L Stewart Massad1, Gypsyamber D'Souza2, Teresa M Darragh3, Howard Minkoff4, Rodney Wright5, Seble Kassaye6, Lorraine Sanchez-Keeland7, Charlesnika T Evans8. 1. Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: massadl@wudosis.wustl.edu. 2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Department of Pathology and Obstetrics, University of California, San Francisco, CA, USA; Department of Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA. 4. Maimonides Medical Center, Brooklyn, NY, USA. 5. Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. 6. Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC, USA. 7. University of Southern California, Los Angeles, CA, USA. 8. Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, IL, USA; Department of Veterans Affairs Center of Innovation for Complex Chronic Healthcare, Edward Hines J. VA Hospital, Hines, IL, USA.
Abstract
OBJECTIVE: The aim of this study is to compare colposcopic findings and the accuracy of colposcopic impression in HIV seropositive and seronegative women with abnormal Pap tests. METHODS: HIV seropositive and seronegative women in a national cohort study had Pap tests collected every six months, with colposcopy for any abnormal result. Prospectively collected colposcopy and histology findings were analyzed retrospectively using Pearson Chi-square, t-test and Wilcoxon two-sample tests, logistic regression models, and Kappa coefficients. RESULTS: After adjusting for age and Pap result, 1618 eligible HIV seropositive women were more likely than 406 seronegative women to have inadequate colposcopic examinations, abnormal colposcopic findings, and large cervical lesions. However, among those with abnormal colposcopy, colposcopic characteristics and lesion size and number did not differ by HIV serostatus. Agreement between colposcopists' impressions and highest grade biopsy diagnoses was fair (kappa coefficient 0.35, 95% C.I. 0.31, 0.38). Agreement did not differ by HIV serostatus and did not improve with multiple biopsies (weighted kappa coefficient 0.35, 95% C.I. 0.32, 0.39) or after including all histology results over two years following colposcopy. CONCLUSION: Although HIV seropositive women with abnormal cytology are more likely to have colposcopic abnormality, the performance of colposcopy appears to be similar to that in HIV seronegative women. Biopsy is required to confirm colposcopic impression.
OBJECTIVE: The aim of this study is to compare colposcopic findings and the accuracy of colposcopic impression in HIV seropositive and seronegative women with abnormal Pap tests. METHODS: HIV seropositive and seronegative women in a national cohort study had Pap tests collected every six months, with colposcopy for any abnormal result. Prospectively collected colposcopy and histology findings were analyzed retrospectively using Pearson Chi-square, t-test and Wilcoxon two-sample tests, logistic regression models, and Kappa coefficients. RESULTS: After adjusting for age and Pap result, 1618 eligible HIV seropositive women were more likely than 406 seronegative women to have inadequate colposcopic examinations, abnormal colposcopic findings, and large cervical lesions. However, among those with abnormal colposcopy, colposcopic characteristics and lesion size and number did not differ by HIV serostatus. Agreement between colposcopists' impressions and highest grade biopsy diagnoses was fair (kappa coefficient 0.35, 95% C.I. 0.31, 0.38). Agreement did not differ by HIV serostatus and did not improve with multiple biopsies (weighted kappa coefficient 0.35, 95% C.I. 0.32, 0.39) or after including all histology results over two years following colposcopy. CONCLUSION: Although HIV seropositive women with abnormal cytology are more likely to have colposcopic abnormality, the performance of colposcopy appears to be similar to that in HIV seronegative women. Biopsy is required to confirm colposcopic impression.
Authors: Margaret E Baum; Janet S Rader; Randall K Gibb; Rebecca P McAlister; Matthew A Powell; David G Mutch; Feng Gao; Jason D Wright Journal: Gynecol Oncol Date: 2006-07-27 Impact factor: 5.482
Authors: Nicolas Wentzensen; Rosemary E Zuna; Mark E Sherman; Michael A Gold; Mark Schiffman; S Terence Dunn; Jose Jeronimo; Roy Zhang; Joan Walker; Sophia S Wang Journal: Gynecol Oncol Date: 2009-09-20 Impact factor: 5.482
Authors: L Stewart Massad; Charlesnika T Evans; Gypsyamber D'Souza; Teresa Darragh; Howard Minkoff; Donna Henry; Lakshmi Goparaju; Laila I Muderspach; D Heather Watts Journal: J Low Genit Tract Dis Date: 2008-07 Impact factor: 1.925
Authors: L Stewart Massad; Eric C Seaberg; Rodney L Wright; Teresa Darragh; Yi-Chun Lee; Christine Colie; Robert Burk; Howard D Strickler; D Heather Watts Journal: Obstet Gynecol Date: 2008-06 Impact factor: 7.661