Cancer Cytopathology； December 2014, Volume 122, Issue 12
Women who are infected with the human immunodeficiency virus (HIV) are at high risk of human papillomavirus-persistent infections. Invasive cervical cancer is listed among the illnesses associated with the acquired immunodeficiency syndrome. The objective of the current study was to investigate whether, in South Africa, the accuracy of abnormal cytology confirmed by a histological diagnosis using loop electrosurgical excision procedure (LEEP) is affected by knowledge of the woman's HIV serostatus.
Of 7648 biopsy specimens, 941 were LEEPs indicated by a cytology report of low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion. A total of 618 specimens (65.7%) were from HIV-uninfected women and 323 specimens (34.3%) were from HIV-infected women. Those women with an unknown pre-LEEP cytological diagnosis were excluded from the study.
The total prevalence of HIV infection among the 7648 patients was 18.6%, reflecting its prevalence in the general population of women aged 15 to 49 years. The rate of HIV infection among 3462 women with invasive cervical cancer was 10.7%. The overall prevalence of preinvasive lesions was 73.9% in HIV-infected women compared with 50.3% in women not infected with HIV (P<.0001). The concordance and discordance rates between cytology and histology were similar in uninfected and infected women (P =.93 and P =.18, respectively). Among HIV-infected women, 79.1% of discordant results were due to cytological overdiagnosis; among HIV-negative women, 86.5% of discordant results were due to underdiagnosis (P<.0001).
It appears that the finding of a higher prevalence of preinvasive lesions combined with the knowledge of a patient's HIV-positive serostatus prompts more cytological overdiagnosis, thereby resulting in avoidable LEEP interventions.
人類免疫缺陷病毒（HIV）感染是女性持續感染人乳頭瘤病毒的高危因素。獲得性免疫缺陷症候群相關疾病中包括浸潤性宮頸癌。本研究的目的旨在研究南非人群中，經電套圈外科切除（LEEP）、組織學診斷證實的細胞學診斷異常準確性是否受女性HIV感染狀況的影響。
7648例活檢病例中，941例為細胞學報告為低級別鱗狀上皮內病變或高級別鱗狀上皮內病變的LEEP標本。其中有未感染HIV女性618例（65.7%），感染HIV的女性323例（34.3%），在LEEP前未進行細胞學診斷者排除出本研究範圍。
7648例中HIV感染率為18.6%，在普通人群中，女性患病年齡為15-49歲。3462例浸潤性宮頸癌中HIV感染率為10.7%。HIV感染者與HIV未感染者癌前病變整體患病率分別為73.9%和50.3% (P<.0001)。未感染和感染HIV女性的細胞學與組織學診斷的一致率與不一致率相似 (分別為P =0.93和 P =0.18)。HIV感染女性的診斷不一致結果中，79.1%是由於細胞學過診斷，HIV陰性女性的診斷不一致結果中，86.5%是由於細胞學診斷不足 (P<.0001)。
本研究發現，患者血清學HIV陽性時會導致細胞學過診斷，從而出現高比例的癌前病變，因此導致了不必要的LEEP。