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Agreement between methods for diagnosing HPV-induced anal lesions in women with cervical neoplasia
Sandra de Andrade Heráclio1, Alex Sandro Rolland de Souza, Fátima Regina Gomes Pinto
1Department of Lower Genital Tract Pathology, Women's Healthcare Center, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and Cytopathology Division of the Pernambuco Public Health Laboratory, Recife, Brazil. sandra_heráclio@hotmail.com
Objective:
To evaluate agreement between 3 methods for screening anal intraepithelial lesions: anal cytology, anoscopy and human papillomavirus (HPV) detection by PCR.
Study Design:
This prospective, cross-sectional study screened 324 women with cervical neoplasia for anal neoplasia. Agreement between methods was calculated using the κ coefficient.
Results:
Of 324 anal cytologies performed, 31.5% (n = 102) were found to be abnormal: low-grade anal lesions were detected in 19.1% (n = 62) of cases, high-grade lesions in 3.1% (n = 10) and atypical squamous cells of undetermined significance in 9.3% (n = 30). With respect to the biopsies, 25.7% (n = 20) were positive, consisting of 7 cases of HPV infection, 5 anal intraepithelial neoplasia (AIN) grade 1, 6 AIN grade 2, and 2 AIN grade 3. Twenty-one samples (6.5%) were inadequate for HPV analysis. Of the 303 adequate samples, 84.2% (n = 255) tested positive for HPV. Agreement between cytology and anoscopy was fair (κ = 0.31). Agreement between PCR for HPV and cytology was slight (κ = 0.08) and no agreement was found between PCR for HPV and anoscopy (κ = 0.00).
Conclusion:
Agreement between the different methods of diagnosing HPV-induced anal lesions is slight to fair; however, anal cytology permits identification of cases in which lesions are present, allowing them to be referred for anoscopy and biopsy.
