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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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Rodrigues LLS, Pilotto JH, Martinelli KG, Nicol AF, De Paula VS, Gheit T, Oliveira NSC, Silva-de-Jesus C, Sahasrabuddhe VV, Da Silva DM, Kast WM, Hardick J, Gaydos CA, Morgado MG. Diversity of Anal HPV and Non-HPV Sexually Transmitted Infections and Concordance with Genital Infections in HIV-Infected and HIV-Uninfected Women in the Tapajós Region, Amazon, Brazil. Viruses 2023; 15:1328. [PMID: 37376627 PMCID: PMC10302924 DOI: 10.3390/v15061328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study was to classify the diversity of anal HPV and non-HPV sexually transmitted infections (STIs) and compare the concordance between anal and genital infections in HIV-infected and uninfected women living in the Tapajós region, Amazon, Brazil. A cross-sectional study was performed with 112 HIV-uninfected and 41 HIV-infected nonindigenous women. Anal and cervical scrapings were collected and analyzed for HPV, Chlamydia trachomatis (CT), Neisseria gonorrheae (NG), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), and Human alphaherpesvirus 2 (HSV-2). The Kappa test evaluated the concordance between anal and genital infections. The overall prevalence of anal HPV infection was 31.3% in HIV-uninfected and 97.6% in HIV-infected women. The most frequent anal high-risk HPV (hrHPV) types were HPV18 and HPV16 in HIV-uninfected women and HPV51, HPV59, HPV31, and HPV58 in HIV-infected women. Anal HPV75 Betapapillomavirus was also identified. Anal non-HPV STIs were identified in 13.0% of all participants. The concordance analysis was fair for CT, MG, and HSV-2, almost perfect agreement for NG, moderate for HPV, and variable for the most frequent anal hrHPV types. Thus, a high prevalence of anal HPV infection with moderate and fair concordance between anal and genital HPV and non-HPV STIs was observed in our study.
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Affiliation(s)
- Luana Lorena Silva Rodrigues
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Saúde Coletiva, Universidade Federal do Oeste do Pará, Santarém 68135-110, Brazil
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (J.H.P.); (C.S.-d.-J.)
- Programa de Pós-Graduação em Medicina Tropical, IOC-FIOCRUZ, Rio de Janeiro 21040-360, Brazil
| | - José Henrique Pilotto
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (J.H.P.); (C.S.-d.-J.)
| | | | - Alcina F. Nicol
- Instituto Nacional de Infectologia Evandro Chagas, INI-FIOCRUZ, Rio de Janeiro 21040-360, Brazil;
| | - Vanessa Salete De Paula
- Laboratório de Virologia Molecular e Parasitologia, IOC-FIOCRUZ, Rio de Janeiro 21040-360, Brazil;
| | - Tarik Gheit
- International Agency for Research on Cancer, 69366 Lyon, France;
| | | | - Carlos Silva-de-Jesus
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (J.H.P.); (C.S.-d.-J.)
| | | | - Diane M. Da Silva
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA; (D.M.D.S.); (W.M.K.)
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA
| | - W. Martin Kast
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA; (D.M.D.S.); (W.M.K.)
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA
- Department of Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA 90089, USA
| | - Justin Hardick
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.H.); (C.A.G.)
| | - Charlotte A. Gaydos
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.H.); (C.A.G.)
| | - Mariza Gonçalves Morgado
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (J.H.P.); (C.S.-d.-J.)
