scholarly journals The Accuracy of Anal Swab–Based Tests to Detect High-Grade Anal Intraepithelial Neoplasia in HIV-Infected Patients: A Systematic Review and Meta-analysis

2019 ◽  
Vol 6 (5) ◽  
Author(s):  
Fernando Dias Gonçalves Lima ◽  
Janine D Viset ◽  
Mariska M G Leeflang ◽  
Jacqueline Limpens ◽  
Jan M Prins ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Predictive Value ◽  
Dna Detection ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
High Grade ◽  
Ki 67 ◽  
Hpv Dna ◽  
Anal Swab

Abstract Background The incidence of high-risk human papillomavirus (HR-HPV)–induced anal cancer is increasingly problematic among HIV-positive patients. Anal cancer is preceded by precursor lesions, anal intraepithelial neoplasia (AIN). AIN detection requires high-resolution anoscopy, a cumbersome and time-consuming procedure. We aggregated evidence on anal swab–based tests to detect AIN in HIV-positive patients. Methods We searched MEDLINE and EMBASE for cross-sectional studies on AIN detection with anal cytology, HR-HPV DNA detection, HPV E6/E7 mRNA analysis, and P16INK4a and Ki-67 immunostaining. Summary estimates of sensitivity and specificity were calculated using bivariate logistic regression. Cytology was reported using the terms squamous intra-epithelial lesion (SIL) for AIN and high-grade SIL (HSIL) for high-grade AIN (HGAIN). Results We included 22 studies. Using cytology with a cutoff of any SIL to detect HGAIN, we detected a sensitivity of 82% (95% CI, 74%–87%) and specificity of 45% (95% CI, 44%–66%); with the cutoff of HSIL, the sensitivity was 44% (95% CI, 45%–67%) and the specificity was 79% (95% CI, 69%-87%). The sensitivity of HPV DNA to detect HGAIN was 91% (95% CI, 82%–95%) and the specificity was 27% (95% CI, 21%–33%). For MSM, the positive predictive value (PPV) of cytology with a cutoff of any SIL was 36% (95% CI, 23%–50%) and the negative predictive value (NPV) was 87% (95% CI, 78%–93%), whereas cytology with a cutoff of HSIL had a PPV of 62% (95% CI, 50%–73%) and an NPV of 78% (95% CI, 65%–87%). The PPV of HR-HPV DNA detection was 37% (95% CI, 20%–57%) and the NPV was 87% (95% CI, 79%–93%). Conclusions Given its sensitivity, cytology with a cutoff of any SIL could be considered as a triaging method, whereas cytology with a cutoff of HSIL had better specificity and could be used for quality assurance. HR-HPV DNA detection had poor specificity and PPV, making it unsuitable for triage.

Progression From Perianal High-Grade Anal Intraepithelial Neoplasia to Anal Cancer in HIV-Positive Men Who Have Sex With Men

2016 ◽  
Vol 59 (9) ◽  
pp. 836-842 ◽  
Author(s):  
Jill Tinmouth ◽  
Valentina Peeva ◽  
Henok Amare ◽  
Sandra Blitz ◽  
Janet Raboud ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
High Grade ◽  
Sex With Men ◽  
Hiv Positive Men

29. WHAT DO ANAL CYTOLOGY RESULTS MEAN?

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 296
Author(s):  
R. Hillman
Keyword(s):  
Anal Cancer ◽  
Screening Program ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Screening Programs ◽  
Anal Dysplasia ◽  
Anal Swab

Background: Between 1970 and 2000 in Australia, anal cancer rates have increased over fourfold. Furthermore, the prevalence rate of anal cancer in MSM is approximately 35 cases/100�000, comparable to that of cervical cancer in women prior to the introduction of the national cervical screening program. These observations have led to calls for the introduction of targeted anal cytological screening program for MSMs. Our study examined the effectiveness of anal cytological testing in detecting histologically proven high grade anal intraepithelial neoplasia (HGAIN, also known as AIN2 & 3). Methods: A retrospective case note review of people attending an anal dysplasia clinic from July 2002 to May 2007 was performed. Cytological results of anal swabs were compared to results of biopsies obtained through high resolution anoscopy. Results: 436 anal cytological results were identified. Of these, 5% were unsatisfactory, 51% showed low grade changes and 44% showed high grade changes. 185 cases were then paired with corresponding histological results. Analysing the data from the perspective of diagnosing histologically proven HGAIN, anal swab cytological abnormalities revealed a sensitivity of 54% and specificity of 90% for the most recent cytological test and 83% and 39% respectively, when analysed according to most serious cytological result ever. Conclusions: Our sensitivities of 54-83% and specificities of 39-90% are consistent with those found with cervical cytology, but emphasize the need for caution in their interpretation. However, before any anal cytological screening programs are introduced, it is important to also establish that treatment of any high grade anal dysplasia detected by such screening is of value in preventing progression to cancer.

