Performance of cytology and colposcopy in diagnosis of cervical intraepithelial neoplasia (CIN) in HIV-positive and HIV-negative women

As part of an extensive multi-institutional DIANAIDS-HIV-HPV-SIL project ru n in Italy (co-ordinated by ISS), the present study compares the performanc e (sensitivity, specificity, agreement) of routine cervical smear cytology with that of colposcopy in the detection of histologically-confirmed CIN le sions in 37 HIV-positive and 21 HIV-negative women, belonging to the DIANAI DS cohort of 459 women. All women were subjected to a cervical smear, colpo scopy and biopsy, making possible the pairwise comparison of these techniqu es. In the whole series of HIV-positive and HIV-negative women, cytology ha d a sensitivity of 86.9% and specificity of 83.3%, the sensitivity of grade 2 abnormality on colposcopy against histology being 82.6% and specificity, 33.3%. No statistically significant difference was observed in the perform ance of Pap smears between the HIV-positive and HIV-negative women. The sen sitivity of cytology was 89.7% vs 82.4% and the specificity, 75% vs 100%. F or colposcopy, the sensitivity was 79.3% vs 88.2% and the specificity, 75% vs 50%, These data suggest that cervical Pap smear cytology is a highly sen sitive and specific diagnostic tool in the clinical monitoring of lower gen ital tract pathology in HIV-positive women. Colposcopy, on the other hand, proved to be a somewhat less accurate diagnostic tool in these women.