title: High-resolution anoscopy in women with cervical neoplasia.
abstract: OBJECTIVE
  To describe high-resolution anoscopy (HRA) findings and compare them with histopathology results.
  
  
  METHODS
  In a cross-sectional, observational study performed between December 2008 and December 2009, women receiving care at a center in Recife, Brazil, after a histopathologic diagnosis of cervical intraepithelial neoplasia or cervical cancer were screened for anal neoplasia by HRA. Patients with anal lesions were divided into groups A (metaplasia and/or human papillomavirus infection) and B (anal intraepithelial neoplasia [AIN]). Patients with squamous cell atypia in group A and all patients in group B underwent histopathologic analysis. Agreement between HRA and histopathology findings was estimated for group B.
  
  
  RESULTS
  HRA was done in 324 women, 204 (63.0%) of whom had anal lesions. Overall, 169 cases (82.8%) were classified as group A and 35 (17.2%) as group B. Histopathologic data were obtained for 28 of the 35 group B cases. Histopathology was suggestive of AIN in 19 (67.9%), resulting in a κ coefficient of 0.45 (95% confidence interval [CI] 0.26-0.65; P<0.001). Relative to histopathology, HRA had sensitivity of 57.6% (95% CI 40.8%-72.7%), specificity of 86.1% (95% CI 75.7%-92.5%), positive likelihood ratio of 4.1 (95% CI 3.1-5.5), negative likelihood ratio of 0.5 (95% CI 0.4-0.5), and accuracy of 76.5% (95% CI 67.2%-83.8%).
  
  
  CONCLUSIONS
  HRA findings can be systematized, reducing the subjectivity of interpretation.
authors.affiliation: Department of Lower Genital Tract Pathology, Women's Healthcare Center, Instituto Materno Infantil Professor Fernando Figueira, Recife, Brazil. Electronic address: sandra_heraclio@hotmail.com.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Heráclio
authors.affiliation: Department of Lower Genital Tract Pathology, Women's Healthcare Center, Instituto Materno Infantil Professor Fernando Figueira, Recife, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Schettini
authors.affiliation: Cytopathology Division, Pernambuco Public Health Laboratory, Recife, Brazil.
authors.forename: Micheline L
authors.initials: ML
authors.lastname: Oliveira
authors.affiliation: Department of Lower Genital Tract Pathology, Women's Healthcare Center, Instituto Materno Infantil Professor Fernando Figueira, Recife, Brazil.
authors.forename: Alex Sandro R
authors.initials: AS
authors.lastname: Souza
authors.affiliation: Department of Biology, Federal Rural University of Pernambuco, Recife, Brazil.
authors.forename: Paulo Roberto E
authors.initials: PR
authors.lastname: Souza
authors.affiliation: Department of Lower Genital Tract Pathology, Women's Healthcare Center, Instituto Materno Infantil Professor Fernando Figueira, Recife, Brazil.
authors.forename: Melania Maria R
authors.initials: MM
authors.lastname: Amorim
mesh_terms: D000328:Adult; D001004:Anus Diseases / Q000175:diagnosis* / Q000473:pathology; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001938:Brazil; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis; D011351:Proctoscopy / Q000379:methods*; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology*
keywords: Anal neoplasia; Cervical intraepithelial neoplasia; Early cancer detection; Papillomaviridae