A comparative study between conventional and liquid‐based cytology in screening for anal intraepithelial lesions in HIV‐positive patients

Maia, Livia Bravo; Marinho, Larissa Cardoso; Barbosa, Tânia Wanderley Paes; Filho, Eronides Salustiano Batalha; Velasco, L.; Costa, Patrícia Godoy Garcia; Carneiro, Fabiana Pirani; Oliveira, Paulo Gonçalves de

doi:10.1002/dc.23130

Cited by 15 publications

(17 citation statements)

References 18 publications

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“…Twenty-one studies described cytology [22–41, 43]. Seventeen described liquid-based cytology [22–31, 33, 35, 38–41, 43], 3 conventional cytology [32, 36, 37] and 1 both conventional and liquid-based cytology [34]. Eleven studies described HR-HPV DNA detection [23–25, 27, 30, 31, 33, 38–40, 43], 3 HPV E6/E7 mRNA analysis [38, 40, 44], 3 p16INK4a immunostaining [38, 39, 42], and 1 p16INK4a/Ki-67 dual staining [41].…”

Section: Resultsmentioning

confidence: 99%

The Accuracy of Anal Swab–Based Tests to Detect High-Grade Anal Intraepithelial Neoplasia in HIV-Infected Patients: A Systematic Review and Meta-analysis

Lima¹,

Viset²,

Leeflang³

et al. 2019

Open Forum Infectious Diseases

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Background The incidence of high-risk human papillomavirus (HR-HPV)–induced anal cancer is increasingly problematic among HIV-positive patients. Anal cancer is preceded by precursor lesions, anal intraepithelial neoplasia (AIN). AIN detection requires high-resolution anoscopy, a cumbersome and time-consuming procedure. We aggregated evidence on anal swab–based tests to detect AIN in HIV-positive patients. Methods We searched MEDLINE and EMBASE for cross-sectional studies on AIN detection with anal cytology, HR-HPV DNA detection, HPV E6/E7 mRNA analysis, and P16INK4a and Ki-67 immunostaining. Summary estimates of sensitivity and specificity were calculated using bivariate logistic regression. Cytology was reported using the terms squamous intra-epithelial lesion (SIL) for AIN and high-grade SIL (HSIL) for high-grade AIN (HGAIN). Results We included 22 studies. Using cytology with a cutoff of any SIL to detect HGAIN, we detected a sensitivity of 82% (95% CI, 74%–87%) and specificity of 45% (95% CI, 44%–66%); with the cutoff of HSIL, the sensitivity was 44% (95% CI, 45%–67%) and the specificity was 79% (95% CI, 69%-87%). The sensitivity of HPV DNA to detect HGAIN was 91% (95% CI, 82%–95%) and the specificity was 27% (95% CI, 21%–33%). For MSM, the positive predictive value (PPV) of cytology with a cutoff of any SIL was 36% (95% CI, 23%–50%) and the negative predictive value (NPV) was 87% (95% CI, 78%–93%), whereas cytology with a cutoff of HSIL had a PPV of 62% (95% CI, 50%–73%) and an NPV of 78% (95% CI, 65%–87%). The PPV of HR-HPV DNA detection was 37% (95% CI, 20%–57%) and the NPV was 87% (95% CI, 79%–93%). Conclusions Given its sensitivity, cytology with a cutoff of any SIL could be considered as a triaging method, whereas cytology with a cutoff of HSIL had better specificity and could be used for quality assurance. HR-HPV DNA detection had poor specificity and PPV, making it unsuitable for triage.

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Section: Resultsmentioning

confidence: 99%

The Accuracy of Anal Swab–Based Tests to Detect High-Grade Anal Intraepithelial Neoplasia in HIV-Infected Patients: A Systematic Review and Meta-analysis

Lima¹,

Viset²,

Leeflang³

et al. 2019

Open Forum Infectious Diseases

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“…Some investigators have reported that liquid-based preparations increase cell yield and reduce compromising factors such as obscuring fecal material, air-drying, and mechanical artifacts [ 31 , 32 ]. Others report that conventional and liquid-based cytology are equally effective in screening for ASIL [ 33 ]. Self-collection of anal cytology has also been investigated; in a community-based study of MSM, 80 % of men with limited or no experience with anal cytology screening were able to collect a sample on the fi rst attempt that was suffi cient for interpretation by a pathologist [ 34 ].…”

