Comparing cytology, colposcopy and human papillomavirus cervical intraepithelial lesion screening methods in women with systemic lupus erythematosus

• Published in: Lupus Vol. 29; no. 9; pp. 1060 - 1066
• Main Authors: García-Carrasco, Mario, Mendoza-Pinto, Claudia, Méndez-Martínez, Socorro, Rodríguez-Reyes, Ariadna, Munguía-Realpozo, Pamela, Taboada-Cole, Alejandro, Vallejo-Ruiz, Verónica, Etchegaray-Morales, Ivet, Jiménez-Herrera, Rebeca, Juárez-Melchor, Daniela, Villanueva-López, Isaí
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.08.2020; Sage Publications Ltd
• Subjects: Adult; Alphapapillomavirus; Biopsy; Carcinoma, Squamous Cell - pathology; Cellular biology; Cervical cancer; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - virology; Colposcopy; Confidence intervals; Cytology; DNA, Viral - isolation & purification; Female; Human papillomavirus; Humans; Lesions; Lupus; Lupus Erythematosus, Systemic - complications; Mass Screening - methods; Mexico; Middle Aged; Papanicolaou Test; Papillomavirus Infections - diagnosis; Predictive Value of Tests; Sensitivity and Specificity; Systemic lupus erythematosus; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - virology; Vaginal Smears; Mexico; cervical squamous intraepithelial lesions; cytology; Systemic lupus erythematosus; cervical pathology
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203320931176

Objective To compare the performance of cytology, colposcopy and human papillomavirus in detecting cervical intraepithelial lesions in women with systemic lupus erythematosus. Methods Papanicolaou smears (normal, low-grade squamous intraepithelial lesion, high grade squamous intraepithelial lesion), colposcopy findings, human papillomavirus and co-testing (Papanicolaou smear + human papillomavirus) were compared with cervical biopsy findings in women with systemic lupus erythematosus. Sensitivity, specificity, false-positive and false-negative rates, positive and negative predictive values and likelihood ratios of cytologic smears, colposcopy findings, human papillomavirus and co-testing were determined. Results Cytology and colposcopy were performed in 170 systemic lupus erythematosus women (mean age and disease duration of 43.7±12.1 years and 9.7±5.3 years, respectively) and biopsies were performed in 55 patients (38.2% normal, 60.0% low-grade squamous intraepithelial lesion and 1.8% high grade squamous intraepithelial lesion). The sensitivity, specificity, positive predictive value and negative predictive value of cytology were 14.7% (95% confidence interval 5.5–31.8%), 95.2% (95% confidence interval 74.1–99.7%), 83.3% (95% confidence interval 36.4–99.1%) and 40.8% (95% confidence interval 27.3–55.7%), respectively. The sensitivity, specificity and positive predictive value of colposcopy findings were 100.0% (95% confidence interval 87.3–100.0%), 0.0% (95% confidence interval 0.0–19.2%) and 61.8% (95% confidence interval 47.7–74.2%), respectively. The sensitivity and specificity of co-testing were 8.0% (95% confidence interval 1.3–27.5%) and 100.0% (95% confidence interval 71.6–100.0%). The positive predictive value and negative predictive values were 100.0% (95% confidence interval 19.7–100.0%) and 36.1% (95% confidence interval 33.5–38.8%), respectively. Conclusions In systemic lupus erythematosus patients, colposcopy impressions were more sensitive than cytology and co-testing. However, cytology and co-testing were the most specific tests. The results should be interpreted with caution due to the small sample size.