Histopathologic and Cytologic Follow-Up in High Risk Male Patients with Unsatisfactory Anal Cytology.

Daniel J Zaccarini,Kamal K Khurana

doi:10.1155/2017/9780213

Daniel J Zaccarini, Kamal K Khurana

Open Access

https://doi.org/10.1155/2017/9780213

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Abstract

Objective Anal cytology is being increasingly used as part of anal cancer screening in patients at high risk for anal neoplasia. Most studies in anal cytology have focused on correlating the abnormal anal Pap smear with histopathologic outcomes. The aim of this study was to document histopathologic or repeat anal cytology outcomes in patients with unsatisfactory cytology. Materials and Methods Unsatisfactory anal Pap tests in high risk male patients were correlated with follow-up histopathologic diagnoses or cytology. Results 1205 anal tests were performed during the study period and 214 (17.8%) were unsatisfactory. Adequate follow-up cytology was available in 75 cases and revealed epithelial cell abnormality (ECA) in 40% [30/75] (atypical squamous cells of undetermined significance (ASCUS) [20%] and low-grade squamous intraepithelial lesions (LGSIL) [20%]) and was negative for intraepithelial lesion or malignancy (NILM) in 60% [45/75] of cases. 28.7% of unsatisfactory Pap smears had unsatisfactory repeat cytology. Histopathological follow-up on these unsatisfactory Pap smears revealed anal intraepithelial neoplasia (AIN) 1 and AIN 2/3 or 2/3+ in 39% and 18% of the total number of biopsy cases, respectively. Conclusions High risk male patients with unsatisfactory Pap smears are at significant risk of epithelial cell abnormality and histopathologically verifiable anal intraepithelial lesions.

Highlights

Anal cytology is an important preventative screening method for patients at risk for anal carcinoma
Remaining 75 cases had adequate cytology follow-up comprised of 45 cases with negative for intraepithelial lesion or malignancy (NILM) and 30 cases with epithelial cell abnormality (ECA) (Figure 2(b))
Anal cytology is known to underestimate the grade of anal intraepithelial neoplasia (AIN) on biopsy; follow-up of unsatisfactory anal Pap smears has not been extensively studied [3, 10]

Summary

Introduction

Anal cytology is an important preventative screening method for patients at risk for anal carcinoma. Patients at risk include men who have sex with men (MSM), HIV-positive men and women, women with a history of lower genital tract neoplasms, and transplant recipients [1]. In people living with HIV/AIDS it is the fourth most common cancer. The incidence of anal cancer in HIV-infected MSM is estimated at 131 per 100,000 personyears and surpasses the rate of cervical cancer in women prior to the initiation of screening [3, 4]. Survival has increased in HIVpositive patients due to HAART and this has contributed to the increased risk of subsequently developing anal cancer in this patient population since patients are less likely to die from HIV-related complications [6]

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Conclusion