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Monti E, Salmaso M, Alberico D, Emily Cetera G, Viscardi A, Boero V, Di Loreto E, Libutti G, Roncella E, Barbara G. Prevalence of high-grade anal intraepithelial neoplasia in immunocompetent women treated for high-grade cervical intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol 2023; 291:82-87. [PMID: 37852112 DOI: 10.1016/j.ejogrb.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the prevalence of high-grade anal intraepithelial neoplasia (AIN2-3) among immunocompetent women treated for high-grade cervical intraepithelial neoplasia (CIN2-3). Such knowledge is strongly needed to establish whether a screening program should be recommended in this group of patients. METHODS This prospective study included a cohort of consecutive women with no known causes of immunosuppression treated with LEEP (loop electrosurgical excision procedure) for a histopathological diagnosis of CIN2-3 in our center between 2019 and 2021. Following the procedure, all patients were invited to undergo anal cytology and anal high-risk HPV-DNA testing (aHPV-DNA). In cases in which one or both tests resulted positive, a high-resolution anoscopy with a biopsy of suspicious lesions was performed. All women also completed a questionnaire on sexual habits. RESULTS At total of 100 women were enrolled in the study. Among these, eight patients had a concomitant or past diagnosis of anogenital warts, while one patient had received a previous diagnosis of high-grade vaginal intraepithelial neoplasia. Anal Pap smears were positive for low-grade lesions in three patients, while 73 women tested positive for aHPV-DNA. Histological examinations revealed the presence of AIN2-3 lesions in four patients (6.5%; 95% C.I., 1.8 to 15.7%), who subsequently underwent excisional treatment. CONCLUSIONS Women with a history of high-grade cervical intraepithelial neoplasia have an intermediate risk of developing high-grade anal intraepithelial neoplasia. Future studies are needed in order to assess an ideal screening approach for this condition.
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Affiliation(s)
- Ermelinda Monti
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Marta Salmaso
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Daniela Alberico
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Anna Viscardi
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Giada Libutti
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Elena Roncella
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy.
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, via della Commenda 12, Milan, Italy.
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Anal Cancer in High-Risk Women: The Lost Tribe. Cancers (Basel) 2022; 15:cancers15010060. [PMID: 36612055 PMCID: PMC9817901 DOI: 10.3390/cancers15010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
In developed countries the incidence of anal squamous cell carcinoma (SCC) has been rising; especially in women over the age of 60 years who present with more advanced disease stage than men. Historically, anal SCC screening has focused on people living with Human Immunodeficiency Virus (HIV) (PLWH) who are considered to be at the highest risk of anal SCC, and its precancerous lesion, anal squamous intraepithelial lesion (SIL). Despite this, women with vulval high-grade squamous epithelial lesions (HSIL) and SCCs have been shown to be as affected by anal HSIL and SCC as some PLWH. Nevertheless, there are no guidelines for the management of anal HSIL in this patient group. The ANCHOR trial demonstrated that treating anal HSIL significantly reduces the risk of anal SCC in PLWH, there is therefore an unmet requirement to clarify whether the screening and treatment of HSIL in women with a prior genital HSIL is also beneficial. This review presents the current evidence supporting the screening, treatment, and surveillance of anal HSIL in high-risk women with a previous history of genital HSIL and/or SCC.
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Melo KMRL, Eleutério Junior J, Peixoto RAC, Rebouças KCF, Eleutério RMN. Anal High-risk HPV and Liquid-based Cytology of Immunocompetent Brazilian Women with Genital High-risk HPV. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:280-286. [PMID: 35139570 PMCID: PMC9948116 DOI: 10.1055/s-0042-1742405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the frequency of the occurrence of high-risk human papillomavirus (HPV) and abnormal anal cytology in immunocompetent women with and without HPV-induced genital lesions. METHODS This analytical cross-sectional, observational study was conducted between July 2017 and December 2018 in a specialized outpatient clinic of a tertiary hospital in Fortaleza, CE. Fifty-seven immunocompetent women with and without genital intraepithelial lesions were assessed; they were divided into two groups: group 1 was comprised of women with HPV-associated genital lesions (n = 26), and group 2 was comprised of those without HPV-associated genital lesions (n = 31). Samples for liquid-based cytology and high-risk DNA-HPV polymerase chain reaction real-time tests were collected from the cervix and anus. All cases were evaluated using high-resolution anoscopy; biopsies were performed when required. The Fisher exact and chi-squared tests were applied for consolidated data in the contingency table, and the Student t-test and Mann-Whitney U-test for independent variables. RESULTS Anal high-risk HPV infections were more frequent in group 1 (odds ratio [OR], 4.95; 95% confidence interval [CI], 1.34-18.3; p = 0.012), along with concomitant high-risk HPV infections in the uterine cervix and the anus (OR 18.8; 95% CI, 2.20-160; p < 0.001). The incidence of high-risk cervical HPV infection was associated with high-risk anal HPV infection (OR, 4.95; 95% CI, 1.34-18.3; p = 0.012). There was no statistical difference concerning abnormal anal cytology or anoscopy between the groups, and no anal intraepithelial lesion was found in either group. CONCLUSION Immunocompetent women with HPV-associated genital lesions and high-risk cervical HPV were more likely to have high-risk anal HPV.
