Conventional cytologic diagnosis of human papillomavirus-induced anal intraepithelial neoplasia: The experience of a referral center in Rio de Janeiro, Brazil.

BACKGROUND: Screening of anal cancer is rarely available or performed in Brazil. This study analyzes the diagnostic performance of conventional cytology (CC) in the prevention of anal cancer in a coloproctology and gynecology outpatient clinics in a public hospital in Rio de Janeiro, Brazil. METHODS: From 2005 to 2017, 1066 conventional cytological samples were collected. We analyze the causes of unsatisfactory samples (11.3%) and compare the cytological diagnoses of 83 samples from persons living with HIV and persons not living with HIV and in specific situations, using as the gold standard high-resolution anoscopy or histopathology in cases biopsied within 6 months after cytology. RESULTS: The sensitivity of cytology with diagnosis of ASC-US for detection of anal intraepithelial neoplasia of any grade was 85%, specificity was 41%, positive and negative predictive values were 64% and 75%, respectively, and positive and negative likelihood ratios were 1.46 and 0.35, respectively. CONCLUSION: Conventional cytology available in resource-limited settings is a simple, noninvasive, low-cost method that proved feasible for outpatient screening of precursor lesions of the anal canal.

Value of conventional cytology in the presence of macroscopic lesions of the anal canal / Valor da citologia convencional na presença de lesões macroscópicas do canal anal

OBJECTIVES: To verify the value of conventional cytology for the diagnosis of macroscopic lesions of the anal canal and to describe the limitations of the samples. METHOD: We evaluated 395 conventional cytology samples obtained by brushing the anal canal of patients (predominantly male, HIV-positive) and compared them to the presence of macroscopic lesions of the anal canal observed under anorectal examination. RESULTS: Of the total, 91.6% of samples were classified as adequate. Cellular elements representative of the anal transformation zone were observed in 63.5% of samples. Sensitivity in the presence or absence of cellularity was 80% and 31%, respectively. CONCLUSION: The study demonstrates the feasibility of using conventional anal cytology in outpatients. (AU)

OBJETIVO: verificar o valor da citologia convencional no diagnóstico de lesões macroscópicas do canal anal e descrever as limitações das amostras obtidas. MÉTODO: avaliamos 395 exames citológicos convencionais obtidos por escovado do canal anal de pacientes predominantemente do sexo masculino, soropositivos para HIV, e comparamos com a presença de lesões macroscópicas do canal anal constatadas ao exame proctológico. RESULTADO: o percentual de amostras adequadas foi de 91,6%, e os elementos celulares representativos da zona de transformação anal foram observados em 63,5% das amostras. Encontramos sensibilidade de 80% e 31% na presença ou ausência desta celularidade, respectivamente. CONCLUSÃO: O estudo demonstra a possibilidade de utilização da citologia anal convencional no rastreio de lesões macroscópicas do canal anal em pacientes ambulatoriais. (AU)

Rastreamento de lesões pré-neoplásicas do ânus: citologia anal e anuscopia de alta resolução novas armas para prevenção / Premalignant screening for anal lesions: anal cytology and high resolution anoscopy. New resources for prevention

Squamous anal cell carcinoma frequency has been changing during the last decades. It was a rare disease in the past with 0.2 cases per 100,000 inhabitants in Denmark before the 60’s and 0.5 per 100,000 in the United States of America (USA) in 1973. Currently these figures have risen to a 1.00 / 100,000 ratio in accordance with the public records in the USA. Although the incidence in the general population can still be considered low, regardless of having doubled during the past 30 years, some specific groups in the population seem to have a higher level of risk, with a ratio of 70 ocurrences per each group of 100,000 individuals. The relationship between infections caused by oncogenic types of human papillomavirus and the similarity with cervical squamous cell carcinoma lead us to believe that screening techniques similar to the ones used as from the 40’s aiming the control of the cervical carcinoma, such as Papanicolaou smear (anal cytology) and colposcopy (high resolution anoscopy), may be effective on anal cancer prevention in those specific groups, or at least, to its early diagnosis. This article presents the techniques for tracking these early anal cancer lesions justifying them as a Public Health point of view.