An Exploratory Survey on the Use of Anal Cytology as a Tool for Anal Cancer Screening in Italy

Anal cytology and human papillomavirus (HPV) testing are the most common tools for anal cancer screening. We conducted an exploratory survey on the use of anal cytology in Italy. The Italian Society of Cytology (SICi) disseminated a questionnaire to its members and contacts on screened populations, departments collecting the samples, devices used, type of cytology (conventional or liquid based), professionals evaluating cytology, reporting system, use of anal cytology alone or in combination-test modality, diagnostic procedure for screen-positive individuals, and departments involved. Eighteen centers participated in the survey. In 15 centers (83.3%), anal cytology is performed on more than one at-risk population: men who have sex with men (MSM)/transgender women (TW) living with human immunodeficiency virus (LWH 13 centers, 72.2%), women with a history of gynecologic (pre)cancer (10 centers, 55.6%), women LWH (nine centers, 50.0%), men who have sex with women LWH, and MSM/TW not LWH (eight centers, 44.4%). Samples mostly come from infectious disease (nine, 50.0%) and sexually transmitted infection units (seven, 38.9%). A median of 140 samples (IQR, 30-500) are collected per year, with 13 centers (72.2%) using a cytobrush. Cytology is generally conventional (11 centers, 61.1%) and is mainly interpreted by histopathologists (66.7%) and biologists (55.6%). All centers use the Bethesda System for reporting cytology. Most of the centers use cytology in co-testing with HPV (10, 55.6%). Twelve centers (66.7%) perform high-resolution anoscopy, and the diagnostic procedure is frequently performed in general surgery (eight, 44.6%). Most of the centers employ anal cytology in people LWH and perform conventional cytology. Screening modality is variable, with more than half of the centers using cytology in co-testing with HPV. The use of high-resolution anoscopy is still suboptimal.

Screening for anal cancer prevention in Italy relies on heterogeneous and not fully satisfactory tools. Further efforts should be made to implement the optimal strategies in order to address the needs of the populations with the highest anal cancer risk.