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Affiliation(s)
| | - José Eleutério Junior
- Faculdade de Medicina, Departamento de Saúde Materno-Infantil, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Raquel Autran Coelho Peixoto
- Faculdade de Medicina, Departamento de Saúde Materno-Infantil, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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Albuquerque A, Godfrey MAL, Cappello C, Pesola F, Bowring J, Cuming T, De Masi A, Rosenthal AN, Sasieni P, Nathan M. Multizonal anogenital neoplasia in women: a cohort analysis. BMC Cancer 2021; 21:232. [PMID: 33676451 PMCID: PMC7937256 DOI: 10.1186/s12885-021-07949-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is currently a lack of information on full anogenital evaluation of women with a previous history of anogenital neoplasia. METHODS Retrospective analysis of the Homerton Anogenital Neoplasia Service records from January 2012 to March 2017, to identify all new referrals of women with previous anogenital neoplasia, who had had at least one complete examination of all anogenital sites. Multizonal anogenital disease (MZD) was defined as the presence of high-grade squamous intraepithelial lesions (HSIL)/carcinoma concurrently at two or more of the following sites/zones: perianus, anal canal, vulva, vagina or cervix. RESULTS 253 women were included, mean age was 47 (SD=15) years and median duration of follow-up was 12 (IQR=21) months. Fifty-six women (22%) were diagnosed with MZD at first assessment and/or during follow-up. Current smokers (RR=1.84, 95% CI 1.21-2.79, p=0.004) and women on immunodulators/immunosuppressive drugs (RR=2.57, 95% CI 1.72-3.86, p<0.001) had an increased risk for MZD. The risk was lower for women without a previous history of anogenital high-grade lesions/cancer compared to those with this history (RR=0.06, 95% CI 0.01-0.45, p=0.006). CONCLUSIONS Multizonal assessment was important to diagnose occult areas of disease and should be especially considered in current smokers, pharmacologically immunocompromised and those with a previous history of anogenital HSIL/cancer.
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MESH Headings
- Adult
- Anal Canal/diagnostic imaging
- Anal Canal/pathology
- Anal Canal/virology
- Anus Neoplasms/diagnosis
- Anus Neoplasms/epidemiology
- Anus Neoplasms/pathology
- Anus Neoplasms/virology
- Biopsy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/virology
- Cervix Uteri/diagnostic imaging
- Cervix Uteri/pathology
- Cervix Uteri/virology
- Colposcopy
- Female
- Follow-Up Studies
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/epidemiology
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/virology
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/virology
- Papillomavirus Infections/diagnosis
- Papillomavirus Infections/epidemiology
- Papillomavirus Infections/pathology
- Papillomavirus Infections/virology
- Retrospective Studies
- Tertiary Care Centers/statistics & numerical data
- Vagina/diagnostic imaging
- Vagina/pathology
- Vagina/virology
- Vulva/diagnostic imaging
- Vulva/pathology
- Vulva/virology
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Affiliation(s)
- Andreia Albuquerque
- Homerton Anogenital Neoplasia Service (HANS), Homerton University Hospital, London, UK.
