Audit of paired anal cytology and histopathology outcomes in patients referred to a public sexual health clinic
Vincent M. Williams A G , Cecily Metcalf B , Martyn A. French C D and Jenny C. McCloskey E FA Western Australian Biomedical Research Institute, School of Biomedical Sciences within the Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, WA, Australia.
B Department of Anatomical Pathology, Royal Perth Hospital, GPO Box X2213, Perth, WA 6847, Australia.
C Department of Clinical Immunology, Royal Perth Hospital, GPO Box X2213, Perth, WA 6847, Australia.
D School of Surgery and Pathology, University of Western Australia, PO Box M509, WA 6009, Australia.
E Sexual Health Clinic, Royal Perth Hospital, GPO Box X2213, Perth, WA 6847, Australia.
F School of Biomedical and Chemical Sciences, University of Western Australia, PO Box M502, WA 6009, Australia.
G Corresponding author. Email v.williams@curtin.edu.au
Sexual Health 7(3) 346-351 https://doi.org/10.1071/SH09118
Submitted: 5 November 2009 Accepted: 28 May 2010 Published: 19 August 2010
Abstract
Background: The level of agreement between anal cytology and histopathology is not clear with only a few studies evaluating the reliability of anal specimen reporting. Australian data in relation to this are limited. Methods: The results of paired anal cytology and histopathology specimens received between 2002 and 2008 from patients who were referred within the sexual health clinic were retrieved from the anatomical pathology database. A total of 248 paired samples from 154 (21 females, 133 males) participants were extracted. Concurrent high risk human papilloma virus (hrHPV) DNA assay and HIV status for the study group were also collected. Data were tabulated according to reported grade of squamous abnormality based on the Bethesda system. Using the biopsy result as the gold standard the specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for cytology were calculated and the association between grade of abnormality, HIV status and hrHPV infection estimated. Results: Concordance between cytology and histology showed that in 204 (85%) paired samples both tests were categorised as abnormal (Kappa statistic 0.73, P = 0.013). The cytology result showed a sensitivity of 96%, specificity 14%, PPV 89% and NPV 31% when compared with histopathology. HrHPV assay was positive in 192 (80%) samples. High-grade squamous abnormalities were reported in biopsy specimens from 60% (n = 42/67) of HIV-positive subjects and 25% (n = 22/87) of HIV-negative subjects. HIV-positive individuals were more likely to be hrHPV positive, odds ratio (OR) 6.21 [95% confidence interval (CI) 2.69 to 14.34], when compared with HIV-negative subjects. Conclusion: Anal cytology is highly sensitive for the detection of abnormal squamous cells. While cytology has low specificity for predicting the grade of abnormality compared with biopsy outcome, its application as a screening method in asymptomatic at risk populations warrants further study.
Additional keywords: anal biopsy, anal intraepithelial neoplasia, cytology, hrHPV.
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