A composite cytology-histology endpoint allows a more accurate estimate of anal high-grade squamous intraepithelial lesion prevalence Academic Article uri icon

abstract

  • There is debate about the accuracy of anal cytology and high-resolution anoscopy (HRA), in the diagnosis of anal human papillomavirus (HPV)-related squamous intraepithelial lesions (SIL). Few studies have performed both simultaneously in a large sample of high-risk individuals.At baseline in a community-based cohort of HIV-infected and uninfected homosexual men ages ≥35 years in Sydney, Australia, all men underwent anal swabbing for cytology and HPV genotyping, and HRA-guided biopsy. We evaluated the separate and combined diagnostic accuracy of cytology and histology, based on a comparison with the prevalence of HPV16 and other high-risk (HR) HPV. We examined trends in HPV prevalence across cytology-histology combinations.Anal swab, HRA, and HPV genotyping results were available for 605 of 617 participants. The prevalence of cytologically predicted high-grade SIL (HSIL, 17.9%) was lower than histologically diagnosed HSIL (31.7%, P < 0.001). The prevalence of composite-HSIL (detected by either method) was 37.7%. HPV16 prevalence was similar in men with HSIL by cytology (59.3%), HSIL by histology (51.0%), and composite-HSIL (50.0%). HPV16 prevalence was 31.1% in men with composite-atypical squamous cells suggestive of HSIL, to 18.5% in men with composite-low-grade SIL, to 12.1% in men with composite-negative results (Ptrend < 0.001).Significantly more HSIL was detected when a composite cytology-histology endpoint was used. Increasing grade of composite endpoint was associated with increasing HPV16 prevalence.These data suggest that a composite cytology-histology endpoint reflects meaningful disease categories and is likely to be an important biomarker in anal cancer prevention. Cancer Epidemiol Biomarkers Prev; 25(7); 1134-43. ©2016 AACR.

authors

  • Machalek, DA
  • Poynten, IM
  • Jin, F
  • Hillman, RJ
  • Templeton, DJ
  • Law, C
  • Roberts, JM
  • Tabrizi, SN
  • Garland, SM
  • Farnsworth, A
  • Fairley, CK
  • Grulich, AE
  • Acraman, B
  • Adams, M
  • Carr, A
  • Carroll, S
  • Cooper, D
  • Cornall, A
  • Crampton, L
  • Ekman, D
  • Fairley, K
  • Feeney, L
  • Fraissard, E
  • Howard, K
  • Law, M
  • McCaffery, K
  • McDonald, R
  • McGrath, P
  • Mellor, R
  • Norris, R
  • O'Dwyer, M
  • Pendlebury, S
  • Petoumenos, K
  • Phillips, S
  • Prestage, G
  • Richards, A
  • Schema, L
  • Seeds, D
  • Segelov, E
  • Templeton, D
  • Thurloe, J
  • Tong, W
  • Varma, R

publication date

  • 2016