Anal cytology for anal cancer screening: Is it time yet?

2004 ◽  
Vol 30 (6) ◽  
pp. 371-374 ◽  
Author(s):  
Teresa M. Darragh
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Anal Cytology ◽  
Anal Cancer Screening

Cytology in Anal Cancer Screening: Practical Review for Clinicians

2019 ◽  
Vol 64 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Andreia Albuquerque
Keyword(s):  
Cancer Screening ◽  
High Risk ◽  
Anal Cancer ◽  
Risk Groups ◽  
Hiv Positive ◽  
Solid Organ ◽  
Anal Squamous Cell Carcinoma ◽  
Incidence And Mortality ◽  
Anal Cytology ◽  
Anal Cancer Screening

The incidence and mortality of anal squamous cell carcinoma (SCC) are expected to continue to increase in the next 20 years. High-risk groups for anal SCC, i.e., human immunodeficiency virus (HIV)-positive patients, men who have sex with men (MSM), women with previous genital neoplasia, and solid-organ transplant recipients, have been identified. HIV-positive MSM have the highest risk, and some societies have advocated for anal cancer screening to be done in this population. Screening for anal SCC follows the same principles as that for cervical cancer since there are similarities between the two types of cancers. Anal cytology has been recommended as an initial screening method for high-risk groups, e.g., HIV-positive MSM. Normally, the cytology is liquid based and collected blindly by a clinician using a Dacron swab and it is especially used for internal lesions detection. The sensitivity to predict anal high-grade squamous intraepithelial lesions is higher in immunosuppressed patients with a high burden of the disease. The report should include the classification, normally according to the Bethesda terminology and the sample adequacy, in a manner similar to that for cervical cytology. In cases involving unsatisfactory samples, it is important to repeat the procedure given the prevalence of anal squamous cytological abnormalities in follow-up cytology procedures. The absence of transformation zone cells in anal cytology seems to increase the risk of false-negative results.

scholarly journals Acceptability of anal cancer screening tests for women living with HIV in the EVVA study

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
E. Kaufman ◽  
C. De Castro ◽  
T. Williamson ◽  
B. Lessard ◽  
M. Munoz ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Screening Tests ◽  
Adult Women ◽  
Hpv Testing ◽  
Women Living With Hiv ◽  
Cancer Screening Tests ◽  
Anal Cytology ◽  
Anal Cancer Screening ◽  
Living With Hiv

Background Anal cancer is potentially preventable through screening. For screening to be implemented, the screening procedures must be acceptable to the affected population. The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a population of women living with hiv who had experienced the tests.Methods The evva study (“Evaluation of Human Immunodeficiency Virus, Human Papillomavirus, and Anal Intraepithelial Neoplasia in Women”) is a prospective cohort study of adult women living with hiv in Montreal, Quebec. Participants were screened with cervical or anal hpv testing and cervical or anal cytology every 6 months for 2 years. High-resolution anoscopy (hra) and digital anal rectal examination (dare) were also performed systematically, with biopsies, at baseline and at 2 years. An acceptability questionnaire was administered at the final visit or at study withdrawal.Results Of 124 women who completed the acceptability questionnaire, most considered screening “an absolute necessity” in routine care for all women living with hiv [77%; 95% confidence interval (ci): 69% to 84%]. Yearly anal cytology or anal hpv testing was considered very acceptable by 81% (95% ci: 73% to 88%); hra every 2 years was considered very acceptable by 84% (95% ci: 77% to 90%); and yearly dare was considered very acceptable by 87% (95% ci: 79% to 92%). Acceptability increased to more than 95% with a longer proposed time interval. Pain was the main reason for lower acceptability.Conclusions Most participating women considered anal cancer screening necessary and very acceptable. Longer screening intervals and adequate pain management could further increase the acceptability of repeated screening.

scholarly journals Recommendations Favoring Anal Cytology as a Method for Anal Cancer Screening: A Systematic Review

Cancers ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 1942 ◽  
Author(s):  
Andreia Albuquerque ◽  
Elisabete Rios ◽  
Fernando Schmitt
Keyword(s):  
Cancer Screening ◽  
High Risk ◽  
Anal Cancer ◽  
Risk Groups ◽  
The United States ◽  
Hiv Positive ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Anal Cytology ◽  
Anal Cancer Screening

Clinicians are increasingly facing the decision of performing anal cancer screening in high-risk groups. Anal cytology is commonly the first approach. We systematically reviewed recommendations favoring anal cytology for anal cancer screening. Three databases were searched: PubMed, Scopus, and Embase, from January 2007 to 12 September 2019. The references cited by the retrieved articles and the websites of relevant organizations were also searched without language restrictions. Studies reporting guidelines from regional or national societies, institutes, or groups were included. Eight papers met the inclusion criteria and were selected, five were from the United States of America (USA) and three from Europe. There were no national recommendations published. There was one guideline specifically for solid-organ transplant recipients. The other seven targeted HIV-positive patients, with HIV-positive men who have sex with men (MSM) included as a screening group in all of these. Two recommendations favored screening in all HIV-positive patients. Five recommendations targeting HIV-positive patients made considerations about the cytology follow-up, recommending at least annual cytology in case of a normal result, and in case of squamous cytological abnormalities, a referral for anoscopy/high-resolution anoscopy. There were no recommendations for upper and lower age limits for screening. In conclusion, several societies recommend anal cancer screening using anal cytology in HIV-positive MSM patients. There is a lack of screening recommendations for other high-risk groups, with only one society recommending screening in transplant recipients.

