Prevalence of anal cytologic abnormalities in a French referral population: a prospective study with special emphasis on HIV, HPV, and smoking.
OBJECTIVE
Studying anal cytology to detect intraepithelial neoplasia has been demonstrated to be useful in highly selected populations. This study was designed to determine the frequency of abnormal smears in a wide sample of patients consulting for anorectal symptoms.


METHODS
An anal smear was proposed during each consultation during a three-month period.


RESULTS
A total of 205 patients (112 females) were included. After the consultation, visible condylomas were detected in 12 (6 percent) of the cases. Two hundred three (99 percent) smears were able to be analyzed. No case of high-grade squamous intraepithelial lesion was found. Four cases of low-grade squamous intraepithelial lesion were found, all in HIV patients with a history of condylomatous lesions. Forty smears were interpreted as atypical squamous cells of undetermined significance and 159 were normal. The prevalence in this population of low-grade squamous intraepithelial lesion was 19 percent (4/21) in HIV seropositive males, and 15 percent (4/26) in the case of a past history of condyloma. The factors associated with an abnormal smear (low-grade squamous intraepithelial lesion or atypical squamous cells of undetermined significance) were a history of anal condylomatous lesions (odd ratio, 4.9; range, 2.1-11.5), HIV seropositivity (odd ratio, 4; range, 1.6-9.9), and smoking (odd ratio, 2.1; range, 1.1-11.5).


CONCLUSIONS
This work confirms that the frequency of low-grade squamous intraepithelial lesion is raised in HIV-seropositive males and also where there is a history of condyloma, which corroborates the necessity for regular monitoring and screening of these patients at risk. This study also suggests that the use of tobacco is associated with anal cytologic abnormalities.
Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 18 rue du sergent Bauchat, Paris, France. proctologie@hopital-dcss.org
Isabelle
I
Etienney
Sarra
S
Vuong
Fady
F
Daniel
Benoît
B
Mory
Milad
M
Taouk
Samy
S
Sultan
Christian
C
Thomas
Josée
J
Bourguignon
Vincent
V
de Parades
Nathalie
N
Méary
André
A
Balaton
Patrick
P
Atienza
Pierre
P
Bauer
D001004:Anus Diseases / Q000453:epidemiology* / Q000821:virology; D016009:Chi-Square Distribution; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology; D011093:Polyethylene Terephthalates; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology
D011093:Polyethylene Terephthalates