title: Blind sampling is superior to anoscope guided sampling for screening for anal intraepithelial neoplasia.
abstract: OBJECTIVE
  Anal cytology smears are either collected "blind" (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability.
  
  
  METHODS
  Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure.
  
  
  RESULTS
  Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as "unsatisfactory" for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p < 0.001).
  
  
  CONCLUSIONS
  Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, 2010, Australia. cvajdic@nchecr.unsw.edu.au
authors.forename: C M
authors.initials: CM
authors.lastname: Vajdic
authors.forename: J S
authors.initials: JS
authors.lastname: Anderson
authors.forename: R J
authors.initials: RJ
authors.lastname: Hillman
authors.forename: G
authors.initials: G
authors.lastname: Medley
authors.forename: A E
authors.initials: AE
authors.lastname: Grulich
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000473:pathology*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011351:Proctoscopy / Q000379:methods* / Q000592:standards; D011379:Prognosis; D013048:Specimen Handling / Q000379:methods* / Q000592:standards