对转诊至公共性健康诊所的患者进行配对肛门细胞学和组织病理学结果的审计。

Audit of paired anal cytology and histopathology outcomes in patients referred to a public sexual health clinic.

作者信息

Williams Vincent M, Metcalf Cecily, French Martyn A, McCloskey Jenny C

机构信息

Western Australian Biomedical Research Institute, Curtin University of Technology, Perth, WA, Australia.

出版信息

Sex Health. 2010 Sep;7(3):346-51. doi: 10.1071/SH09118.

DOI:10.1071/SH09118

PMID:20719226

Abstract

BACKGROUND

The level of agreement between anal cytology and histopathology is not clear with only a few studies evaluating the reliability of anal specimen reporting. Australian data in relation to this are limited.

METHODS

The results of paired anal cytology and histopathology specimens received between 2002 and 2008 from patients who were referred within the sexual health clinic were retrieved from the anatomical pathology database. A total of 248 paired samples from 154 (21 females, 133 males) participants were extracted. Concurrent high risk human papilloma virus (hrHPV) DNA assay and HIV status for the study group were also collected. Data were tabulated according to reported grade of squamous abnormality based on the Bethesda system. Using the biopsy result as the gold standard the specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for cytology were calculated and the association between grade of abnormality, HIV status and hrHPV infection estimated.

RESULTS

Concordance between cytology and histology showed that in 204 (85%) paired samples both tests were categorised as abnormal (Kappa statistic 0.73, P = 0.013). The cytology result showed a sensitivity of 96%, specificity 14%, PPV 89% and NPV 31% when compared with histopathology. HrHPV assay was positive in 192 (80%) samples. High-grade squamous abnormalities were reported in biopsy specimens from 60% (n = 42/67) of HIV-positive subjects and 25% (n = 22/87) of HIV-negative subjects. HIV-positive individuals were more likely to be hrHPV positive, odds ratio (OR) 6.21 [95% confidence interval (CI) 2.69 to 14.34], when compared with HIV-negative subjects.

CONCLUSION

Anal cytology is highly sensitive for the detection of abnormal squamous cells. While cytology has low specificity for predicting the grade of abnormality compared with biopsy outcome, its application as a screening method in asymptomatic at risk populations warrants further study.

摘要

背景

仅有少数研究评估了肛门标本报告的可靠性，肛门细胞学与组织病理学之间的一致性水平尚不清楚。澳大利亚关于这方面的数据有限。

方法

从解剖病理学数据库中检索2002年至2008年期间性健康诊所转诊患者的配对肛门细胞学和组织病理学标本的结果。共提取了来自154名参与者（21名女性，133名男性）的248对样本。还收集了研究组的同时期高危人乳头瘤病毒（hrHPV）DNA检测结果和HIV状态。根据基于贝塞斯达系统报告的鳞状上皮异常等级将数据制成表格。以活检结果作为金标准，计算细胞学的特异性、敏感性、阳性预测值（PPV）和阴性预测值（NPV），并估计异常等级、HIV状态和hrHPV感染之间的关联。

结果

细胞学与组织学之间的一致性表明，在204对（85%）样本中，两项检测均被归类为异常（卡方统计量0.73，P = 0.013）。与组织病理学相比，细胞学结果显示敏感性为96%，特异性为14%，PPV为89%，NPV为31%。192份（80%）样本的hrHPV检测呈阳性。HIV阳性受试者的活检标本中有60%（n = 42/67）报告有高级别鳞状上皮异常，HIV阴性受试者中有25%（n = 22/87）报告有高级别鳞状上皮异常。与HIV阴性受试者相比，HIV阳性个体更有可能hrHPV呈阳性，优势比（OR）为6.21 [95%置信区间（CI）2.69至14.34]。