Abnormal anal cytology risk in women with known genital squamous intraepithelial lesion

The analysis of anal cytology positivity in women with pathological cervical cytology

Objective: Cervical cytology (CC) is a routine screening method used to reduce cervical cancer. Although anal cancer and cervical cancer have similar etiological factors the opinion about the anal cancer screening program is unclear. We aimed to determine the features of women with abnormal anal cytology (AC) who had screened via CC for cervical neoplasia. Methods: Two hundred and five females' CC results were investigated. The patients with normal CC were excluded, finally 87 participants were included. The demographics, medical, sexual, and reproductive features, CC and AC results were analyzed. Results: The study group had a mean age of 40.77 ± 9.50 years. AC was pathological in six patients (6.9%). Four of these (66.7%) were high-grade squamous intraepithelial lesions (HSIL) and two (33.3%) were low-grade squamous intraepithelial lesions (LSIL). The CC results of these patients were all HSIL, all of them were human papillomavirus (HPV) positive, with the most common type being 16 (83.3%). Conclusion: Women with HSIL in CC (especially with concomitant HPV) may be riskier for AC positivity. The others are most likely to have negative AC results. The use of AC for early diagnosis of risky anal intraepithelial lesions (such as a screening tool) may be considered for this group of patients.

Cytology-based Screening for Anal Intraepithelial Neoplasia in Immunocompetent Brazilian Women with a History of High-Grade Cervical Intraepithelial Neoplasia or Cancer

OBJECTIVE

 To determine the prevalence and possible variables associated with anal intraepithelial neoplasia and anal cancer in immunocompetent women with high-grade cervical intraepithelial neoplasia.

METHODS

 A cross-sectional study involving immunocompetent women with a histological diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, conducted between January 2016 and September 2020. All women underwent anal cytology and answered a questionnaire on characterization and potential risk factors. Women with altered cytology were submitted to anoscopy and biopsy.

RESULTS

 A total of 69 women were included in the study. Of these, 7 (10.1%) had abnormal anal cytology results: (high-grade lesion, atypical squamous cells of undetermined significance, and atypical squamous cells, cannot exclude high-grade lesions: 28,5% each; low grade lesion: 14,3%). Of the anoscopies, 3 (42.8%) showed alterations. Of the 2 (28,5% of all abnormal cytology results) biopsies performed, only 1 showed low-grade anal intraepithelial neoplasia. The average number of pregnancies, vaginal deliveries, and abortions was associated with abnormal anal cytology. However, the highest mean regarding the cesarean sections was associated with normal cytology.

CONCLUSION

 The prevalence of anal intraepithelial neoplasia was compatible with data from recent studies, especially those conducted in Brazil. Opportunistic screening for anal intraepithelial neoplasia in this high-risk population should be considered. Anal cytology is suitable for this purpose, due to its low cost and feasibility in public health services.

Anal High-risk HPV and Liquid-based Cytology of Immunocompetent Brazilian Women with Genital High-risk HPV

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.

Prevalence of Abnormal Anal Cytology in Women with Abnormal Cervical Cytology

OBJECTIVE

The aim of this study was to evaluate the prevalence of abnormal anal cytology in women presenting with abnormal cervical cytology (intraepithelial lesion or cervical cancer) at the largest tertiary university hospital in Thailand.

METHODS

A cross-sectional prospective study design was used. Anal cytology was performed on 145 women with abnormal cervical cytology between June 2014-Octoble 2014. If abnormal anal cytology was detected, anoscopy was performed with biopsy in any suspicious area of precancerous change.

RESULTS

Prevalence of abnormal anal cytology was 5.5% (8 patients). Of 8 patients, six patients presented with low-grade squamous intraepithelial lesion, one patient with high-grade squamous intraepithelial lesion, and one with atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion. Abnormal anoscopic impression was found in 3 cases, as follow: The first case showed faint acetowhite lesion and anoscopic impression was low grade squamous intraepithelial lesion; the second case was reported as human papillomavirus (HPV) change by anoscopic impression; and the third case showed dense acetowhite lesion with multiple punctation and pathologic examination showed anal intraepithelial neoplasm III (AIN3). The last patient underwent wide local excision of AIN3 with split-thickness skin graft reconstruction. Final pathology confirmed AIN3 with free resection margin.

CONCLUSION

Prevalence of abnormal anal cytology was 5.5%  in patients with abnormal cervical cytology. The prevalence might be support anal cytology screening in this group of patients.

Prevalence of high-risk human papilloma virus infection and abnormal cytology of the anal transformation zone in women with cervical dysplasia. Bogotá, Colombia, 2017-2019

OBJECTIVE

To determine the prevalence of anal infection caused by high risk human papilloma virus (HR-HPV) and of abnormal anal cytology in women with confirmed cervical dysplasia.