Human Papillomavirus Detection by Hybrid Capture II and Residual or Recurrent High-Grade Squamous Cervical Intraepithelial Neoplasia after Large Loop Excision of the Transformation Zone (LLETZ)

2005 ◽  
Vol 91 (2) ◽  
pp. 188-192 ◽  
Author(s):  
Luís Otávio Sarian ◽  
Sophie Françoise Mauricette Derchain ◽  
Denise da Rocha Pitta ◽  
Liliana Aparecida Angelo Andrade ◽  
Sirlei Siani Moráis ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Dna Detection ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Transformation Zone ◽  
Hybrid Capture ◽  
Hpv Dna ◽  
Large Loop ◽  
Gynecological Examination

Aims and background The purpose of this study was to assess the association between highly-oncogenic types HPV DNA detection by Hybrid Capture II (HCII) and residual or recurrent high-grade cervical intraepithelial neoplasia (CIN 2 or 3) during the follow-up of women submitted to large loop excision of the transformation zone (LLETZ). Study design In this cohort study, 94 women submitted to LLETZ because of CIN 2 or 3 between March 2001 and September 2002 were followed up twice yearly until September 2003. Follow-up visits consisted of an interview regarding clinical, social and demographic characteristics complemented with gynecological examination with specimen collection for Pap test and HCII and colposcopy. Eighty-one patients attended the first visit (mean 4.8 months, range 3-6) and 75 the second visit (mean 10.9 months, range 7-17 months). McNemar's test to assess the variation of HPV DNA detection following LLETZ, odds ratios (OR) to evaluate the correlation between HPV DNA positivity and residual/recurrent CIN during follow-up, and logistic regression to assess the risk of residual/recurrent CIN were used. Results There was a strong and significant reduction in HPV detection after LLETZ ( P <0.001). HPV DNA detection was correlated with residual/recurrent CIN at the first (OR = 103.4; 95% CI 5.5 to 1961.2) and second (OR = 12.7; 95% CI 1.1 to 345.5) follow-up visits. Multivariate analysis showed HPV persistence as a stand-alone risk factor for residual/recurrent CIN (OR = 50.3; 95% CI 3.8 to 663.1). Conclusions High risk HPV DNA detection decreased substantially after CIN treatment with LLETZ, but HPV persistence was strongly correlated with residual/recurrent CIN.

A trial of SGN-00101 (HspE7) to treat high-grade anal intraepithelial neoplasia in HIV-positive individuals

AIDS ◽  
2006 ◽  
Vol 20 (8) ◽  
pp. 1151-1155 ◽  
Author(s):  
Joel M Palefsky ◽  
J Michael Berry ◽  
Naomi Jay ◽  
Marya Krogstad ◽  
Maria Da Costa ◽  
...  
Keyword(s):  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
High Grade

Prevalence and predictors of high-grade anal intraepithelial neoplasia in a community-based sample of homosexual men

Sexual Health ◽  
2012 ◽  
Vol 9 (6) ◽  
pp. 574 ◽  
Author(s):  
Richard J. Hillman ◽  
Marina T. van Leeuwen ◽  
Claire M. Vajdic ◽  
Leo McHugh ◽  
Garrett P. Prestage ◽  
...  
Keyword(s):  
High Risk ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
Homosexual Men ◽  
High Grade ◽  
Community Based ◽  
Cytological Abnormalities ◽  
Hiv Negative ◽  
Hiv Positive Men

