Anal papanicolaou smear in women with abnormal cytology: a thai hospital experience.

Panya Sananpanichkul,Komsun Suwannarurk,Prapap Yuthavisuthi,Nutchanok Thawonwong,Kornkarn Bhamarapravatana,Malee Techapornroong,Sirida Pittyanont

doi:10.7314/apjcp.2015.16.3.1289

Panya Sananpanichkul, Komsun Suwannarurk + Show 5 more

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https://doi.org/10.7314/apjcp.2015.16.3.1289

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Abstract

Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women. This prospective study was conducted in Prapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women were recruited. Participants who had cytological reports of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statistics and logistic regression analysis were used to evaluate correlations between groups. HIV-infected women with abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval 1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9, 39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively. Abnormal cervical cytology in HIV-infected women indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection for evaluation was a major limitation. Improvement of sample collection is recommended for future investigations.

Highlights

Anal cancer is a relatively uncommon malignancy
After the study was approved by Prapokklao Hospital Ethics committee, data were collected from human immunodeficiency virus (HIV)-infected women who came for a routine checkup at Prapokklao Hospital HIV-Gynaecological Clinic, Chanthaburi province, Thailand
Anal cancer is a rare disease with 0.3% increase in incidence per year from 2004 through 2008 (Siegel et al, 2012)

Summary

Introduction

Anal cancer is a relatively uncommon malignancy. Since the anorectal transitional zone shares an embryonic origin with the uterine cervix, human papillomavirus (HPV) infection is a major cause of anal cancer as well as cervical cancer. Women with HIV infection had more than 5 and 14 times to develop cervical and anal cancer comparing to the general population, respectively (Chaturvedi et al, 2009). Anal cancer developed from squamous intraepithelial lesion (SIL) the same as cervical cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent.

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