TY - JOUR
T1 - A composite cytology-histology endpoint allows a more accurate estimate of anal high-grade squamous intraepithelial lesion prevalence
AU - Machalek, Dorothy A.
AU - Poynten, I. Mary
AU - Jin, Fengyi
AU - Hillman, Richard J.
AU - Templeton, David J.
AU - Law, Carmella
AU - Roberts, Jennifer M.
AU - Tabrizi, Sepehr N.
AU - Farnsworth, Annabelle
AU - Fairley, Christopher K.
AU - Grulich, Andrew E.
AU - SPANC Study Team
AU - Carroll, Susan
AU - Segelov, Eva
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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 (Ptrend < 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.
AB - 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 (Ptrend < 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.
UR - http://www.scopus.com/inward/record.url?scp=84973513007&partnerID=8YFLogxK
U2 - 10.1158/1055-9965.EPI-15-1106
DO - 10.1158/1055-9965.EPI-15-1106
M3 - Article
AN - SCOPUS:84973513007
SN - 1055-9965
VL - 25
SP - 1134
EP - 1143
JO - Cancer Epidemiology, Biomarkers and Prevention
JF - Cancer Epidemiology, Biomarkers and Prevention
IS - 7
ER -
