Anal Cytology and Human Papillomavirus Genotyping in Women With a History of Lower Genital Tract Neoplasia Compared With Low-Risk Women

Abstract

OBJECTIVE To compare the prevalence of abnormal anal cytology and high-risk human papillomavirus (HPV) among women with a history of HPV-related genital neoplasia with women without a history of HPV-related genital neoplasia. METHODS A cross-sectional cohort study was performed from December 2012 to February 2014. Women were recruited from outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal cytology, dysplasia, or cancer were considered the high-risk group. Women with no history of high-grade anogenital dysplasia or cancer were considered the low-risk group. Human immunodeficiency virus–positive women were excluded. Anal cytology and HPV genotyping were performed. Women with abnormal anal cytology were referred for high-resolution anoscopy. RESULTS There were 190 women in the high-risk group and 83 in the low-risk group. The high-risk group was slightly older: 57 years compared with 47 years (P=.045); 21.7% of low-risk women had abnormal anal cytology compared with 41.2% of high-risk women (P=.006). High-risk HPV was detected in the anal canal of 1.2% of the low-risk group compared with 20.8% of the high-risk group (P<.001). Among women who underwent anoscopy, no anal dysplasia was detected in the low-risk group, whereas 13.4% in the high-risk group had anal dysplasia with 4.2% having anal intraepithelial neoplasia 2 or greater (P<.001). CONCLUSION Human immunodeficiency virus–negative women with a history of lower genital tract neoplasia are more likely to have positive anal cytology, anal high-risk HPV, and anal intraepithelial neoplasia. Anal cancer screening should be considered for these high-risk women.

Evaluation of anal cytology and dysplasia in women with a history of lower genital tract dysplasia and malignancy

“…In a prior analysis, we demonstrated that women with a history of lower genital tract neoplasia were more likely to have positive anal cytology and high-risk anal HPV than those without neoplasia [8]. In this study we observed high-rates of abnormal anal cytology, high-risk anal HPV and anal dysplasia among women with a history of cervical, vulvar or vaginal cancer or dysplasia.…”

“…This larger study demonstrated the prevalence of 4.3% for AIN2 or greater among women with a history of genital neoplasia or cancer [8]. This represents a significant risk to these women and supports the need for anal cancer screening.…”

“…All women had anal cytologic testing with thin-layer cytology using a swab as previously described in Robison, et al [8]. All cytology samples were evaluated by two trained cytopathologists and the results entered in the electronic record.…”

“…This is an ad hoc analysis of our larger study examining differences in anal cytology and HPV types between women with and without lower genital tract neoplasia [8]. Based on calculations for the number of patients included in this analysis, we can detect a 17% difference between our two groups.…”

Anal cancer and anal cancer precursors in women with a history of HPV-related dysplasia and cancer

“…Like other cross-sectional studies, this study was limited by high rates of insufficient specimens for cytology (10%) and HR-HPV testing (25%), and 40% of the women with abnormal anal cytology actually received HRA. 13 …”