Wiley Dorothy JoAnn, Hsu Hilary, Bolan Robert, Voskanian Alen, Elashoff David, Young Stephen, Dayrit Ruvy, Barman Provaboti, DeAzambuja Katherine, Masongsong Emmanuel V, Martínez-Maza Otoniel, Detels Roger
1Translational Science Section, School of Nursing, University of California at Los Angeles, Los Angeles; 2Los Angeles Gay and Lesbian Center, Jeffrey Goodman Clinic, Hollywood; 3Center for Clinical AIDS Research and Education (University of California at Los Angeles-CARE Center); 4Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles; and 5Jonsson Comprehensive Cancer Center, Los Angeles, CA; 6Tricore Diagnostic Laboratories, University of New Mexico, Albuquerque, NM; and 7University of California at Los Angeles AIDS Institute; and 8Department of Obstetrics and Gynecology, David Geffen School of Medicine, and 9Jonathan & Karin Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA.
J Low Genit Tract Dis. 2013 Oct;17(4):414-24. doi: 10.1097/LGT.0b013e318281d36e.
Nylon-flocked and Dacron swab anal cytology collection procedures were evaluated for detecting high-grade anal intraepithelial neoplasia.
Cross-sectional data for 42 HIV-infected and 16 uninfected men who have sex with men have been used. Sequentially collected anal cytology specimens, high-resolution anoscopy, and medical biopsy evaluated the sensitivity and specificity of cytology for predicting high-grade anal intraepithelial neoplasia. Men showing atypical squamous cells (ASC) or more severe findings by cytology were compared with those showing negative for intraepithelial lesions.
The prevalence of high-grade anal intraepithelial neoplasia was 35% (21/58), and findings were approximately 1.5 times higher among HIV-infected compared with uninfected men. Unsatisfactory cytology was twice as common among Dacron compared with nylon-flocked swab protocol specimens (14% [8/58] vs 7% [4/58]). Sensitivity and specificity for the nylon-flocked protocol cytology showing ASC or more severe findings were 81% (58%-95%) and 73% (50%-89%), respectively. Dacron protocol specimens showed 52% (30%-74%) and 58% (34%-80%) sensitivity and specificity, respectively. Men showing ASC or more severe findings using the nylon-flocked protocol cytology showed 3-fold higher odds for high-grade anal intraepithelial neoplasia compared with men with negative results (p < .05), but no statistically significantly higher odds of high-grade anal intraepithelial neoplasia for men showing ASC or more severe findings compared with those with negative results for Dacron protocol cytology (p > .05).
The nylon-flocked protocol better detects high-grade anal intraepithelial neoplasia than does the Dacron protocol, yields more interpretable results, and classifies men with high-grade anal intraepithelial neoplasia as cytologically abnormal 2.5 times more often, even in this small clinical trial.
NCT00955591.
评估尼龙植绒拭子和涤纶拭子肛门细胞学采集程序在检测高级别肛门上皮内瘤变中的效果。
使用了42名感染HIV和16名未感染HIV的男男性行为者的横断面数据。通过顺序采集肛门细胞学标本、高分辨率肛门镜检查和医学活检，评估了细胞学检测高级别肛门上皮内瘤变的敏感性和特异性。将细胞学检查显示非典型鳞状细胞（ASC）或更严重结果的男性与上皮内病变呈阴性的男性进行比较。
高级别肛门上皮内瘤变的患病率为35%（21/58），感染HIV的男性的患病率比未感染HIV的男性高约1.5倍。与尼龙植绒拭子方案标本相比，涤纶拭子标本中细胞学检查结果不满意的情况常见两倍（14% [8/58] 对7% [4/58]）。尼龙植绒拭子方案细胞学检查显示ASC或更严重结果的敏感性和特异性分别为81%（58%-95%）和73%（50%-89%）。涤纶拭子方案标本的敏感性和特异性分别为52%（30%-74%）和58%（34%-80%）。与结果为阴性的男性相比，使用尼龙植绒拭子方案细胞学检查显示ASC或更严重结果的男性发生高级别肛门上皮内瘤变的几率高3倍（p < 0.05），但与涤纶拭子方案细胞学检查结果为阴性的男性相比，显示ASC或更严重结果的男性发生高级别肛门上皮内瘤变的几率在统计学上无显著升高（p > 0.05）。
即使在这项小型临床试验中，尼龙植绒拭子方案在检测高级别肛门上皮内瘤变方面也比涤纶拭子方案更好，能产生更具可解释性的结果，并且将高级别肛门上皮内瘤变男性归类为细胞学异常的频率高出2.5倍。
NCT00955591。
