High-risk human papillomavirus test in anal smears: can it optimize the screening for anal cancer?
AIDS
; 35(5): 737-745, 2021 04 01.
Article
en En
| MEDLINE
| ID: mdl-33306557
ABSTRACT
OBJECTIVE:
The current method for screening anal cancer is anal cytology, which has low sensitivity. Since high-risk human papillomavirus (HR-HPV) is associated with almost 90% of cases of anal cancer, the objective of this study is to evaluate whether testing for HR-HPV can optimize the screening.DESIGN:
Prospective study with patients enrolled in a screening program for anal dysplasia. Considering high-resolution anoscopy (HRA)-guided biopsy as the gold standard for diagnosis of high-grade squamous intraepithelial lesions, the diagnostic performance of anal cytology, HR-HPV testing, and the combination of both was calculated. SETTINGS A single center for anal dysplasia.PARTICIPANTS:
A total of 364 patients (72% males, 82% HIV-positive). INTERVENTION Patients underwent anal cytology, HR-HPV test, and HRA-guided biopsy of the anal canal. MAIN OUTCOMEMEASURES:
Ability of cytology and HR-HPV test (individually and combined) to detect high-grade squamous intraepithelial lesions, and analysis of the cost of each diagnostic algorithm.RESULTS:
Cytology alone was the cheapest approach, but had the lowest sensitivity [59%, 95% confidence interval (CI) 46-71%], despite of highest specificity (73%, 95% CI 68-78%). Cotesting had the highest sensitivity (85%, 95% CI 74-93%) and lowest specificity (43%, 95% CI 38-49%), and did not seem to be cost-effective. However, HR-HPV testing can be used to triage patients with normal and atypical squamous cells of undetermined significance cytology for HRA, resulting in an algorithm with high sensitivity (80%, 95% CI 68-89%), and specificity (71%, 95% CI 65-76%), allied to a good cost-effectiveness.CONCLUSION:
HR-HPV testing is helpful to optimize the screening in cases of normal and atypical squamous cells of undetermined significance cytology.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias del Ano
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Infecciones por VIH
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Infecciones por Papillomavirus
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Alphapapillomavirus
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
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Risk_factors_studies
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Screening_studies
Límite:
Female
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Humans
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Male
Idioma:
En
Año:
2021
Tipo del documento:
Article