Background We report the prevalence and predictors for high-grade anal intraepithelial neoplasia (HGAIN) in community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney, Australia. Methods: A cross-sectional study of consecutive participants in both cohorts was performed in 2005 (204 HIV-negative and 128 HIV-positive men). Anal swabs collected by a research nurse underwent cytological analysis, using the ThinPrep procedure, and human papillomavirus (HPV) testing. Participants who had cytological abnormalities other than low-grade squamous epithelial lesions (SIL) were referred for high resolution anoscopy (HRA). Results: A total of 114 men had cytological abnormalities (24.3% of HIV-negative and 57.5% of HIV-positive men, odds ratio (OR) = 4.21, 95% confidence interval (CI) 2.57–6.90). However, only three (2.3%) HIV-positive men and no HIV-negative men had high-grade SIL on anal cytology. Seventy-seven men were referred for HRA, of whom 63 (81.8%) attended. Histologically confirmed HGAIN was detected in 21 (33.3%). The prevalence of HGAIN was higher in HIV-positive men (10.8%) than in HIV-negative men (5.0%, OR = 2.29, 95% CI 0.93–5.63, P = 0.071). HGAIN was not related to age but was strongly associated with the detection of high-risk types of anal HPV (OR = 10.1, 95% CI 1.33–76.2) rather than low-risk types (OR = 1.97, 95% CI 0.74–5.25). Conclusion: HGAIN was prevalent in homosexual men across all age groups and was more than twice as common in HIV-positive men compared with HIV-negative men. The presence of high-risk anal HPV was highly predictive of HGAIN.

14. Natural history of high-grade squamous intraepithelial lesions (HSIL) in homosexual men: early evidence from the Study of the Prevention of Anal Cancer (SPANC)

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 576 ◽  
Author(s):  
Andrew E. Grulich ◽  
Fengyi Jin ◽  
I. Mary Poynten ◽  
Jennifer Roberts ◽  
Annabelle Farnsworth ◽  
...  
Keyword(s):  
Natural History ◽  
Anal Cancer ◽  
Cochrane Review ◽  
Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
Homosexual Men ◽  
National Guidelines ◽  
Anal Swab ◽  
History Of ◽  
Hiv Negative

Background Screening for the anal cancer precursor HSIL is not recommended in national guidelines. A recent Cochrane review of HSIL treatment concluded there is no evidence of efficacy. In this context, we aimed to describe the natural history of anal HSIL, and association with human papillomavirus (HPV), in a community-recruited cohort of Australian homosexual men. Methods: The SPANC study is a three-year prospective study in men aged ≥35 years. At each visit, men undergo an anal swab for cytology and HPV genotyping (Roche Linear Array), followed by high-resolution anoscopy-aided biopsy. Anal HSIL is defined as having either anal intraepithelial neoplasia grade 2/3 on histology and/or HSIL/ASC-H on cytology. Results: Among 342 men recruited by March 2013, median age was 49 with 29% HIV positive. At baseline, prevalence of anal HSIL was 50% and 44% in the HIV-positive and HIV-negative groups, respectively (P = 0.303). Among those without HSIL at baseline, HSIL incidence was 28/100 person-years in both the HIV-positive and HIV-negative groups (P = 0.920). Among those with HSIL at baseline, the incidence of change to non-HSIL was 41 and 43/100 person-years (P = 0.851). Men with anal HPV16 at baseline were more likely to develop incident HSIL (57 vs 23/100 person-years, P = 0.010), and less likely to change to non-HSIL (18 vs 61/100 person-years, P = 0.001). Conclusions: Anal HSIL was highly prevalent in these homosexual men. Both incidence of HSIL and change to non-HSIL were common, and were closely associated with HPV16 status. HPV16 positivity may identify men with HSIL at higher risk of anal cancer.

Presence or Absence of Significant HPVE4 Expression in High-grade Anal Intraepithelial Neoplasia With p16/Ki-67 Positivity Indicates Distinct Patterns of Neoplasia

2018 ◽  
Vol 42 (4) ◽  
pp. 463-471 ◽  
Author(s):  
Annemiek Leeman ◽  
Edyta C. Pirog ◽  
John Doorbar ◽  
Miekel M. van de Sandt ◽  
Folkert J. van Kemenade ◽  
...  
Keyword(s):  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
High Grade ◽  
Ki 67
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