Interrater agreement of anal cytology.
BACKGROUND
The majority of anal cancers are caused by persistent infections with carcinogenic human papillomaviruses (HPV). Similar to cervical carcinogenesis, the progression from HPV infection to anal cancer occurs through precancerous lesions that can be treated to prevent invasion. In analogy to cervical cytology, anal cytology has been proposed as a screening tool for anal cancer precursors in high-risk populations.


METHODS
The authors analyzed the interobserver reproducibility of anal cytology in a population of 363 human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). Liquid-based cytology (LBC) specimens were collected in the anal dysplasia clinic before the performance of high-resolution anoscopy on all patients. Papanicolaou-stained LBC slides were evaluated by 2 cytopathologists, each of whom was blinded to the clinical outcome and the other pathologist's results, using the revised Bethesda terminology.


RESULTS
Overall agreement between the 2 observers was 66% (kappa, 0.54; linear-weighted kappa, 0.69). Using dichotomizing cytology results (atypical squamous cells of undetermined significance [ASC-US] or worse vs less than ASC-US), the agreement increased to 86% (kappa, 0.69). An increasing likelihood of testing positive for markers associated with HPV-related transformation, p16/Ki-67, and HPV oncogene messenger RNA was observed, with increasing severity of cytology results noted both for individual cytologists and for consensus cytology interpretation (P value for trend [p(trend)] < .0001 for all).


CONCLUSIONS
Moderate to good agreement was observed between 2 cytopathologists evaluating anal cytology samples collected from HIV-positive MSM. A higher severity of anal cytology was associated with biomarkers of anal precancerous lesions. Anal cytology may be used for anal cancer screening in high-risk populations, and biomarkers of HPV-related transformation can serve as quality control for anal cytology.
Department of Pathology, University of California at San Francisco, San Francisco, California, USA.
Teresa M
TM
Darragh
Diane
D
Tokugawa
Philip E
PE
Castle
Stephen
S
Follansbee
Sylvia
S
Borgonovo
Brandon J
BJ
LaMere
Lauren
L
Schwartz
Julia C
JC
Gage
Barbara
B
Fetterman
Thomas
T
Lorey
Nicolas
N
Wentzensen
D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D015331:Cohort Studies; D003581:Cytodiagnosis / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods*; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology*; D006679:HIV Seropositivity / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000473:pathology*; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D015203:Reproducibility of Results; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D014408:Biomarkers, Tumor