Value of cytological smears and PCR screening for Human Papilloma Virus DNA in detecting anal intraepithelial neoplasia: LTP18

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Aim:To analyze the significance of abnormal anal smears relative to the histology of a surgical sample and PCR detection of HPV/DNA.Method:Between June 2007 and January 2009, 300 successive patients undergoing surgery (hemorrhoidectomy and/or fissurectomy) were included in the study. A cytological smear and a viral sample were taken.Results:The cytological smear was interpretable in 97% of cases and was normal in 216/290 cases. Four high-grade intraepithelial lesions (HSIL) were found and 19 low-grade lesions (LSIL), in five cases high-grade lesions could not be excluded (ASC-H), 30 lesions were of undetermined significance (ASCUS) and there were 16 cell modifications with a non-neoplastic appearance. The PCR test for HPV was positive in 55/278 (19.8%) cases with a high risk genotype in 63.6%. Histological examination was normal in 277/300 (92.3%) cases. The 23 AIN were distributed as follows: 13 AIN1, 6 AIN2 and 4 AIN3. The sensitivity of cytological smears and PCR for detecting AIN was respectively 56 and 60.8%; specificity was 77 and 84.5%. Combining the two screening tests increased sensitivity to 78% but decreased the specificity to 68%.Conclusion:This study confirms the usefulness of anal cytology as a screening tool, considering its simplicity and low cost.

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