METHODS

Cross sectional study that included patients between 30 and 65 years of age with a new diagnosis of cervical dysplasia by histopathology attended in two lower genital tract colposcopy and pathology units (one public and one private institution), conducted between December 2017 and April 2019. Women with human immunodeficiency virus (HIV) infection, immune compromise (use of steroids, transplant, chemo therapy), pregnancy or anorectal malformations were excluded. Consecutive sampling. Socio demographic variables, intercourse type, degree of cervical dysplasia, positive results of HR HPV Polymerase Chain Reaction test in anal canal and HR - HPV type indentified (16-18 or others) were evaluated. Descriptive statistics were used.

RESULTS

Of 188 candidates, 100 were included in the analysis. A 32 % prevalence of high-risk HPV infection and a 2.8 % prevalence of abnormal cytology in the anal canal (ASCUS) were found. Of the HR-HPV infections in the anal canal, 68.8 % corresponded to HR-HPV genotypes different from 16 or 18.

CONCLUSIONS

Prevalence of HR HPV infection in women with lower genital tract dysplasia was 32%. It is important to determine the usefulness of screening for anal mucosa compromise by HPV virus associated with a high risk of cancer in women with cervical dysplasia. Studies are needed on the prognosis of anal HR-HPV infection in women with cervical dysplasia.

The Diagnostic Value of p16/Ki67 Dual Immunostaining for Anal Intraepithelial Neoplasia: A Meta-Analysis

The p16/Ki67 dual immunostaining was performed on anal cytology specimens; this is an anal cancer screening method. A literature search was performed in the BioMed Central, Cochrane Library, Embase, Google Scholar, and PubMed electronic databases for relevant articles. We included studies that discussed the efficacy of p16/Ki67 dual immunostaining for detecting anal intraepithelial neoplasia (AIN). Studies that calculated the diagnostic efficacy on a per-patient basis were included. We excluded review articles, case series, and studies that did not provide sufficient information. We extracted data on true positive, true negative, false positive, and false negative from the included studies to generate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). All analyses were performed with a random-effects model using MetaDiSc 1.4 and MetaDTA. The meta-analysis produced a pooled sensitivity of 0.63 (95% CI: 0.34, 0.86) and specificity of 0.65 (95% CI: 0.46, 0.81) for p16/Ki67 dual immunostaining in detecting AIN. The pooled DOR was 3.26 (95% CI: −0.29, 6.82). A subgroup analysis of HIV-infected men who have sex with men (MSM) demonstrated a pooled sensitivity of 0.75 (95% CI: 0.28, 0.96). p16/Ki67 dual immunostaining might have a higher sensitivity for detecting AIN in HIV-infected MSM. p16/Ki67 dual immunostaining might be more sensitive in HIV-infected MSM and has higher specificity compared to human papillomavirus testing among this high-risk group. p16/Ki67 dual immunostaining might be an adjuvant and potential triage test for anal cytology in anal cancer screening.

Evaluation of Anal Cytology in Women with History of Abnormal Pap Smear, Cervical Intraepithelial Neoplasia, Cervical Cancer and High Risk HPV for Anogenital Dysplasia

Background: Anal cancer is uncommon. Although uncommon, the incidence of anal cancer has increased among the general population of the United States and other countries over the past 30 years. We evaluated anal cytology in women with the history of abnormal pap smear, cervical intraepithelial neoplasia, cervical cancer and high risk HPV for anogenital dysplasia. Methods: In this cross-sectional study, 153 patients over the age of 21 years, referred to Imam Hossein Hospital in 1395-1396 who were being monitored due to abnormal pap smear, cervical cancer, CIN and high risk HPV, were evaluated with anal cytology for anogenital dysplasia. Results: 153 patients were enrolled in four main groups. Among those with a history of abnormal pap smear (39 patients), only 25% of the patients with HSIL had abnormal anal pap smear, and the rest of them had negative anal smear. Among those with a history of CIN (61 patients), patients with CIN III, 30.8% had abnormal anal smear, while the rest had a negative anal smear. Among those with a high risk of HPV (23 patients), 50% of the patients with concurrent positive HPV 16 and 18 had anal abnormal smear. Patients with a history of cervical cancer (30 patients) who had radiotherapy with or without surgery showed a negative anal smear. The ratio of anal SIL positive of individuals with a sexual partner was only 1.9%, while this ratio was 27.3% for those with more than one partner and this difference was statistically significant (P <0.0001). 15.4% of smokers had positive anal SIL test result, while, only 2.9% non-smokers had the same result, and this difference was statistically significant (P = 0.03). 20% of the patients who had anal intercourse showed a positive anal SIL score result, compared to 1% for those who did not. This difference was statistically significant (P <0.0001). Conclusion: Among people with a history of abnormal cervical pap smear, CIN, cervical cancer and high-risk HPV during the last 6 months, abnormal anal tests are most commonly seen in patients who had risk factors such as anal sex, cigarette, multi partner etc. with high grade interepithelial squamous cervix such as HSIL, CIN III, HPV 16 and 18; more studies in larger sample size are needed to have the better conclusion.