Tamizaje con citología anal en mujeres con lesiones premalignas del cuello uterino

Josefina Tarigo; Fernanda Nozar; Diego Greif; Sebastián Ben; Benedicta Caserta; Carolina Viera; Silvana Vitale; Laura Rubano; Leonel Briozzo

doi:10.29193/RMU.39.1.8

Authors

Josefina Tarigo Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Clínica Ginecotocológica A
Fernanda Nozar Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Clínica Ginecotocológica A
Diego Greif Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Clínica Ginecotocológica A
Sebastián Ben Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Clínica Ginecotocológica A
Benedicta Caserta Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Departamento de Anatomía Patológica
Carolina Viera Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Departamento de Anatomía Patológica
Silvana Vitale Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Departamento de Tracto Genital Inferior
Laura Rubano Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Clínica Ginecotocológica A
Leonel Briozzo Universidad de la República, Facultad de Medicina, Hospital Pereira Rossell, Clínica Ginecotocológica A

DOI:

https://doi.org/10.29193/RMU.39.1.8

Keywords:

SCREENING, ANAL CYTOLOGY, CERVICAL INTRAEPITHELIAL NEOPLASIA, HUMAN PAPILLOMA VIRUS

Abstract

Objective: the main objective of the study was to assess the prevalence of anal cytology in women with a history of cervical intraepithelial neoplasia.
Method: cohort transversal study conducted from May, 2018 until August, 2020 at Pereira Rossell Hospital. Two cohorts were studied, one of which included women with a diagnosis of cervical intraepithelial neoplasia and the other one included healthy women who attended their routine follow up, in a 2:1 ratio. The total size of the sample was 205 patients, 135 of which were patients with cervical intraepithelial neoplasia (confidence interval being 95%), presuming a 10% prevalence of anal pre-neoplasic lesions. The sample size of the control cohort was 70 patients as per the pre-defined ratio.
Results: a association was found between the presence of malignant lesions of the cervix and epithelial anomalies detected in the anal cytology, with a prevalence coefficient of 1.77 (CI: 95%: 1,19 – 2,62) and odds ratio of 2,69 (1,36 – 5,30). No significant differences were found between race, type of sexual relationships or smoking variables.
Conclusions: our study concludes there is an association between cervical intraepithelial neoplasia related to HPV and pathological anal screening.

