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Nemcova J, Cerna K, Rob F, Smahelova J, Tresnak Hercogova J, Marx J, Traxmandlova I, Ondic O. Prevalence of high-risk human papillomavirus DNA and mRNA and its association with abnormal anal cytology in the Czech male anal cancer screening cohort. Diagn Cytopathol 2021; 49:1188-1195. [PMID: 34529895 DOI: 10.1002/dc.24873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anal cancer (AC) screening is justified in high-risk populations, particularly HIV-positive men having sex with men (MSM). HR-HPV testing could improve the efficiency of cytologically based screening of AC, as in the screening of biologically analogical cervical cancer. The specificity of HR-HPV testing is influenced by the prevalence of HR-HPV infection in the screened population. Reported anal HR-HPV DNA prevalence in MSM is high, but HR-HPV mRNA reflects rather long-term infections and is more specific for high-grade lesions. However, no data were published about HR-HPV DNA and mRNA prevalence in the Czech AC screening population. METHOD Results of liquid-based anal cytology of 203 predominantly HIV-positive MSM from the Czech AC screening cohort were correlated with results of DNA and E6/E7 mRNA testing of 14 HR-HPV types, and HPV16 genotyping. Eighty-one MSM underwent a standard anoscopy. RESULTS A total of 109 (53.7%) samples had abnormal cytology, with 12 (5.9%) ASC-H/HSIL, 67 (33.0%) samples cytologically negative, and 27 (13.3%) unsatisfactory. HR-HPV DNA was detected in 134 (66.0%) and HR-HPV RNA in 72 (35.5%) anal smears. HR-HPV mRNA and HPV16 mRNA positivity were associated with abnormal cytology (p = .0037, p = .0021). No significant association was found between HR-HPV DNA or HPV16 DNA positivity and abnormal cytology. No high-grade lesions were revealed by anoscopy. CONCLUSION Prevalence of anal HR-HPV DNA among Czech MSM is high, however, the prevalence of HR-HPV mRNA is half and associated with abnormal cytology. Our results indicate an increased efficiency of cytological screening when combined with HR-HPV mRNA testing.
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Affiliation(s)
- Jana Nemcova
- Biomedical Center of the Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Sikl's Department of Pathology, University Hospital in Pilsen, Pilsen, Czech Republic.,Biopticka Laborator s.r.o., Pilsen, Czech Republic
| | - Katerina Cerna
- Biomedical Center of the Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Sikl's Department of Pathology, University Hospital in Pilsen, Pilsen, Czech Republic.,Biopticka Laborator s.r.o., Pilsen, Czech Republic
| | - Filip Rob
- Department of Dermatovenereology, Second Faculty of Medicine, Charles University, Bulovka University Hospital, Prague, Czech Republic
| | - Jana Smahelova
- National Reference Laboratory for Papillomaviruses and Polyomaviruses, Institute Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jana Tresnak Hercogova
- Department of Dermatovenereology, Second Faculty of Medicine, Charles University, Bulovka University Hospital, Prague, Czech Republic
| | - Josef Marx
- Department of Surgery, First Faculty of Medicine, Charles University, Bulovka University Hospital, Prague, Czech Republic
| | - Iva Traxmandlova
- Faculty of Education, Centre for Biology, Geoscience and Environmental Education, University of West Bohemia, Pilsen, Czech Republic.,Global Change Research Institute, Czech Academy of Science, Brno, Czech Republic
| | - Ondrej Ondic
- Biomedical Center of the Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Sikl's Department of Pathology, University Hospital in Pilsen, Pilsen, Czech Republic.,Biopticka Laborator s.r.o., Pilsen, Czech Republic
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Patel AP, Schatz-Siemers NF, Dilcher TL, Goyal A. The interpretation of high-grade squamous intraepithelial lesion on anal cytology: a comparative analysis with the cervical Papanicolaou test. J Am Soc Cytopathol 2020; 9:540-549. [PMID: 32800528 DOI: 10.1016/j.jasc.2020.07.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prior studies have shown that high-grade squamous intraepithelial lesion (HSIL) tends to be underdiagnosed on anal cytology. Our study aims to decipher the interpretative challenges of HSIL that are more specific to anal cytology specimens by comparing them to cervical Papanicolaou tests. MATERIALS AND METHODS One hundred cases each of anal and cervical cytology specimens with HSIL interpretation and concordant histologic follow-up were retrieved and diagnostically confirmed. Patient demographic data were obtained from the electronic medical record. The cytologic specimens were reviewed and statistically compared in terms of proportion of HSIL cells, HSIL patterns and types, and cytoplasmic area of HSIL cells (with digital image analysis). A P value of <0.05 was considered statistically significant. RESULTS Of the patients with anal HSIL, 97% were human immunodeficiency virus-positive and 60% were men who have sex with men. The anal cytology specimens significantly differed from the cervical ones in several respects: proportion of HSIL cells, cytoplasmic area of HSIL cells, cases with HSIL cells in syncytial groups (10 versus 57) and cases with keratinizing HSIL (45 versus 10). The P value was <0.0001 for all comparisons except for the proportion of HSIL cells (P = 0.001). CONCLUSIONS Anal cytologic HSIL, in contrast to its cervical counterpart, exhibits fewer abnormal cells and smaller size of the diagnostic cells with a higher percentage of keratinizing lesions. A careful scrutiny of the sample with an enhanced understanding of the morphology and better sampling may help improve the detection of anal HSIL on cytology.
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Affiliation(s)
- Ami P Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Nina F Schatz-Siemers
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Thomas L Dilcher
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York.