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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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Sánchez-Corredor CD, Guerrero-Machado M, Rubio-Romero JA, Ángel-Müller E, Rey-Serrano G, Díaz-Cruz LA. 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. ACTA ACUST UNITED AC 2020; 71:345-355. [PMID: 33515441 DOI: 10.18597/rcog.3558] [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: 06/12/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
| | - Mónica Guerrero-Machado
- Especialista en Obstetricia y Ginecología Universidad Nacional de Colombia; especialista en Cirugía Endoscópica Ginecológica, Fundación Universitaria de Ciencias de la SaludBogotáColombia
| | - Jorge Andrés Rubio-Romero
- Especialista en Ginecología y Obstetricia; magíster en Epidemiología Clínica. Profesor titular, Departamento de Obstetricia y GinecologíaUniversidad Nacional de Colombia, Bogotá (Colombia)
| | - Edith Ángel-Müller
- Especialista en Ginecología y Obstetricia. Profesora titular, Departamento de Obstetricia y GinecologíaUniversidad Nacional de Colombia, Bogotá(Colombia)
| | - Gustavo Rey-Serrano
- Especialista en Obstetricia y GinecologíaUniversidad Nacional de Colombia; magíster en Salud Sexual y Reproductiva, Universidad El Bosque, Bogotá (Colombia)
| | - Luz Amparo Díaz-Cruz
- Especialista en Ginecología y Obstetricia. Profesora asociada, Departamento de Obstetricia y GinecologíaUniversidad Nacional de Colombia, Bogotá (Colombia)
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Rubio-Romero JA, Díaz-Cruz LA. Precurso lesions of anal cancer in women: approach from the gynecologist perspective. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2020; 71:320-322. [PMID: 33515439 DOI: 10.18597/rcog.3646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Luz Amparo Díaz-Cruz
- Profesora Asociada Departamento de Obstetricia y Ginecología, Universidad Nacional de Colombia, Bogotá, Colombia
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Del Pino M, Martí C, Gaber J, Svanholm-Barrie C, Rodríguez-Carunchio L, Rodriguez-Trujillo A, Carreras N, Fuertes I, Barnadas E, Marimón L, Blanco JL, Persing DH, Torné A, Ordi J. mRNA Detection in Anal Cytology: A Feasible Approach for Anal Cancer Screening in Men Who Have Sex with Men Living With HIV. Diagnostics (Basel) 2019; 9:diagnostics9040173. [PMID: 31684110 PMCID: PMC6963475 DOI: 10.3390/diagnostics9040173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022] Open
Abstract
There is growing interest in anal cancer screening strategies. However, cytological/molecular evaluation of anal samples is challenging. We aimed to determine the feasibility of detecting, in anal liquid-based cytologies, the expression of biomarkers involved in the cell cycle disturbance elicited by human papillomavirus (HPV). The accuracy of this approach in the identification of high-grade squamous intraepithelial lesions/anal intraepithelial neoplasia grade2-3 (HSIL/AIN2-3) was also evaluated. 215 anal cytologies from men having sex with men living with human immunodeficiency virus were evaluated. Patients showing concordant cytological and anoscopy-directed biopsy diagnosis were selected: 70 with negative cytology and HPV test, 70 with low-grade SIL (LSIL/AIN1) cytology and biopsy, and 75 with cytology and biopsy of HSIL/AIN2-3. CDKN2A/p16, MKI67 and TOP2A mRNA expression was analyzed. HPV detection was performed with Xpert HPV Assay (Cepheid, Sunnyvale, CA, USA). HSIL/AIN2-3 showed higher expression for the biomarkers than LSIL/AIN1 or negative samples. The specificity for HSIL/AIN2-3 detection for a sensitivity established at 70% was 44.7% (95%confidence interval [CI] 36.5-53.2) for TOP2A and MKI67 and 54.5% (95%CI 46.0-62.8%) for CDKN2A/p16. mRNA detection of cell biomarkers in anal liquid-based cytology is feasible. Further studies are warranted to confirm if strategies based on mRNA detection have any role in anal cancer screening.
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Affiliation(s)
- Marta Del Pino
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Cristina Martí
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | | | | | | | - Adriano Rodriguez-Trujillo
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Núria Carreras
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Irene Fuertes
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
| | - Esther Barnadas
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.
| | - Lorena Marimón
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.
| | - Jose Luis Blanco
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
| | | | - Aureli Torné
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Jaume Ordi
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.
- Institut de Salut Global de Barcelona (ISGlobal), 08036 Barcelona, Spain.
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