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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182928ea6
Clinical Science

Comparable Performance of Conventional and Liquid-Based Cytology in Diagnosing Anal Intraepithelial Neoplasia in HIV-Infected and -Uninfected Thai Men Who Have Sex With Men

Phanuphak, Nittaya MD*,†; Teeratakulpisarn, Nipat MD*; Lim, Cherry BSc*; Changnam, Taweesak MSc*; Kerr, Stephen PhD‡,§; Deesua, Amornrat RN*; Hongchookiat, Piranun RN*; Rodbamrung, Piyanee RN*; Numto, Saranya BSc; Barisri, Jiranuwat BSc*; Phanuphak, Praphan MD, PhD*,†,‡,¶; Keelawat, Somboon MD#; Sohn, Annette H. MD**; Ananworanich, Jintanat MD, PhD*,†,‡,¶; Triratanachat, Surang MD

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Abstract

Background: Anal cytology has increasingly been used to screen for anal intraepithelial neoplasia (AIN) among men who have sex with men (MSM) at increased risk for anal cancer. Use of liquid-based cytology has been reported to reduce fecal and bacterial contamination and air-drying artifact compared with conventional cytology. Costs associated with liquid-based cytology, however, may limit its use in resource-limited settings.

Methods: Anal swab samples were collected from MSM participants and used to prepare conventional and liquid-based cytology slides. Abnormal conventional cytology results triggered referral for high-resolution anoscopy and biopsy. Agreement between the 2 cytology techniques and the positive predictive value ratios of histology confirmed AIN were calculated.

Results: Among 173 MSM, abnormal anal cytology was identified in 46.2% of conventional and 32.4% of liquid-based slides. The results agreed in 62.4% of cases with a κ value of 0.49 (P < 0.001). HIV-infected MSM had a 3.6-fold increased odds of having discordant anal cytology results (95% confidence interval: 1.6 to 7.8; P = 0.001) compared with HIV-uninfected MSM. Histological AIN 2 and 3 were identified in 20 MSM. The positive predictive value ratios and 95% confidence interval indicated no difference between the 2 techniques.

Conclusions: Conventional anal cytology may be a preferred option for resource-limited settings given comparable performances to liquid-based cytology for the detection of AIN, although the agreement between the 2 techniques was lower among HIV-infected MSM. Due to high prevalence of abnormal anal cytology and AIN, health systems should prepare adequate infrastructure for high-resolution anoscopy services and AIN treatment.

© 2013 by Lippincott Williams & Wilkins

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