Del Priore G, Gilmore P R, Maag T, Warshal D P, Cheon T H
Department of Obstetrics and Gynecology, New York University School of Medicine, New York, USA.
J Reprod Med. 1996 Sep;41(9):653-7.
To compare the discrepancy between colposcopically directed punch biopsy and excisional cone biopsy in human immunodeficiency-positive (HIV+) vs. HIV-negative (HIV-) women.
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/mm3, 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.
Disagreement between punch biopsy and cone histology was evident in 41% (12/29) of HIV+ patients and 48% (15/31) of seronegative women (chi 2, P = .78). The cone specimen had a higher grade lesion than the punch 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 (chi 2, P = .01).
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.
比较在人类免疫缺陷病毒阳性（HIV+）和HIV阴性（HIV-）女性中，阴道镜引导下的穿刺活检与切除性锥形活检结果的差异。
我们对阴道镜穿刺活检异常后接受切除性锥形活检的女性进行了病例对照分析。比较了29例HIV+（平均CD4 = 251个细胞/mm³，10例患有获得性免疫缺陷综合征）和31例HIV-女性的穿刺活检和锥形活检组织学结果。仅纳入没有先前宫颈发育异常治疗史、阴道镜检查满意且宫颈细胞学涂片与阴道镜活检结果一致的患者。
HIV+患者中41%（12/29）、血清阴性女性中48%（15/31）的穿刺活检和锥形活检组织学结果存在差异（卡方检验，P = 0.78）。在38%（11/29）的HIV+患者和32%（10/31）的血清阴性女性中，锥形活检标本的病变分级高于穿刺活检（P = 0.65）。总体而言，穿刺活检显示有HPV、宫颈上皮内瘤变（CIN）I或II的患者，30%的锥形活检为CIN III（HIV+女性5/23例，HIV-女性9/23例，P = 0.2）。在穿刺活检有HPV或CIN I的HIV+女性中，50%（9/18，95%置信区间26 - 74%）的切除性锥形活检为CIN II或III，而HIV-患者为18%（2/11）（Fisher检验，P = 0.13）。然而，在锥形活检为CIN II或III的HIV+患者中，47%（9/19）的穿刺活检仅为CIN I或人乳头瘤病毒，而HIV-患者为9%（2/22）（卡方检验，P = 0.01）。
在HIV+和HIV-患者中，阴道镜引导下的穿刺活检对锥形活检组织学结果的预测能力较差。根据置信区间，尽管阴道镜检查满意，但穿刺活检为CIN I的HIV+女性中，至少26%且多达74%的患者在锥形活检时可能有明显更严重的病变。虽然在免疫功能正常的女性中可能观察到CIN I，但由于HIV+女性有更高级别病变的可能性，对其进行观察可能不合理。
