Proctology Service-Medical Intervention, Diaconesses-Croix St Simon Group Hospitals, Paris, France.
Cancer. 2012 Dec 15;118(24):6031-8. doi: 10.1002/cncr.27671. Epub 2012 Jun 6.
The performance of cytologic screening and its correlation with histology and polymerase chain reaction (PCR) detection of human papillomavirus (HPV) DNA have not been evaluated in populations with a low prevalence of anal intraepithelial neoplasia (AIN). The objective of the current study was to analyze the significance of abnormal smears relative to the histology and PCR detection of HPV DNA.
A cytologic smear and a viral sample were taken in 300 consecutive patients undergoing surgery (Milligan-Morgan hemorrhoidectomy and/or fissurectomy) who gave their informed consent.
The cytologic smear was normal in 216 of 290 patients (74.5%). Four high-grade and 19 low-grade intraepithelial neoplastic lesions were identified. In 5 patients, high-grade lesions could not be excluded, 30 lesions were of undetermined significance, and there were 16 cellular modifications with a non-neoplastic appearance. The PCR test for HPV was positive in 18.7% of patients, and a high-risk genotype was identified in 63.6% of positive samples. Histologic examination of the surgical samples was normal in 92.3% of patients. The 23 AIN samples were distributed as follows: 13 grade 1 AIN (AIN1), 6 AIN2, and 4 AIN3. The sensitivity of cytologic smears and PCR for detecting AIN was 56% and 60.8%, respectively, and specificity was 77% and 84.5%, respectively. Combining the 2 tests increased sensitivity to 78% but decreased specificity to 68%.
Compared with a large surgical sample, anal cytologic Papanicolaou smears and HPV PCR exhibited sensitivity and specificity that varied, depending on the risk of HPV infection and AIN. Positive HPV DNA screening increased with AIN grade, and high-risk HPV testing was particularly helpful.
细胞学筛查的表现及其与组织学和聚合酶链反应（PCR）检测人乳头瘤病毒（HPV）DNA 的相关性尚未在肛门上皮内瘤变（AIN）发生率较低的人群中进行评估。本研究的目的是分析异常涂片相对于 HPV DNA 的组织学和 PCR 检测的意义。
对 300 例连续接受手术（Milligan-Morgan 痔切除术和/或肛裂切除术）并同意知情的患者进行细胞学涂片和病毒样本采集。
290 例患者中有 216 例（74.5%）细胞学涂片正常。发现 4 例高级别和 19 例低级别上皮内瘤变。在 5 例患者中，不能排除高级别病变，30 例病变意义不明，16 例细胞形态改变呈非肿瘤性。HPV 的 PCR 检测在 18.7%的患者中呈阳性，在阳性样本中发现 63.6%为高危型。92.3%的患者手术样本组织学检查正常。23 例 AIN 样本分布如下：13 例 AIN1 级（AIN1）、6 例 AIN2 级和 4 例 AIN3 级。细胞学涂片和 PCR 检测 AIN 的敏感性分别为 56%和 60.8%，特异性分别为 77%和 84.5%。将 2 项检测结合起来可将敏感性提高到 78%，但特异性降低到 68%。
与大的手术样本相比，肛门细胞学巴氏涂片和 HPV PCR 显示出不同的敏感性和特异性，这取决于 HPV 感染和 AIN 的风险。HPV DNA 筛查阳性率随 AIN 分级而增加，高危型 HPV 检测尤其有帮助。
