title: Agreement between methods for diagnosing HPV-induced anal lesions in women with cervical neoplasia.
abstract: OBJECTIVE
  To evaluate agreement between 3 methods for screening anal intraepithelial lesions: anal cytology, anoscopy and human papillomavirus (HPV) detection by PCR.
  
  
  METHODS
  This prospective, cross-sectional study screened 324 women with cervical neoplasia for anal neoplasia. Agreement between methods was calculated using the κ coefficient.
  
  
  RESULTS
  Of 324 anal cytologies performed, 31.5% (n = 102) were found to be abnormal: low-grade anal lesions were detected in 19.1% (n = 62) of cases, high-grade lesions in 3.1% (n = 10) and atypical squamous cells of undetermined significance in 9.3% (n = 30). With respect to the biopsies, 25.7% (n = 20) were positive, consisting of 7 cases of HPV infection, 5 anal intraepithelial neoplasia (AIN) grade 1, 6 AIN grade 2, and 2 AIN grade 3. Twenty-one samples (6.5%) were inadequate for HPV analysis. Of the 303 adequate samples, 84.2% (n = 255) tested positive for HPV. Agreement between cytology and anoscopy was fair (κ = 0.31). Agreement between PCR for HPV and cytology was slight (κ = 0.08) and no agreement was found between PCR for HPV and anoscopy (κ = 0.00).
  
  
  CONCLUSIONS
  Agreement between the different methods of diagnosing HPV-induced anal lesions is slight to fair; however, anal cytology permits identification of cases in which lesions are present, allowing them to be referred for anoscopy and biopsy.
authors.affiliation: Department of Lower Genital Tract Pathology, Women's Healthcare Center, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and Cytopathology Division of the Pernambuco Public Health Laboratory, Recife, Brazil. sandra_heráclio@hotmail.com
authors.forename: Sandra de Andrade
authors.initials: Sde A
authors.lastname: Heráclio
authors.forename: Alex Sandro Rolland de
authors.initials: AS
authors.lastname: Souza
authors.forename: Fátima Regina Gomes
authors.initials: FR
authors.lastname: Pinto
authors.forename: Melania Maria Ramos
authors.initials: MM
authors.lastname: Amorim
authors.forename: Micheline de Lucena
authors.initials: Mde L
authors.lastname: Oliveira
authors.forename: Paulo Roberto Eleutério de
authors.initials: PR
authors.lastname: Souza
mesh_terms: D001005:Anus Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology*; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000235:genetics / Q000502:physiology*; D016133:Polymerase Chain Reaction; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000473:pathology / Q000821:virology*