Colposcopic biopsies versus loop electrosurgical excision procedure cone histology in human immunodeficiency virus-positive women

Giuseppe Del Priore, Pamela R. Gilmore, Terry Maag, David P. Warshal, Teresa H. Cheon

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To compare the discrepancy between colposcopically directed punch biopsy and excisional cone biopsy in human immunodeficiency-positive (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 histology were compared in 29 HIV+ (mean CD4 = 251 cells/mm 3, 10 with the acquired immunodeficiency syndrome) and 31 HIV- women. Only patients with no prior treatment for cervical dysplasia, satisfactory colposcopy and cervical cytologic smears concordant with colposcopic biopsies 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 (χ 2, P = .78). The cone specimen had a higher grade lesion than the trench biopsy in 38% (11/29) of HIV+ patients and 32% (10/31) of seronegative women (P =.65). Overall, patients with HPV, cervical intraepithelial neoplasia (CIN) I or II on punch biopsy 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 cone 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 CIN I or human papillomavirus on punch biopsy as compared to 9% (2/22) HIV- patients (χ 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 many as 74% of HIV+ women with CIN I on punch biopsy may have a significantly worse lesion on cone biopsy despite satisfactory colposcopy. Though CIN I may be observed in immunocompetent women, due to the likelihood of a more advanced lesion, observation may not be justified in HIV+ women.

Original languageEnglish (US)
Pages (from-to)653-657
Number of pages5
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume41
Issue number9
StatePublished - Sep 1996
Externally publishedYes

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Histology
HIV
Biopsy
Cervical Intraepithelial Neoplasia
Colposcopy
HIV-2
Confidence Intervals
Uterine Cervical Dysplasia
Vaginal Smears
Acquired Immunodeficiency Syndrome
Observation

Keywords

  • biopsy
  • cervix neoplasms
  • colposcopy
  • HIV

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Colposcopic biopsies versus loop electrosurgical excision procedure cone histology in human immunodeficiency virus-positive women. / Del Priore, Giuseppe; Gilmore, Pamela R.; Maag, Terry; Warshal, David P.; Cheon, Teresa H.

In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist, Vol. 41, No. 9, 09.1996, p. 653-657.

Research output: Contribution to journalArticle

Del Priore, Giuseppe ; Gilmore, Pamela R. ; Maag, Terry ; Warshal, David P. ; Cheon, Teresa H. / Colposcopic biopsies versus loop electrosurgical excision procedure cone histology in human immunodeficiency virus-positive women. In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist. 1996 ; Vol. 41, No. 9. pp. 653-657.
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abstract = "OBJECTIVE: To compare the discrepancy between colposcopically directed punch biopsy and excisional cone biopsy in human immunodeficiency-positive (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 histology were compared in 29 HIV+ (mean CD4 = 251 cells/mm 3, 10 with the acquired immunodeficiency syndrome) and 31 HIV- women. Only patients with no prior treatment for cervical dysplasia, satisfactory colposcopy and cervical cytologic smears concordant with colposcopic biopsies 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 (χ 2, P = .78). The cone specimen had a higher grade lesion than the trench biopsy in 38{\%} (11/29) of HIV+ patients and 32{\%} (10/31) of seronegative women (P =.65). Overall, patients with HPV, cervical intraepithelial neoplasia (CIN) I or II on punch biopsy 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 cone 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 CIN I or human papillomavirus on punch biopsy as compared to 9{\%} (2/22) HIV- patients (χ 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 many as 74{\%} of HIV+ women with CIN I on punch biopsy may have a significantly worse lesion on cone biopsy despite satisfactory colposcopy. Though CIN I may be observed in immunocompetent women, due to the likelihood of a more advanced lesion, observation may not be justified in HIV+ women.",
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AU - Cheon, Teresa H.

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N2 - OBJECTIVE: To compare the discrepancy between colposcopically directed punch biopsy and excisional cone biopsy in human immunodeficiency-positive (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 histology were compared in 29 HIV+ (mean CD4 = 251 cells/mm 3, 10 with the acquired immunodeficiency syndrome) and 31 HIV- women. Only patients with no prior treatment for cervical dysplasia, satisfactory colposcopy and cervical cytologic smears concordant with colposcopic biopsies 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 (χ 2, P = .78). The cone specimen had a higher grade lesion than the trench biopsy in 38% (11/29) of HIV+ patients and 32% (10/31) of seronegative women (P =.65). Overall, patients with HPV, cervical intraepithelial neoplasia (CIN) I or II on punch biopsy 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 cone 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 CIN I or human papillomavirus on punch biopsy as compared to 9% (2/22) HIV- patients (χ 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 many as 74% of HIV+ women with CIN I on punch biopsy may have a significantly worse lesion on cone biopsy despite satisfactory colposcopy. Though CIN I may be observed in immunocompetent women, due to the likelihood of a more advanced lesion, observation may not be justified in HIV+ women.

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