Section: Samplingmentioning

confidence: 97%

Anal Cytology

Darragh

Palefsky

2015

The Bethesda System for Reporting Cervical Cytology

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Anal cytology was fi rst included in the 2001 Bethesda System Atlas. It has gained acceptance as a tool for anal cancer screening in conjunction with high-resolution anoscopy (HRA) and biopsy -in a role similar to the Pap test [ 1 -4 ]. Recommendations in TBS 2001 included guidance on sampling, adequacy, use of Bethesda terminology for anal cytology, and basic morphologic characteristics of anal squamous intraepithelial lesions (ASIL). This 2014 update to the chapter incorporates a brief review of the epidemiology of anal cancer, additional images, and expands information on the performance characteristics of anal cytology, the role of HPV testing and biomarkers, and briefl y addresses clinical management. Anal CancerAnal squamous cell carcinoma is an uncommon cancer. Over 90 % of anal cancers are attributable to persistent HPV infections with HPV16 predominating [ 5 ]. The 2014 American Cancer Society [ 6 ] estimates for anal cancer in the United States are approximately 7,210 new cases (4,550 in women and 2,660 in men) and 950 deaths (580 in women and 370 in men). However, rates of anal squamous cell carcinoma have been increasing over the last several decades, especially in high-risk groups.

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“…Several studies compared both techniques used in anal cytology [31][32][33]. Liquid-based cytology can reduce fecal and bacterial contamination and air-drying artifacts [31].…”

Section: Conventional Smears and Liquid-based Cytologymentioning

confidence: 99%

“…In that case, ThinPrep samples proved to be satisfactory twice as often as conventional smears (p < 0.005) and detected nearly eight times as many squamous intraepithelial lesions (p < 0.005). In a study by Maia et al [33], which included 33 HIV-positive patients who submitted to both an anal cytology and high-resolution anoscopy, conventional cytology identified 75% of patients with a positive biopsy, while liquid-based cytology identified 86% of these patients.…”

Section: Conventional Smears and Liquid-based Cytologymentioning

confidence: 99%

Cytology in Anal Cancer Screening: Practical Review for Clinicians

Albuquerque

2019

Acta Cytologica

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The incidence and mortality of anal squamous cell carcinoma (SCC) are expected to continue to increase in the next 20 years. High-risk groups for anal SCC, i.e., human immunodeficiency virus (HIV)-positive patients, men who have sex with men (MSM), women with previous genital neoplasia, and solid-organ transplant recipients, have been identified. HIV-positive MSM have the highest risk, and some societies have advocated for anal cancer screening to be done in this population. Screening for anal SCC follows the same principles as that for cervical cancer since there are similarities between the two types of cancers. Anal cytology has been recommended as an initial screening method for high-risk groups, e.g., HIV-positive MSM. Normally, the cytology is liquid based and collected blindly by a clinician using a Dacron swab and it is especially used for internal lesions detection. The sensitivity to predict anal high-grade squamous intraepithelial lesions is higher in immunosuppressed patients with a high burden of the disease. The report should include the classification, normally according to the Bethesda terminology and the sample adequacy, in a manner similar to that for cervical cytology. In cases involving unsatisfactory samples, it is important to repeat the procedure given the prevalence of anal squamous cytological abnormalities in follow-up cytology procedures. The absence of transformation zone cells in anal cytology seems to increase the risk of false-negative results.

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A comparative study between conventional and liquid‐based cytology in screening for anal intraepithelial lesions in HIV‐positive patients

Cited by 15 publications

References 18 publications

The Accuracy of Anal Swab–Based Tests to Detect High-Grade Anal Intraepithelial Neoplasia in HIV-Infected Patients: A Systematic Review and Meta-analysis

The Accuracy of Anal Swab–Based Tests to Detect High-Grade Anal Intraepithelial Neoplasia in HIV-Infected Patients: A Systematic Review and Meta-analysis

Anal Cytology

Cytology in Anal Cancer Screening: Practical Review for Clinicians

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