| | - Michelle A L Godfrey
- Department of Obstetrics and Gynaecology, Queen Alexandra Hospital, Portsmouth, UK
| | - Carmelina Cappello
- Homerton Anogenital Neoplasia Service (HANS), Homerton University Hospital, London, UK
| | | | - Julie Bowring
- Homerton Anogenital Neoplasia Service (HANS), Homerton University Hospital, London, UK
| | - Tamzin Cuming
- Homerton Anogenital Neoplasia Service (HANS), Homerton University Hospital, London, UK
| | - Anke De Masi
- Homerton Anogenital Neoplasia Service (HANS), Homerton University Hospital, London, UK
| | - Adam N Rosenthal
- Homerton Anogenital Neoplasia Service (HANS), Homerton University Hospital, London, UK
- University College Hospital NHS Foundation Trust, London, UK
| | | | - Mayura Nathan
- Homerton Anogenital Neoplasia Service (HANS), Homerton University Hospital, London, UK
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Forbes CM, McCloskey J, Forbes GM. Opportunistic detection of anal intraepithelial neoplasia at colonoscopy. JGH Open 2020; 4:1207-1210. [PMID: 33319057 PMCID: PMC7731801 DOI: 10.1002/jgh3.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/26/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND AIM Human papilloma virus-associated anal intraepithelial neoplasia (AIN) precedes most anal cancers and can be detected at colonoscopy. We aimed to quantify AIN detection rates in a general population undergoing colonoscopy. METHODS A retrospective review of a community-based practice for 2 years until December 2019 was conducted. RESULTS A total of 2525 patients (1051 males and 1474 females; median age 59 years) had 2608 colonoscopies. Ten patients (two males and eight females; median age 57.5 years) had incidentally detected AIN (condyloma acuminatum or AIN1, n = 4; AIN2 or 3, n = 6). AIN was detected in 1 of 261 (95% CI 1/142-1/480) colonoscopies and 1 of 163 (95% CI 1/83-1/321) colonoscopies in women over 40 years old. CONCLUSIONS Opportunistically detecting AIN, especially in women over 40 years old, should be an important adjunct to colonoscopy-based colorectal neoplasia detection.
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Affiliation(s)
- Clara M Forbes
- School of Health and Medical SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Jenny McCloskey
- School of Health and Medical SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Department of Sexual HealthRoyal Perth HospitalPerthWestern AustraliaAustralia
| | - Geoffrey M Forbes
- School of Health and Medical SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
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Knight K, Al-Wahid M, Choong JX, Burton K, Lindsay R, McKee RF, Anderson JH, Roxburgh CS. Multidisciplinary management of anal intraepithelial neoplasia and rate of progression to cancer: A retrospective cohort study. Eur J Surg Oncol 2020; 47:304-310. [PMID: 32873453 DOI: 10.1016/j.ejso.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To describe the regional burden of AIN and rate of progression to cancer in patients managed in specialist and non-specialist clinic settings. METHODS Patients with a histopathological diagnosis of AIN between 1994 and 2018 were retrospectively identified. Clinicopathological characteristics including high-risk status (chronic immunosuppressant use or HIV positive), number and type of biopsy (punch/excision) and histopathological findings were recorded. The relationship between clinicopathological characteristics and progression to cancer was assessed using logistic regression. RESULTS Of 250 patients identified, 207 were eligible for inclusion: 144 from the specialist and 63 from the non-specialist clinic. Patients in the specialist clinic were younger (<40 years 31% vs 19%, p = 0.007), more likely to be male (34% vs 16%, p = 0.008) and HIV positive (15% vs 2%, p = 0.012). Patients in the non-specialist clinic were less likely to have AIN3 on initial pathology (68% vs 79%, p = 0.074) and were more often followed up for less than 36 months (46% vs 28%, p = 0.134). The rate of progression to cancer was 17% in the whole cohort (20% vs 10%, p = 0.061). On multivariate analysis, increasing age (OR 3.02, 95%CI 1.58-5.78, p < 0.001), high risk status (OR 3.53, 95% CI 1.43-8.74, p = 0.006) and increasing number of excisions (OR 4.88, 95%CI 2.15-11.07, p < 0.001) were related to progression to cancer. CONCLUSION The specialist clinic provides a structured approach to the follow up of high-risk status patients with AIN. Frequent monitoring with specialist assessments including high resolution anoscopy in a higher volume clinic are required due to the increased risk of progression to anal cancer.
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Affiliation(s)
- Katrina Knight
- Academic Unit of Colorectal Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 10 - 16 Alexandra Parade, Glasgow G31 2ER, Scotland, UK.