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Chen CC, Chou YY. Predictive value of the anal cytology for detecting anal intraepithelial neoplasia or worse: A systematic review and meta-analysis. Diagn Cytopathol 2019; 47:307-314. [PMID: 30605263 DOI: 10.1002/dc.24078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/13/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Cheng-Chieh Chen
- Department of Pathology and Laboratory Medicine; Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan, Republic of China
| | - Yuh-Yu Chou
- Department of Pathology and Laboratory Medicine; Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan, Republic of China
- Department of Pathology, School of Medicine; College of Medicine, Taipei Medical University; Taipei Taiwan, Republic of China
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Donà MG, Benevolo M, Latini A, Rollo F, Colafigli M, Frasca M, Zaccarelli M, Giglio A, Moretto D, Pescarmona E, Cristaudo A, Giuliani M. Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer. Cancer Cytopathol 2018; 126:461-470. [PMID: 29694716 DOI: 10.1002/cncy.22003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anal cytology may be useful for evaluating lesions associated with human papillomavirus (HPV) in individuals at increased risk for anal cancer. METHODS Liquid-based cytology was used to assess anal cytological lesions among human immunodeficiency virus (HIV)-infected and HIV-uninfected men who have sex with men (MSM). The Linear Array HPV genotyping test was used for HPV detection. RESULTS This cross-sectional study included 1021 MSM, of whom 388 were HIV-infected (38.0%). Anal cytological lesions (atypical squamous cells of undetermined significance or more severe [ASCUS+]) were observed in 32.5% and 53.2% of the HIV-uninfected and HIV-infected individuals, respectively (P < .0001). The highest ASCUS + prevalence was observed among ≥45-year-old HIV-uninfected MSM (37.3%) and 25-to 29-year-old HIV-infected MSM (66.7%). High-grade squamous intraepithelial lesions (HSILs) peaked in ≥ 45-year-old HIV-uninfected subjects and 35- to 39-year-old HIV-infected subjects. Individuals with anal infections with high-risk (HR) HPV types were 3 to 4 times more likely to have an ASCUS + report. An HPV-16 and/or HPV-18 infection increased the odds of HSIL or more severe cytology (HSIL+) for HIV-infected MSM almost 4 times. MSM concurrently infected with HR and low-risk HPVs were significantly more likely to have low-grade squamous intraepithelial lesions or more severe cytology (LSIL+) than those infected with only HR types. No significant associations were found between cytological abnormalities and the HIV load and nadir and current CD4 + counts. CONCLUSIONS The prevalence of anal cytological lesions is high in MSM, even in HIV-infected individuals treated with combined antiretroviral therapy. In these subjects, HSILs occur more frequently and at a younger age in comparison with HIV-uninfected counterparts. Specific diagnostic procedures should be implemented to manage individuals at increased risk for anal cancer with an abnormal anal Papanicolaou test. Cancer Cytopathol 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Maria Gabriella Donà
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Alessandra Latini
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Manuela Colafigli
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Mirko Frasca
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Amalia Giglio
- Microbiology and Clinical Pathology Department, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Domenico Moretto
- Microbiology and Clinical Pathology Department, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Edoardo Pescarmona
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Antonio Cristaudo
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Massimo Giuliani
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
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Khattab R, McMeekin E, Taege AJ, Hekman JM, Brainard JA, Underwood D, Procop GW, Sturgis CD. Unsatisfactory exfoliative anal cytology samples, 15-year experience with histologic, cytologic, and molecular follow-up. Diagn Cytopathol 2017; 46:117-121. [PMID: 29124900 DOI: 10.1002/dc.23858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/21/2017] [Accepted: 10/23/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of anal carcinoma has risen in recent decades. Exfoliative cytology screening of selected high risk patients is performed in many centers. Unsatisfactory cytology results are frustrating to patients, clinicians, and laboratorians. The aim of this study is to ascertain outcomes of patients with non-diagnostic anal cytology. METHODS A retrospective review of anal cytology testing performed at the Cleveland Clinic between 01/01/2001 and 12/31/2015 was performed. All cases were received as liquid-based samples and processed as ThinPreps (Hologic, Marlborough, MA). Co-testing for HR-HPV DNA was performed using Hybrid Capture 2® (Qiagen, Germantown, MD) in the majority of patients. RESULTS Of 1,276 ThinPrep anal cytology samples, 130 (10%) were deemed unsatisfactory. 77% of patients were HIV positive. 85% were males. Of the unsatisfactory cases, 116 (89%) were co-tested for HR-HPV DNA. Of those, 40 patients (34%) had a simultaneous positive HR-HPV DNA. Adequate follow up cytology within a one year and a two year period revealed that 18/130 (14%) and 26/130 (20%) of patients had ASC or SIL respectively. Histologic follow-up within one and two years showed 3 patients (2%) and 8 patients (6%) with HSIL or worse. CONCLUSIONS High risk patients with unsatisfactory anal cytology are not "negative". At least one-third proved to be concomitantly HR-HPV DNA positive with one-fifth showing subsequent cytologic squamous abnormalities and with more than 5% being diagnosed with a high grade intraepithelial lesion within two years. Prompt repeat cytology and/or HR-HPV DNA is recommended for high risk patients with non-diagnostic cytology.
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Affiliation(s)
- Ruba Khattab
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Emily McMeekin
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan J Taege
- Department of Infectious Diseases, Cleveland Clinic, Ohio
| | - James M Hekman
- Department of Community Internal Medicine, Cleveland Clinic, Ohio
| | - Jennifer A Brainard
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dawn Underwood
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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