title: A six-year experience with anal cytology in women with HPV in the lower genital tract: utility, limitations, and clinical correlation.
abstract: This study assessed the utility and limitations of anal cytology as a screening method for women infected with human papilloma virus (HPV) in the lower genital tract. Furthermore, this study aimed to establish risk factors for pathological anal cytology/biopsy findings, the prevalence of anatomopathological lesions associated with positive anal brushings, and the frequency of concomitant lesions of the lower genital tract. A cross-sectional, retrospective, descriptive study in 207 women with HPV-associated lesions of the lower genital tract and 25 women with immunosuppression was carried out. Anal cytology, high resolution anoscopy, and biopsy of suspicious lesions were performed. In total, 232 anal brushings were performed: 184 (79.3%) were negative, 24 (10.34%) showed atypical squamous cells of undeterminated significance, 18 (7.7%) showed low-grade squamous intraepithelial lesions, and 6 (2.6%) showed high-grade squamous intraepithelial lesion. Cytohistological correlation was obtained for 70 cases. The sensitivity of anal cytology in detecting intraepithelial lesions was 70%, whereas the specificity was 93%. The sensitivity of the method for detecting high-grade lesions (84%) was higher, than that for detecting low-grade lesions (66%). The most frequently associated pathology was vulvar lesion. It is important to perform anal brushings in women who have had lower genital tract biopsies for HPV-associated lesions due to the high prevalence of anal lesions in such patients. Anal cytology is useful for detecting high-grade lesions but the sensitivity for detecting low-grade lesions is low. It is of the utmost importance to perform high-resolution anoscopy and biopsy in women with suspicious lesions in order to confirm the pathology.
authors.affiliation: Gynecological Pathology Division, Department of Pathology, Hospital de Clínicas "José de San Martín," Universidad de Buenos Aires, Argentina.
authors.forename: L H
authors.initials: LH
authors.lastname: Cardinal
authors.forename: P
authors.initials: P
authors.lastname: Carballo
authors.forename: M C Cabral
authors.initials: MC
authors.lastname: Lorenzo
authors.forename: A
authors.initials: A
authors.lastname: García
authors.forename: V
authors.initials: V
authors.lastname: Suzuki
authors.forename: S
authors.initials: S
authors.lastname: Tatti
authors.forename: S
authors.initials: S
authors.lastname: Vighi
authors.forename: L B
authors.initials: LB
authors.lastname: Díaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000276:immunology / Q000473:pathology; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D065309:Atypical Squamous Cells of the Cervix; D001706:Biopsy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000706:statistics & numerical data*; D007165:Immunosuppression Therapy; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014846:Vulvar Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology
keywords: AIN; HPV-lower genital tract; anal cytology; high-resolution anoscopy; screening; women group