compared in 29 HIV+ (mean CD4 = 251 cells/mm(3), 10 with th e acquired immunodeficiency syndrome) and 31 HIV- women. Only pa patie nts with no prior treatment for Cervical dysplasia, satisfactory colpo scopy and cervical cytologic smears concordant with colposcopic biopsi es were included. RESULTS: Disagreement between punch biopsy and cone histology was evident in 41% (12/29) of HIV+ patients and 48% (15/31) of seronegative women (chi(2), P = .78). The cone specimen had it high er grade lesion than the punch biopsy in 38% (11/29) of HIV+ patients and 32% (10/31) of seronegative women (P = .65). Overall, patients wit h HPV, cervical intraepithelial neoplasia (CIN) I or II on punch biops y had CIN III on 30% of cone biopsies (5/23 HIV+ vs. 9/23 HIV - women, P = .2). In HIV+ women with HPV or CIN I on punch biopsy, 50% (9/18, 95% confidence interval 26-74%) had CIN II or III on the excisional co ne vs. 18% (2/11) HIV- patients (Fisher's test, P = .13). However, in HIV+ patients with CIN II or III on cone biopsy, 47% (9/19) had only C IN I or human papillomavirus on punch biopsy as compared to 9% (2/22) HIV - patients (chi(2), P = .01). CONCLUSION: Colposcopically directed punch biopsies are poor predictors of cone histology in both HIV+ and HIV- patients. Based on confidence intervals, at least 26% and as man y as 74% of HIV+ women with CIN I on punch biopsy may have a significa ntly worse lesion on cone biopsy despite satisfactory colposcopy. Thou gh CIN I may be observed in immunocompetent women, due to the likeliho od of a more advanced lesion, observation may not be justified in HIV women.