Vajdic C M, Anderson J S, Hillman R J, Medley G, Grulich A E
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, 2010, Australia.
Sex Transm Infect. 2005 Oct;81(5):415-8. doi: 10.1136/sti.2004.014407.
Anal cytology smears are either collected "blind" (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability.
Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure.
Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as "unsatisfactory" for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p < 0.001).
Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.
肛门细胞学涂片采集方法有“盲目”采集（将拭子插入肛管4厘米并旋转）或通过肛门镜引导采集（观察转化区后取样）。我们比较了这两种涂片技术在样本质量和患者可接受性方面的差异。
采用配对随机序列临床试验，151名男同性恋者（95名HIV阳性）在一次就诊时接受了两种涂片技术；涂片顺序随机，标本阅片时采用盲法。两种技术均使用涂有聚酯纤维的拭子，并用水润滑。细胞学标本采用液基采集法（ThinPrep）制备。观察指标包括细胞学标本的充分性、细胞学分类、直肠柱状细胞、鳞状细胞和化生细胞的存在情况、污染情况、患者舒适度和可接受性以及ThinPrep程序后剩余的液体量。
无论涂片顺序如何，通过肛门镜引导采集的涂片检测到高级别异常的可能性低于盲目采集的涂片（分别为15例和27例，p = 0.001）。在控制涂片顺序后，通过肛门镜引导采集的涂片在细胞学评估中更有可能被判定为“不满意”（比值比6.93，95%可信区间1.92至24.94），且与盲目采集的涂片相比，含有较少的鳞状细胞（比值比0.20，95%可信区间0.04至0.94）和化生细胞（比值比0.12，95%可信区间0.03至0.54）；两种技术之间没有其他统计学上的显著差异。无论采用哪种涂片技术，首次进行的涂片检测到高级别异常的可能性均高于第二次进行的涂片（分别为23例和8例，p < 0.001）。
在男同性恋者肛门肿瘤筛查中，盲目细胞学涂片优于肛门镜引导涂片。
