HPV Rectal lesions, diagnosis with anal PAP and high resolution anoscopy with biopsies
First series in Uruguay
Keywords:
ANUS NEOPLASMS, PAPILLOMAVIRUS INFECTIONS, PAPANICOLAU TESTAbstract
Introduction: the incidence of anal cáncer has doubled in the last decades. The HPV is the cause for the most frequent sexually transmitted disease in the world, and causes 90% of anal cancers.
This is the first time a protocol for screening rectoanal neoplasias is followed in Uruguay, using PAPs and high resolution anoscopies with biopsies.
Objetives: to describe rectoanal lesions associated with HPV in a population of patients belonging to risk groups with anal PAP (citology) and biopsies with high resolution anoscopy with aceto-whitening. To compare the diagnostic yield of anal PAP with histology in high resolution anoscopy with aceto-whitening guided biopsy samples (golden standard).
Method: we conducted a statistical description of the population studied. We conducted the agreement test (Kappa coefficient). Internal validity coefficients were calculated (sensitivity and specificity). The Epi-Info version 3.5.1 statistics package was used to process the information.
Results: 60 patients were considered for the study, average age was 33 years old, 78% were female. The Kappa coefficient for agreement between histology and the cell classification with PAP was 0.403, IC 95% (0.17-0.63). PAPA sensitivity was 92%, specificity was 46%.
Conclusion: the sensitivity of anal PAP we have found suggests it could be considered as a screening technique for the diagnosis of these lesions. Its scarce specificity suggests the need for confirmation with high resolution anoscopy with aceto-whitening guided biopsy in the future in the cases when PAP cytology is positive.
References
(2) Metcalf A, Dean T. Risk of dysplasia in anal condyloma. Surgery 1995; 118:724-6. ]
(3) Palefsky JM, Rubin M. The epidemilogy of anal human papillomavirus and related neoplasia. Obstet Gynecol Clin North Am 2009; 36:187-200. ]
(4) Palefsky J. Human papillomavirus-related disease in people with HIV. Curr Opin HIV AIDS 2009; 4(1): 52-6. ]
(5) D’Souza G, Wiley DJ, Li X, Chmiel JS, Margolick JB, Cranston RD, et al. Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study. J Acquir Inmune Defic Syndr 2008; 48(4): 491-9.
(6) Moscicki AB, Palefsky JM. Human papillomavirus in men: an update. J Low Genit Tract Dis 2011; 15(3):231-4. ]
(7) Park IU, Palefsky JM. Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men. Curr Infect Dis Rep 2010; 12: 126-33. ]
(8) Chin-Hong PV, Berry JM, Cheng SC, Catania JA, Da Costa M, Darragh TM, et al. Comparison of patient-and clinician-collected anal cytology samples to screen for human papillomavirus-associated anal intraepithelial neoplasia in men have sex with men. Ann Intern Med 2008; 149:300-6. ]
(9) Pera M, Sugrañes G, Ordi J, Trias M. Asociación entre la infección por el virus del papiloma humano, las lesiones premalignas del cáncer anal y el virus de la inmunodeficiencia humana: estudio prospectivo en individuos con condilomas acuminados. Med Clin (Barc) 1999; 113: 13-7. ]
(10) Hessol NA, Holly EA, Efird JT, Minkoff H, Schowalter K, Darragh TM, et al. Anal intraepithelial neoplasia in multisite study of HIV-infected and high-risk HIV-uninfected women. AIDS 2009; 23(1): 59-70. ]
(11) de Sanjosé S, Palefsky J. Cervical and anal HPV infections in HIV positive women and men.Virus Res 2002; 89: 201-11. ]
(12) Nadal SR, Calore EE, Nadal LR, Horta SH, Manzione CR. Citologia anal para rastreamento de lesões pré-neoplásicas Rev Assoc Med Bras 2007; 53(2): 147-51. ]
(13) Berry-Lawhorn JM, Chrobak D, Jay N, Palefsky JM. Who ist ready to screen for anal squamous intraepithelial lesions and why should they perform high-resolution anoscopy? Sex Transm Dis 2014; 41: 254-6. ]
(14) Panther LA, Wagner K, Proper J, Fugelso DK, Chatis PA, Weeden W, et al. High resolution anoscopy findings for men who have sex with men: inaccuracy of anal cytology as a predictor of histologic high-grade anal intraepithelial neoplasia and the impact of HIV serostatus. Clin Infect Dis. 2004; 38(10):1490-2. ]
(15) Scholefield JH, Johnson J, Hitchcock A, Kocjan G, Smith JH, Smith PA, et al. Guidelines for anal cytology—to make cytological diagnosis and follow up much more reliable. Citopathology 1998; 9: 15-22.
(16) Ministerio de Salud Pública. Unidad de Gestión. Proyecto Fondo Mundial para el SIDA, Area Salud Sexual y Reproductiva. Guía de atención a la salud de hombres que tienen sexo con hombres y trans femeninas. Montevideo, 2012: 104 p. ]
(17) Tatti S, Suzuki V, Fleider L, Maldonado V, Caruso R, Tinnirello M de L. Anal intraepithelial lesions in women with human papillomavirus-related diseases. J Low Genit Tract Dis 2012; 16(4): 454-9. ]
(18) Surawicz CM, Critchlow C, Sayer J, Hurt C, Hawes S, et al. High grade anal dysplasia in visually normal mucosa in homosexual men: seven cases. Am J Gastroenterol 1995; 90(10): 1776-8. ]
(19) Richel O, Hallensleben ND, Kreuter A, van Noesel CJ, Prins JM, de Vries HJ. Hight-resolution anoscopy: clinical features of anal intraephitelial neoplasia in HIV-positive men. Dis Colon Rectum 2013; 56:1237-42. ]
(20) Gimenez F, Costa-e-Silva IT, Daumas A, Araújo Jd, Medeiros SG, Ferreira L. The value of high-resolution anoscopy in the diagnosis of anal cancer precursor lesions in HIV-positive patients. Arq Gastroenterol 2011; 48(2): 136-45. ]
(21) Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33:159-74. ]
(22) Swedich KA, Lee EQ, Goldstone SE. The changing picture of high-grade anal intraepithelial neoplasia in men who have sex with men: the effects of 10 year of experience performing high-resolution anoscopy. Dis Colon Rectum 2011; 54: 1003-7. ]
(23) Goldstone SE, Moshier E. Detection of oncogenic human papillomavirus impacts anal screening guidelines in men who have sex with men. Dis Colon Rectum 2010; 53:1135-42.
