Screening methods for high-grade dysplasia in patients with anal condyloma.
Human papilloma virus (HPV) is one of the most common sexually transmitted diseases in the United States. HPV infection can cause anal condylomas and is a risk factor for dysplasia. High-grade dysplasia may progress to squamous cell carcinoma. Currently, biopsy and histological examination are required to grade dysplasia. The purpose of this study is to determine whether anal cytology, morphological characteristics, and/or the presence of high-risk oncogenic HPV-types are effective noninvasive methods to detect high-risk anal condylomas.


METHODS
From November 2003 to June 2004, all patients with anal condyloma were prospectively evaluated for anal cytology, high-risk oncogenic HPV-types, and tissue biopsies. The Bethesda classification system was used to classify cytologic findings and histological examination, which were grouped as high-risk (HRL) and low-risk (LRL) lesions. Histology results served as true disease for all comparisons.


RESULTS
Forty-seven patients with anal condyloma were studied; 43 (91.5%) were men, and the mean age was 39 +/- 11 years. Histology showed 19 (40.5%) patients with HRL, and 28 (59.5%) patients with LRL. Cytology correctly identified 8 patients with HRL and 27 patients with LRL (sensitivity 42% and specificity 96%). High-risk oncogenic HPV-types were found in 84.2% of HRL and 39.3% of LRL (P = 0.0029). Combining cytology with oncogenic HPV-testing, the sensitivity of detecting HRL increased to 89%, and specificity decreased to 42%.


CONCLUSIONS
Anal cytology alone is not accurate for detecting HRL in patients with anal condylomas. Combining oncogenic HPV-testing with cytology is more sensitive in detecting HRL in patients with anal condyloma, and therefore, a more effective screening tool.
Papaconstantinou
Harry T
HT
Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9156, USA. harry.papaconstantinou@utsouthwestern.edu
Lee
Augustine J
AJ
Simmang
Clifford L
CL
Ashfaq
Raheela
R
Gokaslan
Sefik T
ST
Sokol
Saul
S
Huber
Philip J
PJ
Gregorcyk
Sharon G
SG
D000328:Adult; D001003:Anal Canal / Q000473:pathology*; D001004:Anus Diseases / Q000473:pathology*; D001005:Anus Neoplasms / Q000473:pathology*; D001706:Biopsy; D003218:Condylomata Acuminata / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000473:pathology*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000473:pathology*