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Research Publications

Comparison of 2 anal cytology protocols to predict high-grade anal intraepithelial neoplasia.

Wiley DJ, Hsu H, Bolan R, Voskanian A, Elashoff D, Young S, Dayrit R, Barman P, Deazambuja K, Masongsong EV, Martínez-Maza O, Detels R.

1Translational Science Section, School of Nursing, University of California at Los Angeles, Los Angeles; 2Los Angeles Gay and Lesbian Center, Jeffrey Goodman Clinic, Hollywood; 3Center for Clinical AIDS Research and Education (University of California at Los Angeles-CARE Center); 4Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles; and 5Jonsson Comprehensive Cancer Center, Los Angeles, CA; 6Tricore Diagnostic Laboratories, University of New Mexico, Albuquerque, NM; and 7University of California at Los Angeles AIDS Institute; and 8Department of Obstetrics and Gynecology, David Geffen School of Medicine, and 9Jonathan & Karin Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA.

OBJECTIVES: Nylon-flocked and Dacron swab anal cytology collection procedures were evaluated for detecting high-grade anal intraepithelial neoplasia.

MATERIALS AND METHODS: Cross-sectional data for 42 HIV-infected and 16 uninfected men who have sex with men have been used. Sequentially collected anal cytology specimens, high-resolution anoscopy, and medical biopsy evaluated the sensitivity and specificity of cytology for predicting high-grade anal intraepithelial neoplasia. Men showing atypical squamous cells (ASC) or more severe findings by cytology were compared with those showing negative for intraepithelial lesions.

RESULTS: The prevalence of high-grade anal intraepithelial neoplasia was 35% (21/58), and findings were approximately 1.5 times higher among HIV-infected compared with uninfected men. Unsatisfactory cytology was twice as common among Dacron compared with nylon-flocked swab protocol specimens (14% [8/58] vs 7% [4/58]). Sensitivity and specificity for the nylon-flocked protocol cytology showing ASC or more severe findings were 81% (58%-95%) and 73% (50%-89%), respectively. Dacron protocol specimens showed 52% (30%-74%) and 58% (34%-80%) sensitivity and specificity, respectively. Men showing ASC or more severe findings using the nylon-flocked protocol cytology showed 3-fold higher odds for high-grade anal intraepithelial neoplasia compared with men with negative results (p < .05), but no statistically significantly higher odds of high-grade anal intraepithelial neoplasia for men showing ASC or more severe findings compared with those with negative results for Dacron protocol cytology (p > .05).

CONCLUSIONS: The nylon-flocked protocol better detects high-grade anal intraepithelial neoplasia than does the Dacron protocol, yields more interpretable results, and classifies men with high-grade anal intraepithelial neoplasia as cytologically abnormal 2.5 times more often, even in this small clinical trial.Clinical trials registration number: NCT00955591.

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