| | - Muhammed Al-Wahid
- Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Jia Xun Choong
- Undergraduate School of Medicine, Wolfson Medical School Building, University Avenue, Glasgow, G12 8QQ, Scotland, UK
| | - Kevin Burton
- Department of Gynaecological Oncology, Glasgow Royal Infirmary, PRMH Building, 16 Alexandra Parade, Glasgow, G31 2ER, Scotland, UK
| | - Rhona Lindsay
- Department of Gynaecological Oncology, Glasgow Royal Infirmary, PRMH Building, 16 Alexandra Parade, Glasgow, G31 2ER, Scotland, UK
| | - Ruth F McKee
- Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - John H Anderson
- Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Campbell Sd Roxburgh
- Academic Unit of Colorectal Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 10 - 16 Alexandra Parade, Glasgow G31 2ER, Scotland, UK
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Recommendations Favoring Anal Cytology as a Method for Anal Cancer Screening: A Systematic Review. Cancers (Basel) 2019; 11:cancers11121942. [PMID: 31817212 PMCID: PMC6966611 DOI: 10.3390/cancers11121942] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022] Open
Abstract
Clinicians are increasingly facing the decision of performing anal cancer screening in high-risk groups. Anal cytology is commonly the first approach. We systematically reviewed recommendations favoring anal cytology for anal cancer screening. Three databases were searched: PubMed, Scopus, and Embase, from January 2007 to 12 September 2019. The references cited by the retrieved articles and the websites of relevant organizations were also searched without language restrictions. Studies reporting guidelines from regional or national societies, institutes, or groups were included. Eight papers met the inclusion criteria and were selected, five were from the United States of America (USA) and three from Europe. There were no national recommendations published. There was one guideline specifically for solid-organ transplant recipients. The other seven targeted HIV-positive patients, with HIV-positive men who have sex with men (MSM) included as a screening group in all of these. Two recommendations favored screening in all HIV-positive patients. Five recommendations targeting HIV-positive patients made considerations about the cytology follow-up, recommending at least annual cytology in case of a normal result, and in case of squamous cytological abnormalities, a referral for anoscopy/high-resolution anoscopy. There were no recommendations for upper and lower age limits for screening. In conclusion, several societies recommend anal cancer screening using anal cytology in HIV-positive MSM patients. There is a lack of screening recommendations for other high-risk groups, with only one society recommending screening in transplant recipients.
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Albuquerque A, Sheaff M, Stirrup O, Cappello C, Bowring J, Cuming T, De Masi A, Rosenthal AN, Nathan M. Performance of Anal Cytology Compared With High-Resolution Anoscopy and Histology in Women With Lower Anogenital Tract Neoplasia. Clin Infect Dis 2019; 67:1262-1268. [PMID: 29659752 DOI: 10.1093/cid/ciy273] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/03/2018] [Indexed: 12/26/2022] Open
Abstract
Background Information on the performance of anal cytology in women who are high risk for human papillomavirus-related lesions and the factors that might influence cytology are largely lacking. Methods Retrospective study including all new referrals of women with a previous history of anogenital neoplasia from January 2012 to July 2017, with concomitant anal cytology and high-resolution anoscopy with or without biopsies. Results Six hundred and thirty six anal cytology samples and 323 biopsies obtained from 278 women were included. Overall sensitivity and specificity of "any abnormality" on anal cytology to predict any abnormality in histology was 47% (95% confidence interval [CI], 41%-54%) and 84% (95% CI, 73%-91%), respectively. For detecting high-grade squamous intraepithelial lesions (HSIL)/cancer, sensitivity was 71% (95% CI, 61%-79%) and specificity was 73% (95% CI, 66%-79%). There was a poor concordance between cytological and histological grades (κ = 0.147). Cytology had a higher sensitivity to predict HSIL/cancer in immunosuppressed vs nonimmunosuppressed patients (92% vs 60%, P = .002). The sensitivity for HSIL detection was higher when 2 or more quadrants were affected compared with 1 (86% vs 57%, P = .006). A previous history of vulvar HSIL/cancer (odds ratio [OR], 1.71, 1.08-2.73; P = .023), immunosuppression (OR, 1.88, 1.17-3.03; P = .009), and concomitant genital HSIL/cancer (OR, 2.51, 1.47-4.29; P = .001) were risk factors for abnormal cytology. Conclusions Women characteristics can influence the performance of anal cytology. The sensitivity for detecting anal HSIL/cancer was higher in those immunosuppressed and with more extensive disease.
