Anal papanicolaou smear in women with abnormal cytology: a thai hospital experience.
BACKGROUND
Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women.


METHODS
This prospective study was conducted in Prapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women were recruited. Participants who had cytological reports of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statistics and logistic regression analysis were used to evaluate correlations between groups.


RESULTS
HIV-infected women with abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval 1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9, 39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively.


CONCLUSIONS
Abnormal cervical cytology in HIV-infected women indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection for evaluation was a major limitation. Improvement of sample collection is recommended for future investigations.
Department of Obstetrics and Gynaecology, Prapokklao Hospital, Chanthaburi, Thailand E-mail : panysanan@yahoo.com.
Panya
P
Sananpanichkul
Sirida
S
Pittyanont
Prapap
P
Yuthavisuthi
Nutchanok
N
Thawonwong
Malee
M
Techapornroong
Kornkarn
K
Bhamarapravatana
Komsun
K
Suwannarurk
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003581:Cytodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013048:Specimen Handling; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult