Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom.
Faculty of Medicine of the University of Porto, Portugal.
Clin Infect Dis. 2018 Sep 28;67(8):1262-1268. doi: 10.1093/cid/ciy273.
Information on the performance of anal cytology in women who are high risk for human papillomavirus-related lesions and the factors that might influence cytology are largely lacking.
Retrospective study including all new referrals of women with a previous history of anogenital neoplasia from January 2012 to July 2017, with concomitant anal cytology and high-resolution anoscopy with or without biopsies.
Six hundred and thirty six anal cytology samples and 323 biopsies obtained from 278 women were included. Overall sensitivity and specificity of "any abnormality" on anal cytology to predict any abnormality in histology was 47% (95% confidence interval [CI], 41%-54%) and 84% (95% CI, 73%-91%), respectively. For detecting high-grade squamous intraepithelial lesions (HSIL)/cancer, sensitivity was 71% (95% CI, 61%-79%) and specificity was 73% (95% CI, 66%-79%). There was a poor concordance between cytological and histological grades (κ = 0.147). Cytology had a higher sensitivity to predict HSIL/cancer in immunosuppressed vs nonimmunosuppressed patients (92% vs 60%, P = .002). The sensitivity for HSIL detection was higher when 2 or more quadrants were affected compared with 1 (86% vs 57%, P = .006). A previous history of vulvar HSIL/cancer (odds ratio [OR], 1.71, 1.08-2.73; P = .023), immunosuppression (OR, 1.88, 1.17-3.03; P = .009), and concomitant genital HSIL/cancer (OR, 2.51, 1.47-4.29; P = .001) were risk factors for abnormal cytology.
Women characteristics can influence the performance of anal cytology. The sensitivity for detecting anal HSIL/cancer was higher in those immunosuppressed and with more extensive disease.
有关人乳头瘤病毒相关病变高危女性的肛门细胞学表现以及可能影响细胞学的因素的信息在很大程度上尚不清楚。
本回顾性研究纳入了 2012 年 1 月至 2017 年 7 月期间因肛门生殖器肿瘤病史而新转诊的所有女性，她们均进行了肛门细胞学检查和高分辨率肛门镜检查（伴或不伴活检）。
共纳入 278 例女性的 636 例肛门细胞学样本和 323 例活检。肛门细胞学检查“任何异常”预测组织学任何异常的总敏感性和特异性分别为 47%（95%CI，41%-54%）和 84%（95%CI，73%-91%）。对于检测高级别鳞状上皮内病变（HSIL）/癌症，敏感性为 71%（95%CI，61%-79%），特异性为 73%（95%CI，66%-79%）。细胞学和组织学分级之间一致性较差（κ=0.147）。与非免疫抑制患者相比，免疫抑制患者的细胞学检查对 HSIL/癌症的预测敏感性更高（92%比 60%，P=0.002）。当 2 个或更多象限受累时，HSIL 检测的敏感性高于 1 个象限（86%比 57%，P=0.006）。外阴 HSIL/癌症史（比值比[OR]，1.71，1.08-2.73；P=0.023）、免疫抑制（OR，1.88，1.17-3.03；P=0.009）和同时存在生殖器 HSIL/癌症（OR，2.51，1.47-4.29；P=0.001）是细胞学异常的危险因素。
女性特征可能会影响肛门细胞学检查的表现。在免疫抑制和疾病范围较广的患者中，检测肛门 HSIL/癌症的敏感性更高。
