The value of a transformation zone component in anal cytology to detect HSIL

Roberts, J. M.; Jin, Fengyi; Thurloe, Julia K.; Ekman, Deborah; Adams, Marjorie; McDonald, Ross L.; Biro, Clare; Poynten, I. Mary; Grulich, Andrew E.; Farnsworth, Annabelle

doi:10.1002/cncy.21730

Cited by 15 publications

(13 citation statements)

References 40 publications

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“…Another important adequacy criterion is the presence of columnar cells, representing a satisfactory survey of the transformation zone (t-zone) or squamocolumnar junction. 28,29 Darragh et al 30 reported that when samples contain a t-zone, AIN is five times more likely to be detected. This observation held true in our study for HSILs.…”

Section: Discussionmentioning

confidence: 99%

Anal High-Grade Squamous Intraepithelial Lesions in Human Immunodeficiency Virus–Infected Men

Liu

Wang

Kalir

et al. 2017

American Journal of Clinical Pathology

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Section: Discussionmentioning

confidence: 99%

Anal High-Grade Squamous Intraepithelial Lesions in Human Immunodeficiency Virus–Infected Men

Liu

Wang

Kalir

et al. 2017

American Journal of Clinical Pathology

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“…We used the following definitions to determine the agreement between, and accuracy of, cytology and histology 21 . A true‐negative (TN) finding was defined as an NILM cytology result with no concurrent biopsy‐proven HSIL, including cases in which no biopsy was taken.…”

Section: Methodsmentioning

confidence: 99%

“…The objective of this approach is to sample the anal epithelial transformation zone (TZ) since HPV has a particular susceptibility for this area. The Bethesda system does not require adequate representation of the TZ to classify a cervical sample as satisfactory for cytology 20,21 . The Australian SPANC group investigated the correlation between TZ representation in anal cytology samples and biopsy‐proven HSIL and concluded that adequate TZ representation may be an important indicator of sample quality in anal cytology 22 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of two sample collection devices for anal cytology in HIV‐positive men who have sex with men: Cytology brush and Dacron swab

et al. 2021

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Objective HIV‐positive men who have sex with men (MSM) are a vulnerable group for anal cancer (AC), a cancer with a well‐described precursor lesion, which can be detected early in screening programs using anal liquid‐based cytology (aLBC). We aim to compare two aLBC sample collection devices: cytology brush (CB) and Dacron swab (DS). Methods Retrospective analysis of two consecutive study periods, the first using CB and the second DS. Participants underwent an aLBC, a human papillomavirus (HPV) DNA test and a high‐resolution anoscopy (HRA), and a biopsy was performed for suspicious lesions. The sensitivity and specificity of aLBC, area under the receiver operating characteristic (ROC) curve (AUC), and concordance between cytology and HRA were assessed using Cohen’s kappa coefficient. Results A total of 239 participants were enrolled (CB group, 120; DS group, 119). aLBC was benign in 46% of samples, and high‐grade squamous intraepithelial lesion (HSIL) was detected in 11.7%. Prevalence of biopsy‐proven HSIL was 15.3%. No differences in cytological and histological results were observed between the groups. aLBC‐HRA concordance was weak for benign results (CB group, k = 0.309; DS group, k = 0.350) as well as for HSIL (k = 0.321 and 0.387, respectively). Sensitivity and specificity were 100% and 51.4%, respectively, in the CB group and 88% and 54.3% in the DS group (AUC = 0.711 and 0.759, respectively, P‐value = .514). Representation of the transformation zone (TZ) was adequate in 83.3% of samples in the CB group and 50.4% in the DS group (P‐value <.001). Conclusion Our data suggest that both devices had similar accuracy to detect anal HSIL, although samples collected with CB are more likely to have an adequate TZ representation, the presence of which could be an indicator of sample quality.

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“…The transformation zone is the most susceptible area for anal precancerous lesions, and it is a quality indicator, as it is in cervical cytology. The absence of an adequate anal transformation zone component (rectal columnar cells and/or squamous metaplastic cells) was associated with an increase probability of a false-negative cytology (negative cytology with histological HSIL) in MSM [39]. In the anal canal, transformation zone sampling could be even more important than it is in the cervix given the fact that the anal canal is not visualized during cytology sampling [39].…”

Section: Transformation Zonementioning

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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The value of a transformation zone component in anal cytology to detect HSIL

Cited by 15 publications

References 40 publications

Anal High-Grade Squamous Intraepithelial Lesions in Human Immunodeficiency Virus–Infected Men

Anal High-Grade Squamous Intraepithelial Lesions in Human Immunodeficiency Virus–Infected Men

Comparison of two sample collection devices for anal cytology in HIV‐positive men who have sex with men: Cytology brush and Dacron swab

Cytology in Anal Cancer Screening: Practical Review for Clinicians

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