Comparison of 2 Anal Cytology Protocols to Predict High-Grade Anal Intraepithelial Neoplasia

Wiley, Dorothy J.; Hsu, Hil; Bolan, Robert; Voskanian, Alen; Elashoff, David; Young, Stephen; Dayrit, Ruvy; Barman, Provaboti; DeAzambuja, Katherine; Masongsong, Emmanuel; Martı́nez-Maza, Otoniel; Detels, Roger

doi:10.1097/lgt.0b013e318281d36e

Cited by 13 publications

(9 citation statements)

References 63 publications

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“…83 Other implements (such as cervical brushes and a flocked nylon swab) have been studied 20,84-88 and self-sampling may also be feasible in some populations. 89-92 The swab is gently inserted into the anal canal, stopping when the swab abuts the wall of the distal rectum.…”

Section: Anal Cancer Screening Methods: Strengths and Limitationsmentioning

confidence: 99%

Screening for Anal Cancer in Women

Moscicki

Darragh

Berry-Lawhorn

et al. 2015

Journal of Lower Genital Tract Disease

135

122

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Objective The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV) and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goal was to summarize the literature on anal cancer, HSIL and HPV infection in women, and provide screening recommendations in women. Methods A group of experts convened by the ASCCP and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL and anal cancer in women. Results Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with HIV-infected women and those with a history of lower genital tract neoplasia (LGTN) at highest risk compared with the general population. Conclusions While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and have digital anorectal examinations to detect anal cancers. HIV-infected women and women with LGTN, may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL.

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Section: Anal Cancer Screening Methods: Strengths and Limitationsmentioning

confidence: 99%

Screening for Anal Cancer in Women

Moscicki

Darragh

Berry-Lawhorn

et al. 2015

Journal of Lower Genital Tract Disease

135

122

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“…The epithelium of the anal canal is opposed at rest by the tone of the anal sphincters. Cytologic samples are usually obtained without direct visualization of the anal canal [ 22 , 23 ], although some clinicians report using a small anoscope to introduce the collection device [ 24 ]. Obtaining an adequate sample can be a challenge.…”

Section: Samplingmentioning

confidence: 99%

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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“…Our adjusted sensitivity and specificity analyses for either swab fall within the range of published performances. Anal cytology instrumentation builds on more than 50 years of experience with cervical cytology screening strategies: cervical cytopicks; cotton, Dacron, rayon, and NF swabs; brooms; and cytobrushes with and without spatulas . Cervical cytology shows wider variation in sensitivity (34%‐96%; median, 64%) than specificity (92%‐98%; median, 96%) for predicting hHSILs .…”

Section: Discussionmentioning

confidence: 99%

“…Anal cytology instrumentation builds on more than 50 years of experience with cervical cytology screening strategies: cervical cytopicks; cotton, Dacron, rayon, and NF swabs; brooms; and cytobrushes with and without spatulas. [27][28][29][30][31][32][33][34][35] Cervical cytology shows wider variation in sensitivity (34%-96%; median, 64%) than specificity (92%-98%; median, 96%) for predicting hHSILs. 36 Anal cytology studies largely describe screening outcomes alone, and few report complete HRA/histology data.…”

Section: Discussionmentioning

confidence: 99%

Comparison of nylon‐flocked swab and Dacron swab cytology for anal HSIL detection in transgender women and gay, bisexual, and other men who have sex with men

Wiley

Hsu

Ganser

et al. 2019

Cancer Cytopathology

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Background An anal histological high‐grade squamous intraepithelial lesion (hHSIL) is an anal cancer precursor. Experts recommend Dacron swab anal cytology as a primary screen for anal hHSILs, especially among human immunodeficiency virus–infected and –uninfected men who have sex with men (MSM). Studies have shown that Dacron cytology inaccurately predicts anal hHSILs and results in unnecessary diagnostic procedures. Nylon‐flocked (NF) swabs have been shown to trap pathogens and cells well. Thus, this study compared test characteristics of anal cytology using NF and Dacron swab collection protocols to predict anal hHSILs. Methods A single‐visit, randomized clinical trial compared NF and Dacron swab anal cytology specimens to predict high‐resolution anoscopy and biopsy–diagnosed anal hHSILs. Data for 326 gay men, bisexual men, other MSM, and male‐to‐female transgender women contributed descriptive and tabular statistics with which unadjusted and fully adjusted logistic regression models were constructed. The models estimated the odds of hHSILs, test accuracy (area under the curve [AUC]) and sensitivity, and specificity as well as the positive and negative predictive values of abnormal NF and Dacron cytology for predicting hHSILs. Results In the fully adjusted model, the sensitivities for NF and Dacron cytology were nearly equal (48% vs 47%), but the specificity was higher with NF cytology (76% vs 69%). Comparisons of the areas under receiver operating characteristic curves showed that NF cytology alone predicted hHSILs better than the covariate model (AUC, 0.69 vs 0.63; P = .02), but NF and Dacron cytology comparisons showed no statistically significant differences (AUC, 0.69 vs 0.67; P = .3). Conclusions NF cytology and Dacron cytology provide modest sensitivity, but NF cytology has higher specificity and accuracy, and this is important for lowering the costs of population‐based screening.

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Comparison of 2 Anal Cytology Protocols to Predict High-Grade Anal Intraepithelial Neoplasia

Cited by 13 publications

References 63 publications

Screening for Anal Cancer in Women

Screening for Anal Cancer in Women

Anal Cytology

Comparison of nylon‐flocked swab and Dacron swab cytology for anal HSIL detection in transgender women and gay, bisexual, and other men who have sex with men

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