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Affiliation(s)
- Andreia Albuquerque
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom.,Faculty of Medicine of the University of Porto, Portugal
| | - Michael Sheaff
- Cellular Pathology, Barts Health National Health Service Trust
| | - Oliver Stirrup
- Centre for Clinical Research in Infection and Sexual Heath, Institute for Global Health University College London, London, United Kingdom
| | - Carmelina Cappello
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Julie Bowring
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Tamzin Cuming
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Anke De Masi
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Adam N Rosenthal
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom.,University College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Mayura Nathan
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
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Díaz Del Arco C, García D, Sanabria C, Rodríguez Escudero E, Domínguez I, Sanz Ortega G, Fernández Aceñero MJ. Anal cytology in women: Experience from a single tertiary center. Pathol Res Pract 2019; 215:905-909. [PMID: 30718099 DOI: 10.1016/j.prp.2019.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/06/2019] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Anal cytology (AC) can be used as a screening tool for detection of anal HPV associated lesions, mainly in men who have sex with men and in immunosuppressed patients. Our aim is to review our experience with AC in women. MATERIAL & METHODS We have retrospectively reviewed all AC diagnosed between 2010-2017 in a single tertiary hospital (n = 644) and selected those performed in women (n = 158). RESULTS 24.53% of AC were performed in women. 14.7% of all women were HIV positive and 56.7% referred anal intercourse. Squamous lesions were found in 27.2% of women, most of them ASCUS and LSIL (14% and 11.5%). HPV DNA was detected in 38.6% of patients, and 63.9% of them showed positivity for multiple high-risk types. Anal biopsy showed high grade lesions in 20% of biopsied patients. We observed a significant relationship between HPV status and receptive anal sex, and the association between HPV status and anal histological diagnosis tended to significance. Sensitivity, specificity, negative predictive value and positive predictive value for anal cytology were 57%; 83%; 28% and 94%, respectively. 70.9% of women had synchronous cervical cytology, and squamous cervical lesions were detected in 46.4% of the cases, most of them LSIL or ASCUS (21.4% and 15.2%). We did not confirm a significant association between cytological diagnosis of cervical and anal samples. CONCLUSIONS AC is less widely used in women than in homosexual men. However, women show important rates of anal lesions, regardless of their HIV status. More studies should be performed to assess the potential impact of screening protocols in this population.
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Affiliation(s)
- C Díaz Del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Spain.
| | - D García
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
| | - C Sanabria
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
| | | | - I Domínguez
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Department of General and Gastrointestinal Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - G Sanz Ortega
- Department of General and Gastrointestinal Surgery, Hospital Clínico San Carlos, Madrid, Spain.
| | - M J Fernández Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Spain.
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Badoual C, Pavie J, Ménard M, Pernot S, Cochand-Priollet B, Hurel S, Péré H, Bats AS. [Multidisciplinary consultation for patients with HPV-related invasive carcinoma or precancerous lesions]. Cancer Radiother 2018; 22:487-491. [PMID: 30197024 DOI: 10.1016/j.canrad.2018.07.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
Given the recent increase in the number of human papillomavirus (HPV)-induced cancers in other locations than gynaecological, the number of patients with two cancers at distinct sites, and because of the lack of exhaustive data, we decided to create a multidisciplinary network around an HPV consultation at the Georges-Pompidou European Hospital (HEGP). This network aims to set up the best tools for detecting HPV-associated "multisite" precancerous lesions in order to determine the possible impact of dedicated care for this at-risk population. This monthly consultation was created at the HEGP in June 2014. It is currently organized around five consultations: gynaecological, ENT, urological, digestive and immunological. Every patient who has been diagnosed with HPV-related cancer and whose care is provided at the HEGP is offered this particular follow-up: systematically, once the initial lesion has been treated, the patient is convened annually for a day during which it benefits from the consultations mentioned above. A consultation with a psychologist is systematically proposed. Local samples are taken at each site: a cytological examination, the analysis of known predictive and prognostic virological markers are carried out. This study fits more broadly in a theme of clinical and fundamental research around cancers related to HPV.
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Affiliation(s)
- C Badoual
- Service d'anatomie pathologique, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France; Inserm U 970, équipe 10, PARCC, France.
| | - J Pavie
- Service d'immunologie clinique, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Ménard
- Service d'ORL et chirurgie cervico-faciale, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - S Pernot
- Service de hépato-gastro-entérologie et oncologie digestive, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - B Cochand-Priollet
- Service d'anatomie pathologique, faculté Paris-Descartes, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Hurel
- Service d'urologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - H Péré
- Laboratoire de virologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - A-S Bats
- Service de gynécologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
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Hillman RJ, Gunathilake MPW, Jin F, Tong W, Field A, Carr A. Ability to detect high-grade squamous anal intraepithelial lesions at high resolution anoscopy improves over time. Sex Health 2018; 13:177-81. [PMID: 26827158 DOI: 10.1071/sh15170] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Anal cancer is increasing in incidence, has very high rates in specific populations and shares many similarities with cervical cancer. High-grade squamous intraepithelial lesions (HSIL) are regarded as precursors to anal cancer. High resolution anoscopy (HRA), which is derived from colposcopy, is the only currently available tool that can identify areas of the anal canal for targeted biopsy and identification of HSIL. METHODS This study investigated the ability over a period of time of a single anoscopist to identify and adequately biopsy HSIL, correlating with contemporary anal cytological findings. RESULTS Four hundred paired cytology and histology samples collected from 283 patients over a 7-year period from 2004 to 2010 were compared. There was a significant increase in HSIL detection rates when anal squamous cells of undetermined significance (ASC-US; 38.6-66.0%) or low-grade squamous intra-epithelial lesion (38.8-68.3%) were taken as cut-off points (P<0.001 for both). Detection rates did not change significantly when atypical squamous cells-cannot exclude HSIL (ASC-H) or a higher grade lesion (70-76.6%) was taken as the cut-off point. CONCLUSIONS The increase in ability to detect histological HSIL over time and with increasing experience has the potential to impact on delivery of clinical services and the interpretation of clinical trial data. Further studies are required to determine the extent of this effect on other clinicians practising HRA.
