Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency

Authors

  • Pouria Yazdian-Anari Medical Student, Student Research Committee, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Keywords:

immunodeficiency, conventional Pap smear, colposcopy, cervical cancer, sensitivity, specificity

Abstract

Introduction: Cervical cancer is the second most common cancer among women worldwide. The sensitivity of conventional Pap smear in detecting cervical lesions before cervical cancer is 51%, which means the false negative value is 49%. The aim of this study was to compare two methods for screening for cervical cancer in patients with secondary immunodeficiency, i.e., the conventional Pap smear and colposcopy. 

Methods: This cross-sectional study was conducted on 101 immunodeficient patients who were referred to the Gynecologic Clinic at Shahid Sadughi Hospital in Yazd from March 2011 to August 2012. All patients underwent the Pap test, a colposcopy, and a cervical biopsy, with the latter being considered as the gold-standard test.

Results: The most frequency of immunodeficiency was noted among patients with rheumatoid arthritis (53.3%), and this was followed by patients who were undergoing chemotherapy (30.7%), patients with lupus erythematosus (12.9%), and patients with AIDS (3%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Pap smear were18.2, 98.5, 85.5, 71.3, and 72.2%, respectively. The respective values for colposcopy were 66.7, 98.94, 80, 97.9, and 97%, respectively.

Conclusion: In this study the accuracy, sensitivity, specificity, and negative predictive values of colposcopy were higher than those for the Pap smear in detecting high-grade, cervical, pre-malignant lesions (cervical intraepithelial neoplasia: CIN ≥ 2). Therefore, an annual colposcopy is advised for secondary immunodeficient patients instead of a Pap smear.

References

de Freitas AC, Coimbra EC, Leitão MdCG. Molecular targets of HPV oncoproteins: Potential biomarkers

for cervical carcinogenesis. Biochimica et Biophysica Acta (BBA)-Reviews on Cancer. 2014;1845(2):91- 103, doi: 10.1016/j.bbcan.2013.12.004. PMid: 24388872.

Spensley S, Hunter RD, Livsey JE, Swindell R, Davidson SE. Clinical outcome for chemoradiotherapy in

carcinoma of the cervix. Clinical oncology. 2009;21(1):49-55, doi: 10.1016/j.clon.2008.10.014. PMid:

Bueno CT, Silva CMDd, Barcellos RB, Silva Jd, Santos CRd, Menezes JES, et al. Association between

cervical lesion grade and micronucleus frequency in the Papanicolaou test. Genetics and molecular biology.

;37(3):496-9, doi: 10.1590/S1415-47572014000400004. PMid: 25249771, PMCid: PMC4171763.

Peirson L, Fitzpatrick-Lewis D, Ciliska D, Warren R. Screening for cervical cancer: a systematic review

and meta-analysis. Syst Rev. 2013;2(35):1-14, doi: 10.1186/2046-4053-2-35.

Ries L, Melbert D, Krapcho M, Stinchcomb D, Howlader N, Horner M, et al. SEER cancer statistics

review, 1975-2005. Bethesda, MD: National Cancer Institute. 2008:1975-2005,

Berek JS, Hacker NF. Practical Gynecologic Oncology: Lippincott Williams & Wilkins; 2000.

Koutsky LA, Holmes KK, Critchlow CW, Stevens CE, Paavonen J, Beckmann AM, et al. A cohort study of

the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. The New

England journal of medicine. 1992;327(18):1272-8, doi: 10.1056/NEJM199210293271804. PMid: 1328880

Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human

papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. The New England journal of

medicine. 2007;357(16):1579-88, doi: 10.1056/NEJMoa071430. PMid: 17942871

Zarchi MK, Binesh F, Kazemi Z, Teimoori S, Soltani HR, Chiti Z. Value of Colposcopy in the Early

Diagnosis of Cervical Cancer in Patients with Abnormal Pap Smears at Shahid Sadoughi Hospital, Yazd.

Asian Pacific Journal of Cancer Prevention. 2011;12:3439-41.

Karimi Zarchi M, Akhavan A, Fallahzadeh H, Gholami H, Dehghani A, Teimoori S. Outcome of cervical

cancer in Iranian patients according to tumor histology, stage of disease and therapy. Asian Pacific journal

of cancer prevention : APJCP. 2010;11(5):1289-91. PMid: 21198279.

Ley C, Bauer HM, Reingold A, Schiffman MH, Chambers JC, Tashiro CJ, et al. Determinants of genital

human papillomavirus infection in young women. Journal of the National Cancer Institute.

;83(14):997-1003, http://dx.doi.org/10.1093/jnci/83.14.997. PMid: 1649312

Bernard E, Pons-Salort M, Favre M, Heard I, Delarocque-Astagneau E, Guillemot D, et al. Comparing

human papillomavirus prevalences in women with normal cytology or invasive cervical cancer to rank

genotypes according to their oncogenic potential: a meta-analysis of observational studies. BMC infectious

diseases. 2013;13(1):1-11, doi: 10.1186/1471-2334-13-373. PMid: 23941096, PMCid: PMC3751808.

Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus

infection in young women. The New England journal of medicine. 1998;338(7):423-8. doi:

1056/NEJM199802123380703, PMid: 9459645

Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, et al. Accuracy of the

Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review.

