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Combining Diagnostic Techniques Can Improve Surveillance and Follow-Up of Anal Intraepithelial Neoplasia in HIV Patients: Presented at ASCP

By Maggie Schwarz

BALTIMORE, Md -- October 17, 2008 -- Combining screening anal cytology, biopsy, and high-resolution anoscopy can help improve surveillance and follow-up of anal intraepithelial neoplasia in patients with HIV, according to results presented here at the American Society for Clinical Pathology (ASCP) 2008 Annual Meeting.

George C. Chang, MD, Veterans Affairs Medical Center and University of Cincinnati, Cincinnati, Ohio, and colleagues set out to correlate high-resolution anoscopy and biopsy findings with anal cytology.

From 2005 to 2007, Dr. Chang and colleagues used anal cytology tests to screen 142 HIV-positive men for anal intraepithelial neoplasia. Patients with abnormal cytology results then underwent high-resolution anoscopy. Based on Reid's colposcopic index, biopsies were performed on suspicious lesions. Cytology and biopsy were then reviewed independently by 2 investigators using the Bethesda criteria for cervical pap tests.

Results of the total Reid's score were compared with those found on cytology and biopsy, and HIV viral loads within 4 months of anoscopy were used to assess HIV disease status.

The researchers performed 34 high-resolution anoscopies with corresponding biopsies. According to Reid's score, 9% had an anal intraepithelial neoplasia score of I, 41% had a score of I or II, and 50% had a score of II or III.

Biopsy results were normal in 6% of samples, low-grade squamous intraepithelial lesions were found in 29%, high-grade squamous intraepithelial lesions were found in 56%, and squamous-cell carcinoma was identified in 6%.

Reid colposcopic index correlated well with biopsy findings (P = .04), Dr. Chang said. Two squamous-cell carcinomas (1.4% of the samples) were found in patients with no prior screening high-resolution anoscopy.

In patients with normal cytology findings, HIV viral loads were statistically lower than in patients with abnormal cytology (1,321 vs 24,412 copies/mL, P = .02).

Dr. Chang concluded that results from screening anal cytology, biopsy, and high-resolution anoscopy were in concordance.

"Combining all 3 techniques, surveillance, and follow-up of anal intraepithelial neoplasia would be more effective," he said. "These 3 techniques can also serve as useful quality assurance tools for each other."

[Presentation title: Anoscopy and Histologic Findings in HIV Patients With Screening Anal Cytology Tests: A VAMC Report. Abstract P659]

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