High-risk human papillomavirus test in anal smears: can it optimize the screening for anal cancer?

Abstract

Objective: The current method for screening anal cancer is anal cytology, which has low sensitivity. Since high-risk human papillomavirus (HR-HPV) is associated with almost 90% of cases of anal cancer, the objective of this study is to evaluate whether testing for HR-HPV can optimize the screening.Design: Prospective study with patients enrolled in a screening program for anal dysplasia. Considering high-resolution anoscopy (HRA)-guided biopsy as the gold standard for diagnosis of high-grade squamous intraepithelial lesions, the diagnostic performance of anal cytology, HR-HPV testing, and the combination of both was calculated.Settings: A single center for anal dysplasia.Participants: A total of 364 patients (72% males, 82% HIV-positive).Intervention: Patients underwent anal cytology, HR-HPV test, and HRA-guided biopsy of the anal canal.Main outcome measures: Ability of cytology and HR-HPV test (individually and combined) to detect high-grade squamous intraepithelial lesions, and analysis of the cost of each diagnostic algorithm.Results: Cytology alone was the cheapest approach, but had the lowest sensitivity [59%, 95% confidence interval (CI) 46-71%], despite of highest specificity (73%, 95% CI 68-78%). Cotesting had the highest sensitivity (85%, 95% CI 74-93%) and lowest specificity (43%, 95% CI 38-49%), and did not seem to be cost-effective. However, HR-HPV testing can be used to triage patients with normal and atypical squamous cells of undetermined significance cytology for HRA, resulting in an algorithm with high sensitivity (80%, 95% CI 68-89%), and specificity (71%, 95% CI 65-76%), allied to a good cost-effectiveness.Conclusion: HR-HPV testing is helpful to optimize the screening in cases of normal and atypical squamous cells of undetermined significance cytology.

A systematic review and meta‐analysis of cytology and HPV‐related biomarkers for anal cancer screening among different risk groups

“…Briefly, 4717 articles were identified, after removal of duplicates (n = 863), 3748 were excluded based on title/abstract review. Of the remaining 106 articles, 39 were included after full‐text review (Table 1; Supplemental Material) 12‐50 . Most studies reported data for PLWH (n = 29), 12,13,15,16,18‐34,36‐39,41,43,47,50 a majority were among MSM LWH (n = 18) 12,13,15,16,21,25‐27,29,31‐34,36,38,39,47,50 .…”

“…Most studies reported data for PLWH (n = 29), 12,13,15,16,18‐34,36‐39,41,43,47,50 a majority were among MSM LWH (n = 18) 12,13,15,16,21,25‐27,29,31‐34,36,38,39,47,50 . Nine studies reported data exclusively among women, 17,28,30,41,43,45‐47,49 including six among women LWH and six were conducted among MSM without HIV 12,15,25,31,32,47 . Several studies reported data on multiple subgroups (n = 10) 12,15,20,25,31,32,35,43,46,47 .…”

“…Nine studies reported data exclusively among women, 17,28,30,41,43,45‐47,49 including six among women LWH and six were conducted among MSM without HIV 12,15,25,31,32,47 . Several studies reported data on multiple subgroups (n = 10) 12,15,20,25,31,32,35,43,46,47 . Most studies were conducted in the United States (n = 17), followed by Europe (n = 11) and Thailand (n = 3).…”

“…12,15,25,31,32,47 Several studies reported data on multiple subgroups (n = 10). 12,15,20,25,31,32,35,43,46,47 Most studies were conducted in the United States (n = 17), followed by Europe (n = 11) and Thailand (n = 3).…”

Anal cytology and high‐risk human papilloma virus testing in atypical squamous categories: Value of concurrent testing in management of high‐risk population

“…15,18 One recent study similarly finds that co-testing is best used in atypical and normal cytology results resulting in highest specificity and sensitivity. 19 Similar to evidence-based guidelines and protocols for cervical cancer screening, greater data correlating anal cytology, HR-HPV and presence/absence of high-grade lesions on biopsies are necessary. Our data provide evidence for reflex HR-HPV testing in ASCUS diagnoses and potential utilization for clinical practice (Figure 2).…”