A Composite Cytology-Histology Endpoint Allows a More Accurate Estimate of Anal High-Grade Squamous Intraepithelial Lesion Prevalence

作者：Machalek Dorothy A; Poynten I Mary; Jin Fengyi; Hillman Richard J; Templeton David J; Law Carmella; Roberts Jennifer M; Tabrizi Sepehr N; Garland Suzanne M; Farnsworth Annabelle; Fairley Christopher K; Grulich Andrew E^*

来源：Cancer Epidemiology Biomarkers & Prevention, 2016, 25(7): 1134-1143.

DOI：10.1158/1055-9965.EPI-15-1106

Background: There is debate about the accuracy of anal cytology and high-resolution anoscopy (HRA), in the diagnosis of anal human papillomavirus (HPV)-related squamous intraepithelial lesions (SIL). Few studies have performed both simultaneously in a large sample of high-risk individuals.
Methods: At baseline in a community-based cohort of HIV-infected and uninfected homosexual men ages >= 35 years in Sydney, Australia, all men underwent anal swabbing for cytology and HPV genotyping, and HRA-guided biopsy. We evaluated the separate and combined diagnostic accuracy of cytology and histology, based on a comparison with the prevalence of HPV16 and other high-risk (HR) HPV. We examined trends in HPV prevalence across cytology-histology combinations.
Results: Anal swab, HRA, and HPV genotyping results were available for 605 of 617 participants. The prevalence of cytologically predicted high-grade SIL (HSIL, 17.9%) was lower than histologically diagnosed HSIL (31.7%, P < 0.001). The prevalence of composite-HSIL (detected by either method) was 37.7%. HPV16 prevalence was similar in men with HSIL by cytology (59.3%), HSIL by histology (51.0%), and composite-HSIL (50.0%). HPV16 prevalence was 31.1% in men with composite- atypical squamous cells suggestive of HSIL, to 18.5% in men with composite- low-grade SIL, to 12.1% in men with composite negative results (P-trend < 0.001).
Conclusions: Significantly more HSIL was detected when a composite cytology-histology endpoint was used. Increasing grade of composite endpoint was associated with increasing HPV16 prevalence.
Impact: These data suggest that a composite cytology-histology endpoint reflects meaningful disease categories and is likely to be an important biomarker in anal cancer prevention.

• 出版日期2016-7