Department of Gastroenterology, Surgical Division, University of São Paulo, School of Medicine, São Paulo, SP, 01308-050, Brazil.
Dis Colon Rectum. 2009 Nov;52(11):1854-60. doi: 10.1007/DCR.0b013e3181b98f36.
The purpose of this study was to analyze the agreement between anal Pap smear and high-resolution anoscopy-guided biopsy in diagnosing anal dysplasia in HIV-infected patients.
We conducted cross-sectional analysis of HIV-infected patients receiving anal dysplasia screening as part of routine care. Agreement between measures was estimated by weighted kappa statistics, using a three-tiered cytologic and histologic grading system (normal, low-grade dysplasia, and high-grade dysplasia). Estimates of sensitivity, specificity, and predictive values were calculated using a two-tiered cytologic and histologic grading system ("without dysplasia" and "with dysplasia of any grade"). Estimates were also calculated for the detection of high-grade dysplasia.
During a one-year period, 222 patients underwent 330 anal Pap smears followed by high-resolution anoscopy-guided biopsies. There were 311 satisfactory Pap smears with concurrent biopsies. Considering histology the standard, the frequency of anal dysplasia was 46%. Kappa agreement between anal Pap smear and biopsy was 0.20. For detection of anal dysplasia of any grade, anal Pap smear showed sensitivity of 61%, specificity of 60%, positive predictive value of 56%, and negative predictive value of 64%. For high-grade dysplasia, anal Pap smear showed sensitivity of 16% and specificity of 97%.
Anal Pap smears alone were not sensitive enough to rule out anal dysplasia. We recommend that high-resolution anoscopy-guided biopsy be incorporated as a complementary screening test for anal dysplasia in high-risk patients. Following baseline high-resolution anoscopy, these individuals could be followed with serial anal cytology to dictate the need for future high-resolution anoscopy-guided biopsies.
本研究旨在分析肛门巴氏涂片与高分辨率肛门镜引导下活检在诊断 HIV 感染患者肛门发育不良中的一致性。
我们对接受肛门发育不良筛查的 HIV 感染患者进行了横断面分析，该筛查是常规护理的一部分。使用细胞和组织学三级分级系统（正常、低级别发育不良和高级别发育不良），通过加权 kappa 统计来评估测量之间的一致性。使用细胞和组织学两级分级系统（“无发育不良”和“任何级别发育不良”）计算敏感性、特异性和预测值的估计值。还计算了高级别发育不良的检出率。
在一年期间，222 名患者接受了 330 次肛门巴氏涂片检查，随后进行了高分辨率肛门镜引导下活检。有 311 例满意的巴氏涂片与同期活检相匹配。考虑到组织学为标准，肛门发育不良的频率为 46%。肛门巴氏涂片与活检之间的kappa 一致性为 0.20。对于任何级别的肛门发育不良的检测，肛门巴氏涂片的敏感性为 61%，特异性为 60%，阳性预测值为 56%，阴性预测值为 64%。对于高级别发育不良，肛门巴氏涂片的敏感性为 16%，特异性为 97%。
单独的肛门巴氏涂片检查不足以排除肛门发育不良。我们建议将高分辨率肛门镜引导下活检作为高危患者肛门发育不良的补充筛查试验。在基线高分辨率肛门镜检查后，这些患者可以通过连续的肛门细胞学检查来决定是否需要进一步的高分辨率肛门镜引导下活检。
