Anal Intraepithelial Neoplasia in Women With Genital Intraepithelial Neoplasia

Santoso, Joseph T.; Long, Mary M.; Crigger, Mary; Wan, Jim Y.; Haefner, Hope K.

doi:10.1097/aog.0b013e3181ea1834

Cited by 76 publications

(82 citation statements)

References 16 publications

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“…Risk factors for developing anal cancer, in both men and women, include anogenital human papillomavirus infection, anal receptive intercourse, multiple sexual partners, history of sexually transmitted disease, immunosuppression, and history of anal condyloma. Women with anal cancer are likely to have a prior history of cervical intraepithelial neoplasia or cervical carcinoma [4,5].Palefsky reported the sensitivity of anal cytology for detection of biopsy-proven AIN to be 69% in HIV-positive and 47% in HIV-negative men [6]. However, our study and others suggest that anal cytology is not a sensitive method for screening for AIN [5].…”

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confidence: 59%

Section: Introductionmentioning

confidence: 99%

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Keratosis reduces sensitivity of anal cytology in detecting anal intraepithelial neoplasia

ElNaggar

Santoso

Xie

2012

Gynecologic Oncology

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Objective. To identify factors that may contribute to poor sensitivity of anal cytology in contrast to the sensitivity of anoscopy in heterosexual women. Methods. We analyzed 324 patients with biopsy confirmed diagnosis of genital intraepithelial neoplasia (either vulva, vaginal, or cervical) from 2006 to 2011 who underwent both anal cytology and anoscopy. Cytology, anoscopy, and biopsy results were recorded. Biopsy specimens underwent independent analysis for quality of specimen. Also, biopsy specimens were analyzed for characteristics that may contribute to correlation, or lack thereof, between anal cytology and anoscopic directed biopsy.Results. 133 (41%) patients had abnormal anoscopy and underwent directed biopsy. 120 patients with normal anal cytology had anoscopy directed biopsies, resulting in 58 cases of AIN (sensitivity 9.4%; 0.039-0.199). This cohort was noted to have extensive keratosis covering the entire dysplastic anal lesion. 18 patients yielded abnormal anal cytology. Of these patients, 13 had anoscopic directed biopsies revealing 6 with AIN and absent keratosis (specificity 88.6%; 0.78-0.95). The κ statistic for anal cytology and anoscopy was −0.0213 (95% CI = −0.128-0.086).Conclusion. Keratosis reduces the sensitivity of anal cytology. Furthermore, anal cytology poorly correlates with anoscopy in the detection of AIN (κ statistic = −0.0213).© 2011 Elsevier Inc. All rights reserved. IntroductionThe National Cancer Institute estimates that 5,260 new cases of anal cancer were made in 2010. This constitutes a near doubling in the anal cancer rate over the past 10 years. The recently released Surveillance Epidemiology and End Results (SEER) report cites a statistically significant rise in the annual percentage change (APC) of 2.4 from 1992 to 2008 [1].Conversely, cervical cancer APC over the same time period is −2.7, largely attributable to improved screening modalities and guidelines [1]. Routine Pap smear screening has reduced the incidence of cervical cancer from 40 per 100,000 to 8 per 100,000. Because of this success, some have advocated anal intraepithelial neoplasia (AIN) screening using anal cytology at least in certain high risk population [2,3]. Risk factors for developing anal cancer, in both men and women, include anogenital human papillomavirus infection, anal receptive intercourse, multiple sexual partners, history of sexually transmitted disease, immunosuppression, and history of anal condyloma. Women with anal cancer are likely to have a prior history of cervical intraepithelial neoplasia or cervical carcinoma [4,5].Palefsky reported the sensitivity of anal cytology for detection of biopsy-proven AIN to be 69% in HIV-positive and 47% in HIV-negative men [6]. However, our study and others suggest that anal cytology is not a sensitive method for screening for AIN [5]. In our previous study, we evaluated 205 patients with genital dysplasia for both anal cytology and colposcopy. Anal cytology had a sensitivity of 8% and specificity of 94% in the diagnosis of AIN when compared to biopsy....

