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Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e318281d36e
Original Articles

Comparison of 2 Anal Cytology Protocols to Predict High-Grade Anal Intraepithelial Neoplasia

Wiley, Dorothy JoAnn PhD1; Hsu, Hilary BS1; Bolan, Robert MD2; Voskanian, Alen MD3; Elashoff, David PhD4,5; Young, Stephen PhD6; Dayrit, Ruvy BS(c)1; Barman, Provaboti PhD1; DeAzambuja, Katherine BS1; Masongsong, Emmanuel V. BS1; Martínez-Maza, Otoniel PhD7,8; Detels, Roger MD, MS9

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Objectives: Nylon-flocked and Dacron swab anal cytology collection procedures were evaluated for detecting high-grade anal intraepithelial neoplasia.

Materials and Methods: Cross-sectional data for 42 HIV-infected and 16 uninfected men who have sex with men have been used. Sequentially collected anal cytology specimens, high-resolution anoscopy, and medical biopsy evaluated the sensitivity and specificity of cytology for predicting high-grade anal intraepithelial neoplasia. Men showing atypical squamous cells (ASC) or more severe findings by cytology were compared with those showing negative for intraepithelial lesions.

Results: The prevalence of high-grade anal intraepithelial neoplasia was 35% (21/58), and findings were approximately 1.5 times higher among HIV-infected compared with uninfected men. Unsatisfactory cytology was twice as common among Dacron compared with nylon-flocked swab protocol specimens (14% [8/58] vs 7% [4/58]). Sensitivity and specificity for the nylon-flocked protocol cytology showing ASC or more severe findings were 81% (58%–95%) and 73% (50%–89%), respectively. Dacron protocol specimens showed 52% (30%–74%) and 58% (34%–80%) sensitivity and specificity, respectively. Men showing ASC or more severe findings using the nylon-flocked protocol cytology showed 3-fold higher odds for high-grade anal intraepithelial neoplasia compared with men with negative results (p < .05), but no statistically significantly higher odds of high-grade anal intraepithelial neoplasia for men showing ASC or more severe findings compared with those with negative results for Dacron protocol cytology (p > .05).

Conclusions: The nylon-flocked protocol better detects high-grade anal intraepithelial neoplasia than does the Dacron protocol, yields more interpretable results, and classifies men with high-grade anal intraepithelial neoplasia as cytologically abnormal 2.5 times more often, even in this small clinical trial.

Clinical trials registration number: NCT00955591.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology


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