High Resolution Anoscopy Findings for Men Who Have Sex with Men: Inaccuracy of Anal Cytology as a Predictor of Histologic High-Grade Anal Intraepithelial Neoplasia and the Impact of HIV Serostatus

Panther, Lori; Wagner, Katiri; Proper, JoAnn; Fugelso, Dana K.; Chatis, Pamela A.; Weeden, Will; Nasser, Imad; Doweiko, John P.; Dezube, Bruce J.

doi:10.1086/383574

Cited by 130 publications

(82 citation statements)

References 10 publications

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“…44,45 Anal cytology often under-represents the severity of lesions found on HRA-guided biopsy. 31,43,47 Even in experienced hands, the prospective diagnosis of ASCC is infrequent and challenging on cytology. The differential diagnosis between HSIL and invasive ASCC can be difficult.…”

Section: Anal Cancer Screening/darragh and Winklermentioning

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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Section: Anal Cancer Screening/darragh and Winklermentioning

confidence: 99%

Anal cancer and cervical cancer screening: Key differences

Darragh

Winkler

2010

Cancer Cytopathology

191

203

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“…In this example, it is observed, with special attention, the squamocolumnar transition zone after topical application of acetic acid 3%, lesions suspected to be produced by the cytopathic effect of HPV will become whitish and underwent biopsy (26) . The histopathological result of a high resolution anoscopy (HRA) monitored biopsy is considered the goldstandard test for confirming the presence of an anal squamous intraepithelial lesion (35,43) . However, even though HRA is a tool routinely used in the diagnosis of anal lesions, there is little information in the medical literature regarding the success of this medical diagnostic technique regarding the detection of anal cancer precursor lesions.…”

Section: Introductionmentioning

confidence: 99%

The value of high-resolution anoscopy in the diagnosis of anal cancer precursor lesions in hiv-positive patients

Gimenez

Costa-e-Silva

Daumas

et al. 2011

Arq. Gastroenterol.

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-Context -Anal cancer, although a still rare disease, is being observed in ascending rates among some population segments known to be at risk for the development of the disease. Human papillomavirus (HPV) infection, immunodepression and anal intercourse are some factors associated with the development of the malignancy. Its similarities to cervical cancer have led to many studies aiming to establish guidelines for detecting and treating precursor lesions of anal cancer, with the goal of prevention. Highresolution anoscopy is routinely used for the diagnosis of anal cancer precursor lesions in many centers but the medical literature is still deficient concerning the role of this diagnostic modality. Objectives -To evaluate diagnostic validation and precision measures of high-resolution anoscopy in comparison to histopathological results of anal biopsies performed in HIV-positive patients treated at the Tropical Medicine Foundation of Amazonas, AM, Brazil. To observe any possible association between some risk factors for the development of anal cancer and the presence of anal squamous intraepithelial lesions. Methods -A hundred and twenty-eight HIV-positive patients were submitted to anal canal cytological sampling for the detection of HPV infection by a PCR based method. High-resolution anoscopy was then performed after topical application of acetic acid 3% in the anal canal for 2 minutes. Eventual acetowhite lesions that were detected were recorded in respect to location, and classified by their tinctorial pattern, distribution aspect, relief, surface and vascular pattern. Biopsies of acetowhite lesions were performed under local anesthesia and the specimens sent to histopathological analysis. The patients were interviewed for the presence of anal cancer risk factors. Results -The prevalences of anal HPV infection and of anal squamous intraepithelial lesions in the studied population were, respectively, 79% and 39.1%. High-resolution anoscopy showed sensibility of 90%, specificity of 19.23%, positive predictive value of 41.67%, negative predictive value of 75%, and a kappa coefficient of 0.076. From the analyzed lesions, high-grade squamous intraepithelial lesions was more frequently observed in association to dense (68%), flat (61%), smooth (61%), non-papillary (83%) and normal vascular pattern (70%) acetowhite lesions, while low-grade squamous intraepithelial lesions tended to be associated to dense (66%), flat-raised or raised (68%), granular (59%), non-papillary (62%) and normal vascular pattern (53%) acetowhite lesions. No statistical significance was observed as to the association of epidemiological characteristics and of most of the investigated anal cancer risk factors and presence of acetowhite lesions or anal squamous intraepithelial lesions. However, anal receptive sex and anal HPV infection were significantly associated to anal squamous intraepithelial lesions (P = 0.0493 and P = 0.006, respectively). Conclusion -High-resolution anoscopy demonstrated to be a sensitive, but not specific test ...

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“…Diversos estudos [11][12][13][14][15][16][17] mostram que o coito anal receptivo apresenta correlação com citologias anais apresentando lesões intra-epiteliais, seja de baixo ou alto grau, porém o nosso estudo não apresentou esta correlação. Acreditamos que essa discordância tenha ocorrido devido à omissão desse dado por alguns pacientes do nosso estudo.…”

Section: Discussionunclassified