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Anal Papanicolaou Smear in Women with Abnormal Cytology: a Thai Hospital Experience

  • Sananpanichkul, Panya (Department of Obstetrics and Gynaecology, Prapokklao Hospital) ;
  • Pittyanont, Sirida (Department of Obstetrics and Gynaecology, Prapokklao Hospital) ;
  • Yuthavisuthi, Prapap (Department of Obstetrics and Gynaecology, Prapokklao Hospital) ;
  • Thawonwong, Nutchanok (Department of Pathology, Prapokklao Hospital) ;
  • Techapornroong, Malee (Department of Medicine, Prapokklao Hospital) ;
  • Bhamarapravatana, Kornkarn (Department of Preclinical Science, Thammasat University) ;
  • Suwannarurk, Komsun (Department of Obstetrics and Gynaecology, Thammasat University)
  • Published : 2015.03.04

Abstract

Background: Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women. Materials and Methods: This prospective study was conducted in Prapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women were recruited. Participants who had cytological reports of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statistics and logistic regression analysis were used to evaluate correlations between groups. Results: HIV-infected women with abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval 1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9, 39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively. Conclusions: Abnormal cervical cytology in HIV-infected women indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection for evaluation was a major limitation. Improvement of sample collection is recommended for future investigations.

Keywords

Papanicolaou Smear;pap test;anus;cervix;HIV;CIN;AIN

Acknowledgement

Supported by : Institute of Prapokklao Hospital

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  1. Results of the Womenʼs Self-Performed Anal Pap Trial in Human Immunodeficiency Virus–Infected Women vol.43, pp.7, 2016, https://doi.org/10.1097/OLQ.0000000000000448