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Affiliation(s)
- Richard J Hillman
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW 2150, Australia
| | - Manoji P W Gunathilake
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW 2150, Australia
| | - Fengyi Jin
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Winnie Tong
- Centre for Applied Medical Research - Clinical Research Program, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia
| | - Andrew Field
- Department of Anatomical Pathology, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia
| | - Andrew Carr
- Centre for Applied Medical Research - Clinical Research Program, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia
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12
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Heráclio SA, de Souza ASR, de Souza PRE, Katz L, Lima Junior SF, Amorim MMR. Cross-sectional study of anal intraepithelial lesions in women with cervical neoplasia without HIV. Int J Gynaecol Obstet 2017; 140:233-240. [PMID: 29080327 DOI: 10.1002/ijgo.12367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/22/2017] [Accepted: 10/27/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the prevalence of anal intraepithelial lesions and associated risk factors in women with cervical neoplasia. METHODS The present cross-sectional study enrolled patients with intraepithelial or invasive cervical neoplasia who had been referred to the lower genital tract pathology outpatient department of the Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil, between December 1, 2008, and December 31, 2009; patients with HIV infections were excluded. All participants underwent anal cytology and high-resolution anoscopy; sociodemographic and clinical risk factors were identified using multivariate analysis. RESULTS There were 324 patients included and 37 (11.4%) had anal intraepithelial neoplasia. Factors associated with anal intraepithelial neoplasia in the multivariate analysis were being older than 35 years of age (P=0.002), having completed no more than 4 years of education (P=0.012), anomalous anal cytology (P=0.003), and anomalous high-resolution anoscopy findings (P<0.001); subclinical HPV lesions on vulvoscopy (P=0.057) were not associated with anal intraepithelial neoplasia. CONCLUSION The prevalence of anal intraepithelial neoplasia was high among patients with cervical neoplasia who did not have HIV, particularly patients older than 35 years.
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Affiliation(s)
- Sandra A Heráclio
- Department of Pathology of the Lower Genital Tract, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Alex S R de Souza
- Department of Fetal Medicine and Ultrasonography, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Paulo R E de Souza
- Department of Biology, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Leila Katz
- Department of Women's Health, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Sergio F Lima Junior
- Department of Biology, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Melania M R Amorim
- Department of Women's Health, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
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13
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Stier EA, Chiao EY. Anal Cancer and Anal Cancer precursors in Women with a History of HPV-Related Dysplasia and Cancer. SEMINARS IN COLON AND RECTAL SURGERY 2017; 28:97-101. [PMID: 29204065 DOI: 10.1053/j.scrs.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The epidemiology of anal cancer in the U.S. has changed over the past 3 decades. During this period the incidence of anal cancer has increased among both men and women. Of note, women with a history of anogenital HPV infection are at higher risk than the general population for anal cancer. The increased risk ranged from increased incidence rate ratios ranging from 1.82 to 6.3 in women with a history of cervical cancer, to 4.2-16.4 in women with a history of prior cervical intraepithelial neoplasia 3 (CIN 3). In addition, studies describing screening women with a previous history of anogential HPV infection (including CIN 3) for anal HPV and anal pre-cancers demonstrate that the prevalence of anal HPV is measureable in this population. The prevalence of anal high grade squamous intraepithelial lesions (HSIL) in this population was relatively low, which may have been related to the fact that many of these studies had insufficient samples, and the numbers of patients undergoing HRA remain low. Future studies evaluating anal cancer screening strategies in this high-risk group are needed.
