Chen Cheng-Chieh, Chou Yuh-Yu
Department of Pathology and Laboratory Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China.
Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.
Diagn Cytopathol. 2019 Apr;47(4):307-314. doi: 10.1002/dc.24078. Epub 2019 Jan 3.
Anal intraepithelial neoplasia (AIN) refers to a precancerous lesion of anal squamous cell carcinoma (SCC). Human papillomavirus (HPV) is considered a crucial risk factor for AIN. Individuals with high-risk sexual behaviour, such as receptive anal intercourse and multiple sexual partners, as well as men who have sex with men exhibit a relatively high rate of AIN. The anal cytology is a screening method for AIN in high-risk individuals, and patients with abnormal anal cytology may benefit from high-resolution anoscopy. This study explored the predictive value of the anal cytology for the detection of AIN or worse (AIN+).
We searched the databases of PubMed, BioMed Central, Cochrane Library, and Google Scholar for relevant studies. Studies on the diagnostic efficacy of the anal cytology for predicting anal cancer on a per-patient basis were included. We excluded review articles. Either prospective trials or retrospective studies were included. We performed the meta-analysis by using a random-effects model to generate a pooled sensitivity, specificity, and diagnostic odds ratio (DOR). All analyses were performed using the MetaDiSc version 1.4 software (Universidad Complutense, Madrid, Spain).
Twelve studies with 2541 participants were retrieved. The meta-analysis of the studies assessing the predictive value of the anal cytology for detecting AIN+ generated a pooled sensitivity of 0.79 (95% confidence interval [CI], 0.77-0.82) and a pooled specificity of 0.66 (95% CI, 0.64-0.69). The pooled DOR for the anal cytology was 5.31 (95% CI, 3.31-8.49).
Our results revealed that the anal cytology might be effective in diagnosing AIN+.
肛管上皮内瘤变（AIN）是指肛管鳞状细胞癌（SCC）的癌前病变。人乳头瘤病毒（HPV）被认为是AIN的关键危险因素。有高危性行为的个体，如接受肛交和多个性伴侣，以及男男性行为者AIN发生率相对较高。肛门细胞学检查是高危个体AIN的筛查方法，肛门细胞学检查异常的患者可能从高分辨率肛门镜检查中获益。本研究探讨了肛门细胞学检查对AIN或更严重病变（AIN+）检测的预测价值。
我们检索了PubMed、BioMed Central、Cochrane图书馆和谷歌学术数据库中的相关研究。纳入了关于肛门细胞学检查对个体诊断肛管癌的诊断效能的研究。我们排除了综述文章。纳入前瞻性试验或回顾性研究。我们使用随机效应模型进行荟萃分析，以生成合并敏感性、特异性和诊断比值比（DOR）。所有分析均使用MetaDiSc版本1.4软件（西班牙马德里康普顿斯大学）进行。
检索到12项研究，共2541名参与者。对评估肛门细胞学检查对AIN+检测预测价值的研究进行荟萃分析，得出合并敏感性为0.79（95%置信区间[CI]，0.77 - 0.82），合并特异性为0.66（95%CI，0.64 - 0.69）。肛门细胞学检查的合并DOR为5.31（95%CI，3.31 - 8.49）。
我们的结果表明，肛门细胞学检查可能对诊断AIN+有效。
