University Health Network, Toronto General Hospital, Ontario, Canada.
AIDS. 2010 Jun 1;24(9):1307-13. doi: 10.1097/QAD.0b013e328339e592.
To assess anal oncogenic human papillomavirus (HPV) and anal cytology as screening tests for detecting high-grade anal intraepithelial neoplasia (AIN 2+), as this is an immediate anal cancer precursor.
Cross-sectional study of 401 HIV-positive men who have sex with men (MSM). The endpoint was histologically confirmed AIN 2+ obtained by high-resolution anoscopy. Cytology and biopsy specimens were assigned random numbers and independently assessed by two pathologists.
We did concomitant anal cytology, anal HPV testing and HRA with directed biopsies without knowing the results of each intervention. The main outcome measures were the sensitivity, specificity, negative predictive value and positive predictive value of anal cytology and oncogenic HPV for the detection of AIN 2+.
Cytology was abnormal in 67% of patients: high-grade squamous intraepithelial lesion, 12%; low-grade squamous intraepithelial lesion, 43% and atypical squamous cells of undetermined significance, 12%. Biopsies were abnormal in 68% of patients: AIN 2+, 25% and AIN 1, 43%. HPV was detected in 93% with multiple HPV types in 92% and oncogenic HPV types in 88%. Test performance characteristics for the detection of AIN 2+ using any abnormality on anal cytology were: sensitivity 84%, specificity 39%, negative predictive value 88% and positive predictive value 31%; using oncogenic HPV: sensitivity 100%, specificity 16%, negative predictive value 100% and positive predictive value 28%.
Anal cytology and HPV detection have high sensitivity but low specificity for detecting AIN 2+. HIV-positive men who have sex with men have a high prevalence of AIN 2+ and require high-resolution anoscopy for optimal detection of high-grade anal dysplasia.
评估肛门致癌型人乳头瘤病毒（HPV）和肛门细胞学检查作为筛查试验，以检测高级别肛门上皮内瘤变（AIN2+），因为这是一种直接的肛门癌前体。
对 401 名 HIV 阳性男男性接触者（MSM）进行的横断面研究。终点是通过高分辨率肛门镜检查获得的组织学证实的 AIN2+。细胞学和活检标本被分配了随机号码，并由两名病理学家独立评估。
我们同时进行肛门细胞学检查、肛门 HPV 检测和 HRA，并进行有针对性的活检，而不知道每种干预措施的结果。主要观察指标是肛门细胞学和致癌 HPV 检测对 AIN2+的敏感性、特异性、阴性预测值和阳性预测值。
细胞学检查异常率为 67%：高级别鳞状上皮内病变，12%；低级别鳞状上皮内病变，43%；非典型鳞状细胞意义不明确，12%。活检异常率为 68%：AIN2+，25%；AIN1，43%。HPV 检测阳性率为 93%，92%存在多种 HPV 类型，88%存在致癌 HPV 类型。使用任何肛门细胞学异常检测 AIN2+的检测性能特征为：敏感性 84%，特异性 39%，阴性预测值 88%，阳性预测值 31%；使用致癌 HPV：敏感性 100%，特异性 16%，阴性预测值 100%，阳性预测值 28%。
肛门细胞学检查和 HPV 检测对检测 AIN2+具有高敏感性，但特异性低。HIV 阳性男男性接触者的 AIN2+患病率较高，需要进行高分辨率肛门镜检查，以最佳检测高级别肛门发育不良。
