Diagnostic Agreement between Manual Liquid-Based Cytology and Histopathology among HIV-Positive Women at Machakos Level 5 Hospital, Kenya

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.