Diagnostic Agreement between Manual Liquid-Based Cytology and Histopathology among HIV-Positive Women at Machakos Level 5 Hospital, Kenya
Onesmus Muia Mutuku *
Department of Medical Laboratory Sciences, School of Health Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya.
Scholastica Gatwiri Mathenge
Department of Medical Laboratory Sciences, School of Health Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya.
Titus Kamau Karuga
Department of Medical Laboratory Sciences, Karatina University, P.O. BOX 1957—10101, Karatina, Kenya.
Kyama Cleophas Mutinda
Department of Medical Laboratory Sciences, School of Biomedical Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya.
*Author to whom correspondence should be addressed.
Abstract
Aims: This study assessed the diagnostic agreement between manual liquid-based cervical cytology (MLBC) and histopathology among HIV-positive women attending Machakos Level 5 Hospital, Kenya.
Study Design: A prospective comparative cross-sectional study.
Place and Duration of Study: The study was conducted at the Comprehensive Care Centre, Machakos Level 5 Hospital, Machakos County, Kenya, between July and December 2020.
Methodology: The study included 400 HIV-positive women attending the Comprehensive Care Centre. Cervical specimens were collected and processed using the manual liquid-based cytology technique. Cytological examination was performed by the principal investigator, while all abnormal smears were reviewed by a pathologist. Participants with cytological findings of high-grade squamous intraepithelial lesions or worse were referred for biopsy and histopathological examination. Cohen's kappa statistic was used to assess the level of agreement between manual liquid-based cervical cytology and histopathological findings.
Results: Of the 400 women evaluated, 385 had satisfactory cytological specimens, while 15 (3.8%) were unsatisfactory. Cervical cytological abnormalities were detected in 30 (7.8%) women. Ten women with high-grade cytological abnormalities or worse were referred for biopsy and histopathological examination. Histopathology revealed CIN 2 in 4 (40%) women, CIN 3 in 3 (30%), squamous cell carcinoma in 2 (20%), and chronic cervicitis in 1 (10%). The agreement between manual liquid-based cervical cytology and histopathology was moderate (Cohen’s κ = 0.574; 95% CI: 0.41–0.60; p = 0.11), with a contingency coefficient of 0.689.
Conclusion: Manual liquid-based cervical cytology demonstrated moderate diagnostic agreement with histopathology among HIV-positive women. The technique may provide a practical and potentially useful cervical cancer screening approach in resource-limited settings where automated liquid-based cytology is less accessible.
Keywords: Manual liquid-based cytology, cervical cytology, histopathology, diagnostic agreement, cervical intraepithelial neoplasia, squamous cell carcinoma, cervical cancer screening, HIV-positive women, resource-limited settings