Document Detail


Comparable performance of conventional and liquid-based cytology in diagnosing anal intraepithelial neoplasia in HIV-infected and -uninfected Thai men who have sex with men.
MedLine Citation:
PMID:  23535296     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Anal cytology has increasingly been used to screen for anal intraepithelial neoplasia (AIN) among men who have sex with men (MSM) at increased risk for anal cancer. Use of liquid-based cytology has been reported to reduce fecal and bacterial contamination and air-drying artifact compared with conventional cytology. Costs associated with liquid-based cytology, however, may limit its use in resource-limited settings.
METHODS: Anal swab samples were collected from MSM participants and used to prepare conventional and liquid-based cytology slides. Abnormal conventional cytology results triggered referral for high-resolution anoscopy and biopsy. Agreement between the 2 cytology techniques and the positive predictive value ratios of histology confirmed AIN were calculated.
RESULTS: Among 173 MSM, abnormal anal cytology was identified in 46.2% of conventional and 32.4% of liquid-based slides. The results agreed in 62.4% of cases with a κ value of 0.49 (P < 0.001). HIV-infected MSM had a 3.6-fold increased odds of having discordant anal cytology results (95% confidence interval: 1.6 to 7.8; P = 0.001) compared with HIV-uninfected MSM. Histological AIN 2 and 3 were identified in 20 MSM. The positive predictive value ratios and 95% confidence interval indicated no difference between the 2 techniques.
CONCLUSIONS: Conventional anal cytology may be a preferred option for resource-limited settings given comparable performances to liquid-based cytology for the detection of AIN, although the agreement between the 2 techniques was lower among HIV-infected MSM. Due to high prevalence of abnormal anal cytology and AIN, health systems should prepare adequate infrastructure for high-resolution anoscopy services and AIN treatment.
Authors:
Nittaya Phanuphak; Nipat Teeratakulpisarn; Cherry Lim; Taweesak Changnam; Stephen Kerr; Amornrat Deesua; Piranun Hongchookiat; Piyanee Rodbamrung; Saranya Numto; Jiranuwat Barisri; Praphan Phanuphak; Somboon Keelawat; Annette H Sohn; Jintanat Ananworanich; Surang Triratanachat
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  63     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-01     Completed Date:  2013-09-17     Revised Date:  2014-08-04    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  464-71     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anal Canal / pathology*
Anus Neoplasms / pathology*,  virology
Biopsy
Carcinoma in Situ / pathology*,  virology
Confidence Intervals
Cytodiagnosis / methods*
Endoscopy, Gastrointestinal
HIV Infections / complications*
Histocytological Preparation Techniques / methods*
Homosexuality, Male*
Humans
Male
Odds Ratio
Predictive Value of Tests
Specimen Handling / methods
Thailand
Grant Support
ID/Acronym/Agency:
U01 AI069907/AI/NIAID NIH HHS; U01AI069907/AI/NIAID NIH HHS; //PEPFAR
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