Correlation of anal cytology with follow-up histology and Human Papillomavirus genotyping: A 10-year experience from an academic medical center |
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| Affiliation: | 1. Department of Pathology, University of Rochester, Rochester, New York;2. Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio;1. Division of Adolescent and Transition Medicine, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;2. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;3. Department of Epidemiology, School of Public Health, University of California, Los Angeles, Los Angeles, California;4. Division of Biostatistics and Epidemiology, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;5. Division of Infectious Diseases, School of Medicine, Indiana University, Indianapolis, Indiana;6. Division of Cancer Epidemiology, McGill University, Montreal, Quebec;1. Departments of Internal Medicine, Surgery, and Pathology, Howard University College of Medicine, Washington DC;2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland;3. Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland;4. Departments of Internal Medicine and Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan |
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| Abstract: | BackgroundAnal cytology (AC) is accepted as a practical screening modality for anal cancer. However, studies suggest that AC and anal biopsy dysplasia correlation is less robust than in cervicovaginal specimens. The current study goals were to look at our institutional experience in a subset of ACs and correlate with surgical pathology (SP), as well as evaluate their Human Papillomavirus (HPV) status.Methods377 ACs from 169 patients (151 males and 18 females) from 2008 to 2017 were included. HPV genotyping (n = 47) and SP within one year of AC (n = 58) were reviewed.ResultsAC/SP was discrepant in 22 cases (37.9%), with a tendency towards AC underestimating the degree of dysplasia. Specifically, any abnormality on AC was 93.8% sensitive for detecting high-grade dysplasia (HGD). However, when requiring a high-grade AC diagnosis, the sensitivity decreases to 12.5%. “Other high-risk HPV” was the most common genotype (57.4%). When considered with all AC with a high-grade diagnosis, co-testing with HPV improved the sensitivity for HGD to 56.3%. Sensitivity improved further to 87.5% when only considering cases with both AC and HPV testing, and were high-risk HPV positive. Furthermore, following review and consensus diagnosis, 8 cases changed from “Discrepant” to “Agreed”, reducing the discrepancy rate to 24.1%. Remaining discrepancies were explained by sampling error.ConclusionGiven the enhanced sensitivity of AC and HPV testing together, and sampling error seen with AC leading to underestimating dysplasia, we recommend AC and HPV co-testing, as well as describing confounding factors in AC reports and obtaining consensus opinion in equivocal cases. |
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