Evaluating the performance of anal cytology and high‐risk HPV genotyping for detecting anal HSIL in a clinic‐based sample of people living with and without HIV in Puerto Rico

Abstract

BackgroundGiven the disproportionately elevated anal cancer risk in high‐risk populations, it is important to assess the performance of commonly used anal cancer screening tools to improve the effectiveness of detection and treatment methods. This study evaluates 1) the concordance between anal cytology and histology results and 2) the performance of cytology and high‐risk human papillomavirus (HR‐HPV) genotyping as screening tools for detecting histologically confirmed anal high‐grade squamous intraepithelial lesions (HSIL).MethodsData from the Anal Neoplasia Clinic in Puerto Rico (2014–2021; n = 466) was used. The clinical performance of anal cytology and HR‐HPV genotyping to detect HSIL was compared to the gold standard: high‐resolution anoscopy‐guided biopsy. Sensitivity, specificity, positive predictive value, negative predictive value, and κ coefficients were calculated.ResultsA total of 66.95% of the patients were men, 74.0% were people living with HIV, 76.2% had anal HR‐HPV infection, and 40.34% had histologically confirmed anal HSIL. The weighted κ statistic between the tests (cytology and histology) was 0.25 (p < .001). The sensitivity and specificity of cytology alone to detect anal HSIL were 84.3% (95% confidence interval [CI], 78.3%–89.1%) and 36.0% (95% CI, 30.3%–42.0%), respectively. Anal HR‐HPV genotyping had higher sensitivity (92.2%; 95% CI, 87.4%–95.6%) and similar specificity (34.8%; 95% CI, 29.2%–40.7%) compared to cytology. The two tests combined (positive results following cytology or HR‐HPV test) improved sensitivity to detect anal HSIL (97.9%; 95% CI, 94.8%–99.4%), but specificity was compromised (19.2%; 95% CI, 14.7%–24.4%).ConclusionAlthough HR‐HPV genotyping improved the detection of anal HSIL, HR‐HPV testing had lower specificity than anal cytology alone.

Human papillomavirus genotyping in high‐grade vaginal intraepithelial neoplasia: A multicentric Italian study

“…Detection of multiple infections decreased from VaIN2 (30.3%) to VaIN3 (18.4%), suggesting that selection of the most carcinogenic HPV genotypes has occurred, along with clearance of the least carcinogenic ones during the oncogenic process 13 . This is in line with other reports, 10,12 and also with other HPV‐related intraepithelial neoplasms and cancers such as vulva and anus 14–16 …”

“…13 This is in line with other reports, 10,12 and also with other HPV-related intraepithelial neoplasms and cancers such as vulva and anus. [14][15][16] Since one of the HPV types included in the HPV 9-valent vaccine was present in 70.2% of VaIN2/3 cases, these lesions could have been likely prevented by 9-HPV vaccination, underlying the importance of this intervention in appropriate age. Recent cohort studies from Denmark 17 indicated that VaIN incidence decreased significantly after 2006 among women under 30 years of age, with an annual decrease of almost 16% per year, that is after HPV vaccine approval.…”