scholarly journals The Diagnostic Value of p16/Ki67 Dual Immunostaining for Anal Intraepithelial Neoplasia: A Meta-Analysis

2020 ◽  
Vol 14 (6) ◽  
pp. 155798832097763
Author(s):  
Cheng-Chieh Chen ◽  
Kuan-Chun Hsueh ◽  
Cheng-Huang Shen ◽  
Chyi-Huey Bai ◽  
Chia-Chang Wu ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Meta Analysis ◽  
Screening Method ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Cochrane Library ◽  
Sufficient Information ◽  
Anal Cytology ◽  
Anal Cancer Screening

The p16/Ki67 dual immunostaining was performed on anal cytology specimens; this is an anal cancer screening method. A literature search was performed in the BioMed Central, Cochrane Library, Embase, Google Scholar, and PubMed electronic databases for relevant articles. We included studies that discussed the efficacy of p16/Ki67 dual immunostaining for detecting anal intraepithelial neoplasia (AIN). Studies that calculated the diagnostic efficacy on a per-patient basis were included. We excluded review articles, case series, and studies that did not provide sufficient information. We extracted data on true positive, true negative, false positive, and false negative from the included studies to generate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). All analyses were performed with a random-effects model using MetaDiSc 1.4 and MetaDTA. The meta-analysis produced a pooled sensitivity of 0.63 (95% CI: 0.34, 0.86) and specificity of 0.65 (95% CI: 0.46, 0.81) for p16/Ki67 dual immunostaining in detecting AIN. The pooled DOR was 3.26 (95% CI: −0.29, 6.82). A subgroup analysis of HIV-infected men who have sex with men (MSM) demonstrated a pooled sensitivity of 0.75 (95% CI: 0.28, 0.96). p16/Ki67 dual immunostaining might have a higher sensitivity for detecting AIN in HIV-infected MSM. p16/Ki67 dual immunostaining might be more sensitive in HIV-infected MSM and has higher specificity compared to human papillomavirus testing among this high-risk group. p16/Ki67 dual immunostaining might be an adjuvant and potential triage test for anal cytology in anal cancer screening.

38. Anal cancer screening in HIV primary care: uptake and outcomes

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 588 ◽  
Author(s):  
Irving E. Salit ◽  
Sandra Blitz ◽  
Evan Collins ◽  
Banita Aggarwal ◽  
Janet Raboud ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Screening ◽  
Anal Cancer ◽  
High Grade ◽  
Anal Cytology ◽  
Hiv Primary Care ◽  
Anal Cancer Screening ◽  
Primary Care Practices ◽  
To Receive ◽  
Intraepithelial Lesions

Background Anal cytology (Pap tests) plus high-resolution anoscopy (HRA) as required are felt to be the optimal approach to anal cancer screening. We present preliminary results from STANDOUT, a study of acceptability and outcomes of anal cancer screening of HIV+ MSM in primary care practices. Methods: All previously unscreened HIV+ MSM from 9 HIV primary care practices, were invited by email or letter to receive anal cancer screening. Responders had anal cytology done at specially arranged or routine clinic visits. Those with high-grade squamous intraepithelial lesions (HSIL) on anal cytology were offered HRA to assess for anal intraepithelial neoplasia (AIN). Those with AIN 2/3 on biopsy were randomised to receive trichloroacetic acid (TCA) or infrared coagulator (IRC) treatments. Results: 1733 patients were invited and 921 (53%) agreed to have anal cytology done. Among those screened, 3 had unsatisfactory samples; 596 (65%) had normal cytology, 253 (27%) had low-grade squamous intraepithelial lesions (LSIL) and 69 (7.5%) had HSIL. HRA results are available in 64: 41 (64%) had histologic high-grade disease (29 had AIN2 and 12 had AIN3). Those with AIN 2/3 were randomised to receive treatment with TCA (16 patients) or IRC (18 patients). Treatment successes at 3 months were 6 of 15 patients for TCA (40%) and 11 of 16 patients for IRC (69%). Conclusions: In this sample of HIV+ MSM, about half of those invited for anal cancer screening agreed to have it done. Most with HSIL had histological high-grade disease and were treated. IRC was more successful than TCA at ablating high-grade disease.

