Anal Papanicolaou Smear in Women with Abnormal Cytology: a Thai Hospital Experience

Background: Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Womeninfected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening programfor AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervicaland anal cytology in HIV-infected women. Materials and
Methods: This prospective study was conducted inPrapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women wererecruited. Participants who had cytological reports of equally or over “abnormal squamous/glandular cells ofundetermined significance” (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statisticsand logistic regression analysis were used to evaluate correlations between groups.
Results: HIV-infected womenwith abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this studywas the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positivepredictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9,39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively.
Conclusions: Abnormal cervical cytology in HIV-infectedwomen indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection forevaluation was a major limitation. Improvement of sample collection is recommended for future investigations.