Comparison of patient- and clinician-collected anal cytology samples to screen for human papillomavirus - Associated anal Intraepithelial neoplasia in men who have sex with men
Comparison of patient- and clinician-collected anal cytology samples to screen for human papillomavirus - Associated anal Intraepithelial neoplasia in men who have sex with men
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DOI：
10.7326/0003-4819-149-5-200809020-00004
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发表时间：
2008-09-02
影响因子：
39.2
通讯作者：
Palefsky, Joel M.
中科院分区：
文献类型：
--
作者：
Chin-Hong, Peter V.;Berry, J. Michael;Palefsky, Joel M.
背景资料：人乳头瘤病毒（HPV）相关的肛门癌的患病率正在增加，并且在美国与男性发生性关系的男性和HIV阳性个体中比宫颈癌在女性中更常见。细胞学筛查可以发现肛门癌的前体，肛门上皮内瘤变（AIN）。鲜为人知的是自我收集的样本AIN筛查，很少有社区为基础的AIN estimates exist.Objective：比较自我收集与cliniciancollected肛门细胞学标本的敏感性，以检测活检证实AIN和AIN的患病率估计在社区sample.Design：横断面研究。参与者邮寄肛门细胞学自我收集试剂盒与说明。临床医生重复进行肛门细胞学检查，并进行高分辨率肛门镜检查，以活检作为诊断参考标准。地点：加州的旧金山弗朗西斯科。患者：以社区为基础的男男性行为样本。测量：肛门HPV和AIN的患病率。自我收集和临床医生收集的肛门细胞学标本诊断AIN.Results的敏感性和特异性进行了计算：活检证实的AIN被诊断为57%的HIV阳性和35%的HIV阴性的参与者（P = 0.04），80%提供了足够的自我收集的标本进行解释。在HIV阳性男性中，细胞学检测AIN的灵敏度为75%（95%CI，51%至93%）（自我收集）和90%（CI，68%至99%）（临床医生收集）; HIV阴性男性中的相应值分别为48%（CI，26%至70%）和62%（CI，38%至82%）。细胞学检测艾滋病毒阳性男性AIN的特异性为50%（CI，22%至78%）时，自我收集和64%（CI，36%至86%）时，临床医生收集;相应的值在艾滋病毒阴性男性分别为86%（CI，71%至94%）和85%（CI，72%至93%）。参与者自我报告HIV状态。结论：在以社区为基础的样本中，高比例的HIV阳性和HIV阴性的男性与男性发生性关系有AIN。细胞学检测AIN的灵敏度是较高的临床医生收集的标本与自我收集的标本和HIV阳性与HIV阴性的男性。细胞学检测AIN的特异性在HIV阴性男性中高于HIV阳性男性。然而，细胞学结果阴性的患者发生AIN的概率可能不够低（HIV阴性男性为23%，HIV阳性男性为45%，患者采集标本），临床医生不建议对细胞学结果阴性的患者进行一次性检查。这些数据提出了一个问题，是否最佳的人群筛查策略是细胞学筛查与肛门镜检查只为那些谁测试阳性或肛门镜检查是否应该推荐给每个人在这些风险群体。由于资源有限，接受肛门镜检查培训的临床医生数量有限，细胞学筛查可能是目前在高危人群中识别疾病的最佳方法。
Background: Human papillomavirus (HPV)-associated anal cancer is increasing in prevalence and is more common among men who have sex with men and HIV-positive individuals than cervical cancer is among women in the United States. Cytology screening can detect the anal cancer precursor, anal intraepithelial neoplasia (AIN). Little is known about self-collected samples for AIN screening, and few community-based AIN estimates exist.Objective: To compare the sensitivity of self-collected versus cliniciancollected anal cytology specimens to detect biopsy-confirmed AIN and the prevalence estimate of AIN in a community sample.Design: Cross-sectional study. Participants were mailed anal cytology self-collection kits with instructions. Clinicians repeated anal cytology and performed high-resolution anoscopy with biopsies as the diagnostic reference standard.Setting: San Francisco, California.Patients: Community-based sample of men who have sex with men.Measurements: Prevalence of anal HPV and AIN. Sensitivity and specificity of self-collected and clinician-collected anal cytology specimens to diagnose AIN were calculated.Results: Biopsy-proven AIN was diagnosed in 57% of HIV-positive and 35% of HIV-negative participants (P = 0.04), and 80% provided adequate self-collected specimens for interpretation. The sensitivity of cytology to detect AIN in HIV-positive men was 75% (95% CI, 51% to 93%) when self-collected and 90% (CI, 68% to 99%) when clinician-collected; respective values in HIV-negative men were 48% (CI, 26% to 70%) and 62% (CI, 38% to 82%). The specificity of cytology to detect AIN in HIV-positive men was 50% (CI, 22% to 78%) when self-collected and 64% (CI, 36% to 86%) when clinician-collected; respective values in HIV-negative men were 86% (CI, 71% to 94%) and 85% (CI, 72% to 93%).Limitations: The study sample was from a narrowly defined geographical area. Participants self-reported HIV status.Conclusion: In a community-based sample, a high proportion of HIV-positive and HIV-negative men who have sex with men have AIN. The sensitivity of cytology to detect AIN is higher for clinician-collected versus self-collected specimens and for HIV-positive versus HIV-negative men. The specificity of cytology to detect AIN is higher in HIV-negative versus HIV-positive men. However, the probability of AIN in a patient with a negative cytology result may not be low enough (23% for HIV-negative men and 45% for HIV-positive men with a patient-collected specimen) for clinicians to be comfortable recommending no anoscopy for those with a negative cytology result if done as a one-time test. These data raise the question of whether the optimal population screening strategy is cytology screening with anoscopy only for those who test positive or whether anoscopy should be recommended for everyone in these risk groups. Given limited resources and the limited number of clinicians trained in anoscopy, cytology screening may be the best current approach to identifying disease in the at-risk population.