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contrasting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Keratosis reduces sensitivity of anal cytology in detecting anal intraepithelial neoplasia

ElNaggar

Santoso

Xie

2012

Gynecologic Oncology

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“…6 Women with multicentric lower genital tract squamous intraepithelial neoplasia are also at increased risk to develop anal intraepithelial and invasive lesions. 7 Although anal cancer is rare, its incidence in HIVpositive MSM is alarmingly high and continues to increase. Before the HIV pandemic, the incidence of anal cancer in MSM 8 was approximately 35 per 100,000-a rate similar to that of cervical cancer before the initiation of Pap test screening.…”

Section: Epidemiology and Pathogenesis Of Anal Cancermentioning

confidence: 99%

Anal cancer and cervical cancer screening: Key differences

Darragh

Winkler

2010

Cancer Cytopathology

191

203

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Cervical cancer and anal cancer share many similarities including causation by oncogenic human papillomaviruses; however, significant differences exist in their epidemiology, risk factors, biologic behavior, management, and treatment. Although rare, the incidence of anal cancer is alarmingly high and continues to increase in high-risk populations, particularly men who have sex with men regardless of their human immunodeficiency virus (HIV) status. There are no national screening guidelines for anal cancer. Using the success of cervical cancer screening as a model, anal cancer screening approaches apply anal cytology, highresolution anoscopy, and directed biopsy to guide treatment and management strategies. Although much has been learned about the natural history and epidemiology of anal intraepithelial neoplasia (AIN), the rate of progression of high-grade anal intraepithelial neoplasia (HGAIN) to invasive squamous cell carcinomas is not known. The impact of screening and treatment of HGAIN on morbidity and mortality from anal cancer are also unknown. Because the incidence of HGAIN and anal squamous cell carcinoma continue to increase, it is imperative to find pathways for effective screening, early detection, and therapeutic intervention. This article provides an overview of anal cancer screening while highlighting its differences from cervi- Compared with cervical cancer, anal cancer is rare. The National Cancer Institute estimates that 5260 patients will be diagnosed with anal cancer in 2010 and that 720 men and women will die of the disease. 1 Compare this to cervical cancer statistics in the United States for 2010: 12,200 will be diagnosed with cervical cancer and 4210 women will die and this is with successful opportunistic Papanicolaou (Pap) testing to screen for this cancer in the United States. Yet, in patients with the highest risk of anal cancer, its incidence was more than double that of cervical cancer prior to the initiation of Pap screening and is increasing, while rates for cervical cancer continue to decrease. As the incidence of anal carcinoma increases in populations at risk, cytologic screening, combined with early detection and treatment, has been proposed as a method to reduce the morbidity and mortality from invasive anal squamous cell carcinoma (ASCC).

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“…Concerning high-grade AIN, the sensitivity and specificity were, respectively, 16% and 97%, concluding that anal cytology is not sensitive enough to rule out anal dysplasia and should therefore be complemented by high-resolution anoscopy. Santoso et al 11 found a 5.9% prevalence of cytological changes in women with genital intraepithelial neoplasia, compared to 38% of women with abnormalities at anoscopy and 12.5% of biopsy-proven anal intraepithelial neoplasia. These data show a sensitivity and specificity of anal cytology around 8% and 94%, respectively.…”

Section: Introductionmentioning

confidence: 98%

HPV infection and intraepithelial lesions from the anal region: how to diagnose?

Carvalho¹,

Ferreira²,

Bueno³

2011

Braz J Infect Dis

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In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy. Keywords: anal canal; papillomavirus infections; cell biology; carcinoma in situ.identify these pre-invasive lesions is being questioned. Such questions relate to the groups to be screened and the best way to implement it such screening. The purpose of this study was to review the literature about the use of anal cytology and anoscopy to screening and evaluation of anal intraepithelial neoplasia. ANAL CYTOLOGYAnal cytology is a noninvasive method of screening, which is performed primarily by anal secretion collection through a brush (Dacron swab) introduced into the anal canal and removed with gentle rotation movements. It is indicated to avoid anal sex and douching in the day before the procedure, since these practices can decrease cellular recovery. Special caution should be taken for not touching anal canal warts and rectum walls with the brush to avoid any fecal contamination.

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Anal Intraepithelial Neoplasia in Women With Genital Intraepithelial Neoplasia

Abstract: Patients with cervical, vulvar, and vaginal intraepithelial neoplasia have 12.2% prevalence of anal intraepithelial neoplasia and should be screened with high-resolution anoscopy. In anal intraepithelial neoplasia screening, anoscopy is more sensitive but less specific than anal cytology.

Cited by 76 publications

References 16 publications

Keratosis reduces sensitivity of anal cytology in detecting anal intraepithelial neoplasia

Keratosis reduces sensitivity of anal cytology in detecting anal intraepithelial neoplasia

Anal cancer and cervical cancer screening: Key differences

HPV infection and intraepithelial lesions from the anal region: how to diagnose?

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