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Affiliation(s)
- Elizabeth A Stier
- Department of Obstetrics and Gynecology Boston University School of Medicine, Boston, MA
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14
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Simpson S, Blomfield P, Cornall A, Tabrizi SN, Blizzard L, Turner R. Front-to-back & dabbing wiping behaviour post-toilet associated with anal neoplasia & HR-HPV carriage in women with previous HPV-mediated gynaecological neoplasia. Cancer Epidemiol 2016; 42:124-32. [PMID: 27107173 DOI: 10.1016/j.canep.2016.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Anal cancer is a human papillomavirus (HPV)-mediated neoplasia of the anal squamous epithelium. Anal cancer is much more common among women, particularly those with a previous high-grade gynaecological neoplasia. METHODS Cross-sectional study of women with a previous HPV-mediated gynaecological neoplasia in Tasmania, Australia. Women presenting for follow-up gynaecological care had anal swab samples taken for anal cytology by Hologic Liquid ThinPrep, followed by HPV genotyping. Women with abnormal anal cytology were invited for high-resolution anoscopy. Potential risk factors, including post-toilet wiping behaviours, were queried by questionnaire while clinical covariates were extracted from medical records. Covariates of anal outcomes evaluated by log-binomial and log-multinomial regression. RESULTS From 163 women enrolled in the study, 65 (39.9%) had abnormal cytology, with 46 (28.2%) being high-grade. Of the 50 women with abnormal anal cytology having high-resolution anoscopy, 32 (64.0%) had abnormal histology with 13 (26.0%) being high-grade. Of the 123 women tested for HR-HPV DNA, 48 (39.0%) had HR-HPV detected, the most common genotypes being 16 and 51 (14/123, 11.4% for both). In addition to some known anal cancer risk factors, we found front-to-back wiping was associated with significantly increased (Prevalence ratio (PR) range: 1.99-3.60) prevalence of cytological and histological abnormality and HR-HPV carriage/co-carriage, while dabbing post-toilet was significantly associated with decreased prevalences (PR range: 0.50-0.62). CONCLUSIONS Post-toilet wiping behaviours were significantly associated with the prevalence of anal cytological, histological and HR-HPV carriage outcomes. This suggests a biologically plausible mechanism for HR-HPV introduction and the higher frequencies of anal neoplasia in women.
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Affiliation(s)
- Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Penny Blomfield
- Gynaecologic Oncology, Royal Hobart Hospital, Hobart, Australia; School of Medicine, University of Tasmania, Hobart, Australia
| | - Alyssa Cornall
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia
| | - Sepehr N Tabrizi
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Richard Turner
- School of Medicine, University of Tasmania, Hobart, Australia
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15
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Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review. Am J Obstet Gynecol 2015; 213:278-309. [PMID: 25797230 DOI: 10.1016/j.ajog.2015.03.034] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
Abstract
The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal human papillomavirus (HPV) infection, anal intraepithelial neoplasia, and anal cancer in women. We conducted a systematic review among publications published from Jan. 1, 1997, to Sept. 30, 2013, to limit to publications from the combined antiretroviral therapy era. Three searches were performed of the National Library of Medicine PubMed database using the following search terms: women and anal HPV, women anal intraepithelial neoplasia, and women and anal cancer. Publications were included in the review if they addressed any of the following outcomes: (1) prevalence, incidence, or clearance of anal HPV infection, (2) prevalence of anal cytological or histological neoplastic abnormalities, or (3) incidence or risk of anal cancer. Thirty-seven publications addressing anal HPV infection and anal cytology remained after applying selection criteria, and 23 anal cancer publications met the selection criteria. Among HIV-positive women, the prevalence of high-risk (HR)-HPV in the anus was 16-85%. Among HIV-negative women, the prevalence of anal HR-HPV infection ranged from 4% to 86%. The prevalence of anal HR-HPV in HIV-negative women with HPV-related pathology of the vulva, vagina, and cervix compared with women with no known HPV-related pathology, varied from 23% to 86% and from 5% to 22%, respectively. Histological anal high-grade squamous intraepithelial lesions (anal intraepithelial neoplasia 2 or greater) was found in 3-26% of the women living with HIV, 0-9% among women with lower genital tract pathology, and 0-3% for women who are HIV negative without known lower genital tract pathology. The incidence of anal cancer among HIV-infected women ranged from 3.9 to 30 per 100,000. Among women with a history of cervical cancer or cervical intraepithelial neoplasia 3, the incidence rates of anal cancer ranged from 0.8 to 63.8 per 100,000 person-years, and in the general population, the incidence rates ranged from 0.55 to 2.4 per 100,000 person-years. This review provides evidence that anal HPV infection and dysplasia are common in women, especially in those who are HIV positive or have a history of HPV-related lower genital tract pathology. The incidence of anal cancer continues to grow in all women, especially those living with HIV, despite the widespread use of combined antiretroviral therapy.