Factors associated with self-reported anal cancer screening history in men who have sex with men

Sexual Health ◽  
2019 ◽  
Vol 16 (1) ◽  
pp. 96 ◽  
Author(s):  
Joseph T. Hicks ◽  
Lu-Yu Hwang ◽  
Sarah Baraniuk ◽  
Margaret White ◽  
Elizabeth Y. Chiao ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Multivariable Analysis ◽  
Computer Assisted ◽  
National Guidelines ◽  
Cancer Data ◽  
Factors Associated ◽  
Anal Cytology ◽  
Sex With Men ◽  
Anal Cancer Screening

Background Men who have sex with men (MSM) are at greater risk of developing anal cancer caused by human papillomavirus (HPV) than the rest of the general population. Currently, there are no formal national guidelines in the US advising men how and when to get anal cancer screening. We sought to assess differences in demographics, familiarity and anxiety about anal cancer among men who report having had anal cancer screening (i.e. anal cytology and/or a digital anorectal examination (DARE)). Methods: MSM were recruited to participate in a study to assess the feasibility of teaching self and partner anal examinations as a means of screening for anal cancer. Data for this secondary analysis were obtained using a written pre-test and a computer-assisted self-interview. Factors associated with screening were assessed with multivariable logistic regression to allow calculation of adjusted odds ratios (aORs). Results: Of the 197 participants with data, 145 (73.6%) reported having had anal cancer screening (either anal cytology, DARE or both) during their lifetime. Men who were younger, Black and HIV-negative were associated with decreased odds of reporting any type of anal cancer screening. For example, compared with White men, Black men were 80% less likely to report screening (aOR 0.2; 95% confidence interval (CI) 0.1–0.5). Self-perception of anal cancer knowledge was not associated with screening in multivariable analysis (aOR 1.6; 95% CI 0.6–3.9). Conclusions: Age, race and HIV status were independently associated with a history of anal cancer screening.

11. Prevalence of anal high risk human papilloma virus (hr-HPV) infection and cytological

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 575
Author(s):  
Sumanth Gandra ◽  
Aline Azar ◽  
Nisha Kini ◽  
Bruce Barton ◽  
Mireya Wessolossky
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Hpv Infection ◽  
Heterosexual Men ◽  
Abnormal Cytology ◽  
Hiv Patients ◽  
Men And Women ◽  
Anal Cytology ◽  
Cytological Abnormalities ◽  
Anal Cancer Screening

Background Although anal HPV infection and cytological abnormalities are highly prevalent among HIV-infected MSM patients, there is limited data on HIV-infected heterosexual men and women. Since November 2010 at our clinic, anal cancer screening with both hr-HPV and cytology was routinely performed in all HIV-infected patients. The purpose of the study was to evaluate the prevalence of anal hr-HPV infection and cytological abnormalities among our cohort of HIV-infected MSM, heterosexual men and women. We also evaluated the performance of hr-HPV and abnormal cytology in detecting high-grade dysplasia (AIN2+). Methods: A retrospective cohort study was conducted in HIV patients who underwent routine screening for anal cancer from January 2011 to January 2013. The hr-HPV test is done concomitantly on an anal cytology specimen using the Hybrid Capture 2 assay (Digene Corporation). Medical records of patients who underwent high-resolution anoscopy (HRA) because of abnormal cytology (ASCUS and above) or positive hr-HPV were reviewed. Results: A total of 221 HIV patients underwent screening with both hr-HPV and anal cytology. Among them, 67% were men (73% MSM vs 27% heterosexual). hr-HPV was positive in 43% (54% MSM, 28% non-MSM and 27% women). Anal cytology was abnormal in 39% (48% MSM, 28% non-MSM and 34% of women). Among 117 (53%) patients with an abnormal screening test, 27% had both hr-HPV infection and abnormal cytology, 14% had only hr-HPV infection and 13% had only abnormal cytology. Cytology results were normal in 50%, non-diagnostic in 10%, ASCUS in 23%, LSIL in 14% and HSIL in 2%. Among 68 HIV patients who underwent HRA because of either abnormal anal cytology or hr-HPV infection, 22 patients had AIN2+ (17 were MSM) and all had hr-HPV. None of 14 patients with negative hr-HPV who underwent HRA for abnormal cytology had AIN2+. Paired results of cytology and biopsy did not correlate (rs = –0.13). Conclusions: Anal hr-HPV infection, cytological abnormalities and AIN2+ are prevalent among our cohort of HIV-infected heterosexual men and women. We suggest anal cancer screening for all HIV-infected patients. In our limited sample, hr-HPV performed better than anal cytology in detecting and ruling out AIN2+.

mRNA Biomarker in Anal Cytology: A Feasible Approach for Anal Cancer Screening in Men Who Have Sex with Men Living with HIV

2019 ◽  
Author(s):  
Marta del Pino ◽  
Cristina Martí ◽  
Jina Gaber ◽  
Cecilia Svanholm-Barrie ◽  
Leonardo Rodríguez-Caruchio ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Anal Cytology ◽  
Sex With Men ◽  
Anal Cancer Screening ◽  
Living With Hiv
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