Estimating the Accuracy of Anal Cytology in the Presence of an Imperfect Reference Standard (original) (raw)
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Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 2017
The human papilloma virus is the leading cause of anal squamous cell carcinoma. Cytological screening may reduce the associated morbidity and mortality. The aim of the study was to estimate the agreement between anal cytological examination, histopathology and anoscopic visual impression. A prospective study of patients who underwent anal dysplasia screening between 2011 and 2015, in a proctology clinic of a tertiary referral center. During the study period, 141 patients (91% men, 87% with HIV infection) underwent 175 anal cytology tests. Of these, 33% were negative for intraepithelial lesions or malignancy (NILM), 22% were atypical squamous cells of uncertain significance (ASCUS), 33% were low-grade squamous intraepithelial lesion (LSIL) and 12% were high-grade squamous intraepithelial lesion (HSIL). With regard to anoscopic visual impression, 46% of patients had no lesions and excision/biopsy of the identified lesions was performed in the remaining patients. The weighted kappa-agr...
Risk factors for anal HSIL in HIV-positive MSM: is targeted screening possible?
AIDS (London, England), 2017
HIV-positive men-who-have-sex-with-men (MSM) are at increased risk for developing anal squamous cell carcinoma (aSCC). Detection of precursor lesions of anal cancer (anal high-grade squamous intraepithelial lesions; HSIL) is cumbersome and expensive. Our objective was to identify potential risk factors for anal HSIL in HIV-positive MSM to develop more stringent screening criteria. We studied a cohort of MSM screened by high-resolution anoscopy (HRA) at three HIV clinics in Amsterdam, the Netherlands. For every first HRA performed in a patient we analyzed five demographic- and seven HIV-related potential risk factors for 4 different outcome measures: histologically proven anal HSIL vs. no SIL, HSIL-AIN2 vs. no SIL, HSIL-AIN3 vs. no SIL and HSIL vs. no HSIL. We used univariable and multi-level, multivariable logistic regression. From 2008 through 2015, 497 out of 1678 (30%) screened HIV-positive MSM had anal HSIL. The mean age was 49 years (SD 9.6), 96% used cART, median duration of c...
HIV Medicine, 2014
Objectives-The aim of the study was to estimate the cumulative incidence of, and rates of progression to, invasive anal cancer (IAC) according to baseline anal cytology screening category in an unselected HIV clinical care cohort in the antiretroviral era. Methods-A retrospective cohort analysis of HIV-infected patients under care at the University of California at San Diego Owen Clinic was carried out. Patients were eligible for this analysis if they had at least two anal cytohistological results available for longitudinal analysis. Kaplan-Meier analysis was used to estimate the cumulative incidence of IAC over time according to baseline cytology category [less than high-grade intraepithelial lesion (HSIL) versus HSIL]. Cox regression analysis was used to adjust for the following covariates: antiretroviral use, level of HIV viraemia, smoking status and infrared photocoagulation (IRC) ablation therapy. Results-Between 2000 and 2012, we followed 2804 HIV-infected patients for a median of 4 years under a clinic protocol requiring baseline anal cytology screening. Incident IAC was diagnosed in 23 patients. Patients with a baseline HSIL anal cytology had an estimated 5-year probability of progression to IAC of 1.7% and an estimated annual progression risk of 1 in 263. None of the examined covariates was significantly associated with IAC incidence when examined in separate unadjusted Cox models. Conclusions-HIV-infected patients with a baseline HSIL anal cytology had a 5-year cumulative incidence of IAC of 1.65%, with an upper 95% confidence bound of 4.5%. This population-based study provides quantitative risk estimates that may be used for counselling patients regarding management options for abnormal cytology results.
Diseases of the Colon & Rectum, 2018
BACKGROUND: Anal canal carcinoma is relevant because it commonly occurs in high-risk groups, and its incidence has been increasing. OBJECTIVE: This study evaluated the accuracy of anal cytology in the screening of precursor lesions of anal cancer, compared with histopathologic examination as the reference, in all subjects and in men who have sex with men, HIV-infected men and women, and men who have sex with men and HIV-infected subgroups. DATA SOURCES: The data included studies identified in the MEDLINE, Latin American and Caribbean Health Sciences, Cochrane Library, and Embase electronic databases, as well as in the grey literature. The search terms included anal cancer, anal dysplasia, anal intraepithelial neoplasia, screening, and anal cytology. STUDY SELECTION: After excluding studies with no histopathological data and those with duplicate and missing data, 34 primary studies were included. INTERVENTION: Cytology of anal smears was studied. MAIN OUTCOME MEASURES: Sensitivity, specificity, diagnostic OR, and area under the curve were measured. RESULTS: A total of 5093 patients were included. The pooled sensitivity of anal cytology was 85.0% (95% CI, 82.0%-87.0%) and pooled specificity was 43.2% (95% CI, 41.4%-45.1%) for the detection of anal intraepithelial neoplasia grade 2 or worse versus anal intraepithelial neoplasia grade 1 and normal when measuring all subjects. The accuracy of anal cytology was higher in the men who have sex with men and HIV-infected and men who have sex with men only subgroups.
