比较 3 种高危人群中使用细胞学和人乳头瘤病毒 DNA 检测的肛门癌筛查算法。

Comparing Anal Cancer Screening Algorithms Using Cytology and Human Papillomavirus DNA Testing in 3 High-Risk Populations.

机构信息

Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

出版信息

J Infect Dis. 2021 Sep 1;224(5):881-888. doi: 10.1093/infdis/jiaa801.

DOI:10.1093/infdis/jiaa801

PMID:33388757

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8408769/

Abstract

BACKGROUND

Screening strategies for high-risk human papillomavirus (hrHPV)-associated anal cancer are evolving. Herein, we compare anal cytology to hrHPV DNA testing and 2 novel cytology/hrHPV cotesting algorithms among 3 high-risk populations.

METHODS

Anal cytology, hrHPV DNA testing, and high-resolution anoscopy (HRA)-guided biopsy results were analyzed from 1837 participants (1504 HIV-infected men who have sex with men (MSM), 155 HIV-uninfected MSM, and 178 HIV-infected women). Performance to detect histological high-grade squamous intraepithelial lesions (HSIL)/cancer was compared between 4 strategies with distinct HRA referral thresholds: cytology (atypical squamous cells of undetermined significance, ASCUS); hrHPV testing (any hrHPV positive); algorithm A (benign cytology/HPV16/18 positive or ASCUS/hrHPV positive); and algorithm B (benign or ASCUS/hrHPV positive).

RESULTS

Histological HSIL/cancer was detected in 756 (41%) participants. Cytology had the lowest sensitivity (0.76-0.89) but highest specificity (0.33-0.36) overall and for each subgroup. Algorithm B was the most sensitive strategy overall (0.97) and for MSM (HIV-infected 0.97; HIV-uninfected 1.00). For women, hrHPV testing and both algorithms yielded higher sensitivity than cytology (0.96, 0.98, and 0.96). Specificity was low for all strategies/subgroups (range, 0.16-0.36).

CONCLUSIONS

Screening algorithms that incorporate cytology and hrHPV testing significantly increased sensitivity but decreased specificity to detect anal precancer/cancer among high-risk populations.

摘要

背景

高危型人乳头瘤病毒（hrHPV）相关肛门癌的筛查策略正在不断发展。在此，我们比较了分析细胞学、hrHPV DNA 检测以及 3 种高危人群中 2 种新型细胞学/HPV 联合检测算法。

方法

对 1837 名参与者（1504 名 HIV 感染的男男性行为者[MSM]、155 名 HIV 未感染的 MSM 和 178 名 HIV 感染的女性）的肛门细胞学、hrHPV DNA 检测和高分辨率肛门镜（HRA）引导活检结果进行了分析。通过 4 种不同的 HRA 转诊阈值的策略来比较对组织学高级别鳞状上皮内病变（HSIL）/癌症的检测性能：细胞学（非典型意义不明确的鳞状细胞，ASCUS）；hrHPV 检测（任何 hrHPV 阳性）；算法 A（良性细胞学/HPV16/18 阳性或 ASCUS/hrHPV 阳性）；和算法 B（良性或 ASCUS/hrHPV 阳性）。

结果

756 名（41%）参与者中发现了组织学 HSIL/癌症。细胞学的总体和每个亚组的敏感性最低（0.76-0.89），但特异性最高（0.33-0.36）。算法 B 是总体上最敏感的策略（0.97），对于 MSM（HIV 感染的为 0.97；HIV 未感染的为 1.00）。对于女性，hrHPV 检测和两种算法的敏感性均高于细胞学（0.96、0.98 和 0.96）。所有策略/亚组的特异性均较低（范围为 0.16-0.36）。