References

1) Santoso J, Long M, Crigger M, Wan J, Haefner H. Anal intraepithelial neoplasia in women with genital intraepithelial neoplasia. Obstet Gynecol 2010; 116(3):578-82. doi: 10.1097/AOG.0b013e3181ea1834.
2) Roberts J, Jin F, Thurloe J, Ekman D, Adams M, McDonald R, et al. The value of a transformation zone component in anal cytology to detect HSIL. Cancer Cytopathol. 2016 Aug;124(8):596-601. doi: 10.1002/cncy.21730.
3) Cronin B, Bregar A, Luis C, Schechter S, Disilvestro P, Pisharodi L, et al. Evaluation of anal cytology and dysplasia in women with a history of lower genital tract dysplasia and malignancy. Gynecol Oncol 2016; 141(3):492-6. doi: 10.1016/j.ygyno.2016.04.015.
4) Stier E, Sebring M, Mendez A, Ba F, Trimble D, Chiao E. Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review. Am J Obstet Gynecol 2015; 213(3):278-309. doi: 10.1016/j.ajog.2015.03.034.
5) Leeds I, Fang S. Anal cancer and intraepithelial neoplasia screening: a review. World J Gastrointest Surg 2016; 8(1):41-51. doi: 10.4240/wjgs.v8.i1.41.
6) Darragh T, Colgan T, Cox J, Heller D, Henry M, Luff R, et al. The lower anogenital squamous terminology standardization project for hpv-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Arch Pathol Lab Med 2012; 136(10):1266-97. doi: 10.5858/arpa.LGT200570.
7) de Martel C, Georges D, Bray F, Ferlay J, Clifford G. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob Health 2020; 8(2):e180-e190. doi: 10.1016/S2214-109X(19)30488-7.
8) Bower M, Powles T, Newsom-Davis T, Thirlwell C, Stebbing J, Mandalia S, et al. HIV-associated anal cancer: has highly active antiretroviral therapy reduced the incidence or improved the outcome? J Acquir Immune Defic Syndr 2004; 37(5):1563-5. doi: 10.1097/00126334-200412150-00004.
9) Centros para el Control y la Prevención de Enfermedades. División de Prevención y Control del Cáncer. Estadísticas sobre el cáncer asociado al VPH. Tasas de cáncer anal asociado al VPH por raza y etnia. Disponible en: https://www.cdc.gov/spanish/cancer/hpv/statistics/anal.htm. (Consulta: noviembre 2020).
10) Comisión Honoraria de lucha Contra el Cáncer. Registro Nacional del Cáncer. Situación epidemiológica del Uruguay en relación con el cáncer. Incidencia de cáncer en el período de cinco años 2012-2016. Tendencia de mortalidad por cáncer hasta 2018. Montevideo: CHLCC, 2020.
11) ElNaggar A, Santoso J. Risk factors for anal intraepithelial neoplasia in women with genital dysplasia. Obstet Gynecol 2013; 122(2 Pt 1):218-23. doi: 10.1097/AOG.0b013e31829a2ace.
12) Lin C, Slama J, Gonzalez P, Goodman M, Xia N, Kreimer A, et al. Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis. Lancet Infect Dis 2019; 19(8):880-91. doi: 10.1016/S1473-3099(19)30164-1.
13) Nayar R, Wilbur D. El Sistema Bethesda para reportar citología cervical: definiciones, criterrios y notas aclaratorias. 3 ed. Buenos Aires: Journal, 2016.
14) World Health Organization. Who Classification of Tumours; female genital tumours. 5 ed. Geneva; WHO, 2020. Disponible en: https://publications.iarc.fr/592. (Consulta: noviembre 2020).
15) Tatti S, Suzuki V, Fleider L, Maldonado V, Caruso R, Tinnirello M. Anal intraepithelial lesions in women with human papillomavirus-related disease. J Low Genit Tract Dis 2012; 16(4):454-9. doi: 10.1097/LGT.0b013e31825d2d7a.
16) Aguiar C, Jaumandreu S, Álvarez C, Rodríguez M, Ortega C. Lesiones rectas por VPH, diagnóstico por PAP anal y anoscopia de alta resolución con biopsias: primera serie en Uruguay. Rev Méd Urug 2015; 31(2):97-102.
17) Fokom Domgue J, Messick C, Milbourne A, Guo M, Salcedo M, Dahlstrom K, et al. Prevalence of high-grade anal dysplasia among women with high-grade lower genital tract dysplasia or cancer: Results of a pilot study. Gynecol Oncol 2019; 153(2):266-70. doi: 10.1016/j.ygyno.2019.02.024.
18) Holly E, Ralston M, Darragh T, Greenblatt R, Jay N, Palefsky J. Prevalence and risk factors for anal squamous intraepithelial lesions in women. J Natl Cancer Inst 2001; 93(11):843-9. doi: 10.1093/jnci/93.11.843.
19) Slama J, Sehnal B, Dusek L, Zima T, Cibula D. Impact of risk factors on prevalence of anal HPV infection in women with simultaneous cervical lesion. Neoplasma 2015; 62(2):308-14. doi: 10.4149/neo_2015_037.
20) Simard E, Watson M, Saraiya M, Clarke C, Palefsky J, Jemal A. Trends in the occurrence of high-grade anal intraepithelial neoplasia in San Francisco: 2000-2009. Cancer 2013; 119(19):3539-45. doi: 10.1002/cncr.28252.
21) Long K, Menon R, Bastawrous A, Billingham R. Screening, surveillance, and treatment of anal intraepithelial neoplasia. Clin Colon Rectal Surg 2016; 29(1):57-64. doi: 10.1055/s-0035-1570394.
22) Willeford W, Bachmann L. Uncertainty Abounds in the World of Anal Dysplasia Screening. Sex Transm Dis 2016; 43(7):436-7. doi: 10.1097/OLQ.0000000000000467.
23) Alam N, White D, Narang S, Daniels I, Smart N. Systematic review of guidelines for the assessment and management of high-grade anal intraepithelial neoplasia (AIN II/III). Colorectal Dis 2016; 18(2):135-46. doi: 10.1111/codi.13215.
24) Bull-Henry K, Morris B, Buchwald U. The importance of anal cancer screening and high-resolution anoscopy to gastroenterology practice. Curr Opin Gastroenterol 2020; 36(5):393-401. doi: 10.1097/MOG.0000000000000661.