Early Impact and Performance Characteristics of an Established Anal Dysplasia Screening Program: Program Evaluation Considerations

Mathews, Christopher; Caperna, Joseph; Cosman, Bard

doi:10.2174/1874613600701010011

Cited by 27 publications

(17 citation statements)

References 61 publications

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“…Moreover, in immunosuppressed women, AIN 3 lesions may progress to invasive carcinoma within a 5-year period [2]. In a cohort study that evaluated the effect of an anal cancer screening program in HIV-positive individuals, a decrease from 90.9 to 70.6% was found in the need for chemotherapy for invasive anal carcinoma [37]. …”

Section: Discussionmentioning

confidence: 99%

Agreement between Methods for Diagnosing HPV-Induced Anal Lesions in Women with Cervical Neoplasia

Heráclio

Souza²,

Pinto³

et al. 2011

Acta Cytologica

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Objective: To evaluate agreement between 3 methods for screening anal intraepithelial lesions: anal cytology, anoscopy and human papillomavirus (HPV) detection by PCR. Study Design: This prospective, cross-sectional study screened 324 women with cervical neoplasia for anal neoplasia. Agreement between methods was calculated using the ĸ coefficient. Results: Of 324 anal cytologies performed, 31.5% (n = 102) were found to be abnormal: low-grade anal lesions were detected in 19.1% (n = 62) of cases, high-grade lesions in 3.1% (n = 10) and atypical squamous cells of undetermined significance in 9.3% (n = 30). With respect to the biopsies, 25.7% (n = 20) were positive, consisting of 7 cases of HPV infection, 5 anal intraepithelial neoplasia (AIN) grade 1, 6 AIN grade 2, and 2 AIN grade 3. Twenty-one samples (6.5%) were inadequate for HPV analysis. Of the 303 adequate samples, 84.2% (n = 255) tested positive for HPV. Agreement between cytology and anoscopy was fair (ĸ = 0.31). Agreement between PCR for HPV and cytology was slight (ĸ = 0.08) and no agreement was found between PCR for HPV and anoscopy (ĸ = 0.00). Conclusion: Agreement between the different methods of diagnosing HPV-induced anal lesions is slight to fair; however, anal cytology permits identification of cases in which lesions are present, allowing them to be referred for anoscopy and biopsy.

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Section: Discussionmentioning

confidence: 99%

Agreement between Methods for Diagnosing HPV-Induced Anal Lesions in Women with Cervical Neoplasia

Heráclio

Souza²,

Pinto³

et al. 2011

Acta Cytologica

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“…Anal cytology was first studied for the detection of anal dysplasia in the 1990s, and anal cytology was first included Review of Anal Cancer Screening Tests/Clarke and Wentzensen in the Bethesda cytology atlas in 2001. 59,60 In the Bethesda System, anal cytology findings are classified similar to those for cervical cytology: atypical squamous cells of undetermined significance (ASC-US), atypical squamous cells cannot exclude high-grade, low-grade squamous intraepithelial lesion, (LSIL) and HSIL. 61 In total, 14 studies reported on the performance of cytology in detecting anal precancers and cancers, including 881 findings of AIN2 or higher and 3706 findings of AIN2 or lower.…”

Section: Performance Of Anal Cytology For the Detection Of Anal Precamentioning

confidence: 99%

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

Clarke

Wentzensen

2018

Cancer Cytopathology

110

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Anal cancer incidence and mortality have been increasing over the past decade. Although the incidence in the general population remains low, it is much higher in certain subgroups, including those living with human immunodeficiency virus and men who have sex with men. Approximately 90% of anal squamous cell cancers are caused by infection with carcinogenic human papillomavirus (HPV). Given the common etiology between anal and cervical carcinogenesis, screening for anal cancer has been proposed in certain high-risk populations using strategies adapted from cervical cancer prevention. In this review, the authors discuss important differences in anal and cervical cancer regarding the populations at risk, disease natural history, and clinical procedures and outcomes that need to be considered when evaluating strategies for anal cancer screening. They also performed a systematic review and meta-analysis of the performance of anal cytology, anal HPV testing, and various biomarkers for the detection of anal precancers and cancers. The implications of these performance estimates are summarized in the context of risk-based screening and management of anal precancers, and important research gaps are highlighted that need to be addressed to fully understand the benefits and harms of anal cancer screening. Cancer Cytopathol 2018. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

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“…Thus, HRA requires extensive training and observer experience in order to warrant that HSIL do not go unnoticed. While the International Anal Neoplasia Society (IANS) recommends a learning period of 50–100 HRA [10], contradictory data was obtained by other studies [11], [12], [13] and it remains unknown which factors influence the learning progression.…”

Section: Introductionmentioning

confidence: 99%

High-resolution anoscopy in HIV-infected men: Assessment of the learning curve and factors that improve the performance

Neukam

Guisado

Fontillón

et al. 2019

Papillomavirus Research

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ObjectiveTo determine the required learning time for high-resolution anoscopy (HRA)-guided biopsy to detect histological high-risk squamous intraepithelial lesions (hHSIL) and to identify factors that impact on the training process.MethodsAll HIV-infected, screening-naïve men-who-have-sex-with-men who underwent HRA conducted by one single observer from 2010 to 2017 in a Spanish HIV-outpatient clinic were analysed.ResultsEighty-five (14.7%) of the 581 patients included presented hHSIL. The factors associated with the capacity to detect hHSIL [adjusted odds ratio (aOR), 95% confidence interval (95%CI)] were the presence of cytological HSIL (3.04, 1.78–5.21; p < 0.001), infection with high-risk human papilloma virus (HR-HPV) (2.89, 1.38–6.05; p = 0.005), the number of biopsies taken/HRA (aOR: 1.28, 1.07–1.52; p = 0.006) and tobacco smoking (1.75; 1.12–2.73; p = 0.014). Two events independently augmented the detection rate of hHSIL: one single experienced pathologist interpreted biopsies after 409 HRA (2.80, 1.74–4.48; p = 0.035) and the anoscopist underwent an additional training after 536 HRA (2.57, 1.07–6.16; p = 0.035). A learning process could be observed throughout the whole study with stable HR-HPV prevalence.ConclusionThe data support the growing evidence that the proposed training volume of 50–200 performances is underestimated. Extensive training of both anoscopist and pathologist is warranted and the development of tools to support the diagnostic performance may be considered.

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Early Impact and Performance Characteristics of an Established Anal Dysplasia Screening Program: Program Evaluation Considerations

Cited by 27 publications

References 61 publications

Agreement between Methods for Diagnosing HPV-Induced Anal Lesions in Women with Cervical Neoplasia

Agreement between Methods for Diagnosing HPV-Induced Anal Lesions in Women with Cervical Neoplasia

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

High-resolution anoscopy in HIV-infected men: Assessment of the learning curve and factors that improve the performance

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