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Moscicki AB, Darragh TM, Berry-Lawhorn JM, Roberts JM, Khan MJ, Boardman LA, Chiao E, Einstein MH, Goldstone SE, Jay N, Likes WM, Stier EA, Welton ML, Wiley DJ, Palefsky JM. Screening for Anal Cancer in Women. J Low Genit Tract Dis 2015; 19:S27-42. [PMID: 26103446 PMCID: PMC4479419 DOI: 10.1097/lgt.0000000000000117] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV), and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goals were to summarize the literature on anal cancer, HSIL, and HPV infection in women and to provide screening recommendations in women. METHODS A group of experts convened by the American Society for Colposcopy and Cervical Pathology and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL, and anal cancer in women. RESULTS Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with human immunodeficiency virus-infected women and those with a history of lower genital tract neoplasia at highest risk compared with the general population. CONCLUSIONS While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and required to have digital anorectal examinations to detect anal cancers. Human immunodeficiency virus-infected women and women with lower genital tract neoplasia may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL.
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Affiliation(s)
- Anna-Barbara Moscicki
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Teresa M. Darragh
- Department of Clinical Pathology, University of California, San Francisco, CA, USA
| | | | | | - Michelle J. Khan
- Division of Women's Reproductive Healthcare Department of OB/GYN, School of Medicine, University of Alabama at Birmingham, AL, USA
| | - Lori A. Boardman
- Florida Hospital for Women, Florida Hospital System, University of Central Florida College of Medicine, FL, USA
| | - Elizabeth Chiao
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Mark H. Einstein
- Department of Obstetrics and Gynecology & Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY
| | | | - Naomi Jay
- Anal Neoplasia Clinic, Research and Education (ANCRE) Center, University of California, San Francisco, CA, USA
| | - Wendy M. Likes
- College of Medicine, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Mark Lane Welton
- Colon & Rectal Surgery, Stanford University School of Medicine Stanford Hospital and Clinics, Stanford, CA, USA
| | - Dorothy J. Wiley
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Joel M. Palefsky
- Department of Infectious Diseases, University of California, San Francisco, CA, USA
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Beltrão M, Wanderley MSO, de Santana NA, Bruneska D, de Lima Filho JL. Site of infections associated with human papillomavirus. Arch Gynecol Obstet 2014; 291:481-91. [PMID: 25245668 DOI: 10.1007/s00404-014-3480-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/12/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most clinically common sexually transmitted infection due to its carcinogenic power and the high number of lesions that it causes at different sites of the human body. MATERIAL AND METHODS Genital tract organs are the most common sites where the virus can be found, but by increasing the sensitivity of diagnostic technique, it is possible to identify viral presence in different regions of the body such as the stomach, the lung, and the urinary tract. These findings break with the traditional HPV skin/genital tropic profile and demonstrate that the virus is capable of infecting a wide variety of cells, tissues, and organs or can, at least, survive in these areas. The widespread presence of the HPV in the human body, often in latent form, led us to consider the hypothesis that HPV latency may be associated with no disease. CONCLUSION This observation raises further questions about the possibility of the virus not causing disease in specific sites of the human body, but rather, behaving like a commensal/opportunistic microorganism.
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Affiliation(s)
- Monique Beltrão
- Laboratory of Imunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235 Cidade Universitária, Recife, PE, CEP 50670-901, Brazil,
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de Parades V, Fathallah N, Barret M, Zeitoun JD, Lemarchand N, Molinié V, Weiss L. Néoplasies intra-épithéliales de l’anus. Presse Med 2013; 42:1091-9. [DOI: 10.1016/j.lpm.2012.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 07/31/2012] [Indexed: 11/30/2022] Open
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Coutlée F, de Pokomandy A, Franco EL. Epidemiology, natural history and risk factors for anal intraepithelial neoplasia. Sex Health 2013; 9:547-55. [PMID: 22954036 DOI: 10.1071/sh11167] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/07/2012] [Indexed: 01/02/2023]
Abstract
Studies conducted in HIV-seropositive individuals have enhanced our understanding of the natural history of anal intraepithelial neoplasia (AIN) and of factors predictive of progression to high-grade AIN, the immediate precursor to anal cancer. AIN is frequently detected in HIV-seropositive individuals. Factors that increase the risk for AIN include HIV infection, low current or nadir blood CD4+ cell counts, receptive anal intercourse, oncogenic human papillomavirus (HPV) infection, persistent anal HPV infection, multiple HPV type infections and high anal HPV viral load. This review confirms the importance of high-grade AIN in HIV-seropositive individuals and HIV-seronegative men having sex with men.
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Affiliation(s)
- François Coutlée
- Départements de Microbiologie et Infectiologie, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
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