Open Forum Infectious Diseases
Background The incidence of high-risk human papillomavirus (HR-HPV)–induced anal cancer is increasingly problematic among HIV-positive patients. Anal cancer is preceded by precursor lesions, anal intraepithelial neoplasia (AIN). AIN detection requires high-resolution anoscopy, a cumbersome and time-consuming procedure. We aggregated evidence on anal swab–based tests to detect AIN in HIV-positive patients. Methods We searched MEDLINE and EMBASE for cross-sectional studies on AIN detection with anal cytology, HR-HPV DNA detection, HPV E6/E7 mRNA analysis, and P16INK4a and Ki-67 immunostaining. Summary estimates of sensitivity and specificity were calculated using bivariate logistic regression. Cytology was reported using the terms squamous intra-epithelial lesion (SIL) for AIN and high-grade SIL (HSIL) for high-grade AIN (HGAIN). Results We included 22 studies. Using cytology with a cutoff of any SIL to detect HGAIN, we detected a sensitivity of 82% (95% CI, 74%–87%) and specificity o...
The Open AIDS Journal, 2007
Background: Screening for invasive anal cancer and its precursors is being increasingly advocated as a response to increasing incidence among HIV-infected persons. We implemented a comprehensive screening program in 2001 and report our early experience to inform monitoring and evaluation of such programs. Our research aims were: (1) to estimate incidence of and mortality from invasive anal cancer (IAC) before (1995)(1996)(1997)(1998)(1999)(2000) and after (2001)(2002)(2003)(2004)(2005) screening program implementation and (2) to examine potential screening program quality indicators.
Cancer Cytopathology, 2019
BackgroundThe incidence of squamous cell carcinoma of the anal canal has been increasing in high‐risk populations. To the authors’ knowledge, there is no international consensus regarding screening for squamous cell carcinoma of the anal canal, but screening is commonly comprised of a Papanicolaou (Pap) test in combination with digital anorectal examination followed by high‐resolution anoscopy if necessary. The current study focused on individuals living with HIV and particularly on women living with HIV.MethodsIn this 5‐year retrospective study, the authors identified 5982 Pap tests, 1848 of which had follow‐up biopsy within 6 months. The rate of atypical squamous cells of undetermined significance was 42%, and approximately 38.1% of cases with this interpretation were diagnosed as high‐grade squamous intraepithelial lesions on follow‐up biopsy. In addition, 82 women with anal cytology had long‐term follow‐up (>10 years) available.ResultsThe authors investigated a relationship b...
Journal of Lower Genital Tract Disease, 2020
Objectives/Purposes:To evaluate the validity of anal cytology against high resolution anoscopy (HRA) in the detection of anal high-grade squamous intraepithelial lesions (HSIL) among women in a clinical setting in Puerto Rico, alone and in combination with high-risk human papillomavirus (HR-HPV) typing.Methods:A cross-sectional study was done among 128 eligible women that attended the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Center between 2014 and 2019. Kappa coefficient, sensitivity, specificity, positive predictive value, and negative predictive value were calculated using HRA with biopsy as the gold standard test. Poisson regression was used to estimate the adjusted prevalence ratio (PR) of anal HR-HPV infection.Results:Overall, 71.1% of women were HIV-infected and 78.9% had anal HR-HPV infection. Squamous intraepithelial lesions (SIL) were detected with anal cytology and histology in 70.3% and 81.3% of women, respectively. The kappa statistic between the tests (cytology and histology) was 0.32 (p<0.05). Measured against the results from histology, the sensitivity of anal cytology alone to detect HSIL was 85.4% (95% CI: 72.2%−93.9%) whereas specificity was 38.8% (95% CI: 28.1–50.3). While the sensitivity of the two tests combined (anal cytology and HR-HPV typing) to detect histologically confirmed HSIL increased (100.0%, 95% CI: 92.6%−100.0%) the specificity decreased (16.3%, 95% CI: 9.0%−26.2%). Meanwhile, women with HSIL had a higher prevalence of HR-HPV infection than those with no SIL/LSIL (PR: 6.23, 95% CI: 1.50–25.83).Conclusions:Anal cytology in combination with HR-HPV typing for the screening of anal intraepithelial neoplasia improved the detection of HSIL in women.