Annals of internal medicine. 2000;132(10):810-9, doi: 10.1056/NEJM199802123380703. PMid: 9459645.

Novak E, Berek JS. Berek & Novak's gynecology: Lippincott Williams & Wilkins; 2007.

Alloub MI, Barr BB, McLaren KM, Smith IW, Bunney MH, Smart GE. Human papillomavirus infection

and cervical intraepithelial neoplasia in women with renal allografts. BMJ (Clinical research ed).

;298(6667):153-6, doi: 10.1136/bmj.298.6667.153.

Cordiner J, Sharp F, Briggs J. Cervical intraepithelial neoplasia in immunosuppressed women after renal

transplantation. Scottish medical journal. 1980;25(4):275-7. PMid: 7010590

Branca M, Rossi E, Alderisio M, Migliore G, Morosini PL, Vecchione A, et al. Performance of cytology

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

women. Cytopathology. 2001;12(2):84-93, doi: 10.1046/j.1365-2303.2001.00299.x. PMid: 11284952

Mitchell MF, Schottenfeld D, Tortolero-Luna G, Cantor SB, Richards-Kortum R. Colposcopy for the

diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstetrics and gynecology. 1998;91(4):626- 31, doi: 10.1016/S0029-7844(98)00006-4.

Gaudette LA, Gao RN, Freitag S, Wideman M. Cancer incidence by ethnic group in the Northwest

Territories (NWT) 1969-1988. Health reports. 1993;5(1):23-32. PMid: 8334235

Yamada R, Sasagawa T, Kirumbi LW, Kingoro A, Karanja DK, Kiptoo M, et al. Human papillomavirus

infection and cervical abnormalities in Nairobi, Kenya, an area with a high prevalence of human

immunodeficiency virus infection. Journal of medical virology. 2008;80(5):847-55, doi:

1002/jmv.21170. PMid: 18360898.

Maiman M, Fruchter RG, Sedlis A, Feldman J, Chen P, Burk RD, et al. Prevalence, risk factors, and

accuracy of cytologic screening for cervical intraepithelial neoplasia in women with the human

immunodeficiency virus. Gynecologic oncology. 1998;68(3):233-9, doi: 10.1006/gyno.1998.4938. PMid:

McAdam M, Sakita J, Tarivonda L, Pang J, Frazer IH. Evaluation of a cervical cancer screening program

based on HPV testing and LLETZ excision in a low resource setting. PloS one. 2010;5(10):e13266, doi:

1371/journal.pone.0013266. PMid:20949059, PMCid: PMC2951361

Yoshida Y, Sato S, Okamura C, Nishino Y, Yajima A. Evaluating the accuracy of uterine cancer screening

with the regional cancer registration system. Acta cytologica. 2001;45(2):157-62, doi: 10.1159/000327270.

PMid: 11284299

Cuzick J, Clavel C, Petry KU, Meijer CJ, Hoyer H, Ratnam S, et al. Overview of the European and North

American studies on HPV testing in primary cervical cancer screening. International journal of cancer

Journal international du cancer. 2006;119(5):1095-101, doi: 10.1002/ijc.21955.

Hamashima C, Aoki D, Miyagi E, Saito E, Nakayama T, Sagawa M, et al. The Japanese guideline for

cervical cancer screening. Japanese journal of clinical oncology. 2010:hyq036.

Anderson JR, Paramsothy P, Heilig C, Jamieson DJ, Shah K, Duerr A. Accuracy of Papanicolaou test

among HIV-infected women. Clinical infectious diseases : an official publication of the Infectious Diseases

Society of America. 2006;42(4):562-8, doi: 10.1086/499357. PMid: 16421802.

Stephens PC, Sloboda Z, Grey S, Stephens R, Hammond A, Hawthorne R, et al. Is the receptivity of

substance abuse prevention programming affected by students' perceptions of the instructor? Health

education & behavior : the official publication of the Society for Public Health Education. 2009;36(4):724- 45, doi: 10.1177/1090198107304388. PMid: 18809689

Anastos K, Denenberg R, Solomon L. Human immunodeficiency virus infection in women. Medical

Clinics of North America. 1997;81(2):533-53, doi: 10.1016/S0025-7125(05)70530-7.

Hankins CA, Lamont JA, Handley M. Cervicovaginal screening in women with HIV infection: a need for

increased vigilance? CMAJ: Canadian Medical Association Journal. 1994;150(5):681. PMid:8313287,

PMCid: PMC1486337

Palefsky JM, Minkoff H, Kalish LA, Levine A, Sacks HS, Garcia P, et al. Cervicovaginal human

papillomavirus infection in human immunodeficiency virus-1 (HIV)-positive and high-risk HIV-negative

women. Journal of the National Cancer Institute. 1999;91(3):226-36, doi: 10.1093/jnci/91.3.226. PMid:

Leibenson L, Banani S, Borer A, Meirovitz M, Avni YS, Singer D, et al. The prevalence of human

papillomavirus and cervical cytology abnormalities in women infected with human immunodeficiency

virus in southern Israel. The Israel Medical Association journal : IMAJ. 2011;13(1):34-8. PMid:21446234

Published

2022-03-08