Prevalence of high-grade anal dysplasia among women with high-grade lower genital tract dysplasia or cancer: Results of a pilot study

Gynecol Oncol. 2019 May;153(2):266-270. doi: 10.1016/j.ygyno.2019.02.024. Epub 2019 Mar 1.

Abstract

Objective: To estimate the prevalence of high-grade anal dysplasia in women with high-grade dysplasia or carcinoma of the cervix, vagina or vulva.

Methods: In this cross-sectional study, participants underwent anal cytology, anal HPV testing with Cervista HPV16/18 and high-resolution anoscopy (HRA). Patients with HSIL (high-grade squamous cell intraepithelial lesion) or greater on anal cytology or anal biopsy were referred to a colorectal surgery specialist for further evaluation.

Results: Seventy-five women were enrolled in the study, including 47 with cervical (cervix group), 10 with vaginal (vagina group), 15 with vulvar (vulva group), 1 with cervical and vaginal, and 2 with vulvar and vaginal disease. The median age in the cervix group (40 years (range 26-69)) was substantially younger than in the vagina (60 years (38-69)) and the vulva (59 years (36-75)) groups. Anal HSIL based on composite endpoints of the most severe cytology or histology result was diagnosed in 6 patients (8.0%). Anal cytology revealed HSIL in 2 (2.7%), atypical squamous cells of undetermined significance (ASCUS) in 12 (16.0%), low-grade squamous cell intraepithelial lesion (LSIL) in 2 (2.7%), and was normal in 59 (78.7%) patients. Anal HPV16/18 test was positive in 15 (20.0%), negative in 48 (64.0%) and insufficient in 12 (16.0%) patients. Of the 6 women with high-grade anal dysplasia, three (50%) had a positive anal HPV16/18 test. No case of anal cancer was observed.

Conclusion: Our results suggest that the prevalence of anal HSIL is elevated among women with HPV-related lower genital tract dysplasia or cancer. To further support the inclusion of this high-risk group into screening guidelines for anal dysplasia, further studies are necessary to determine what screening strategy is suited to this population.

Keywords: Anal dysplasia; Anal screening; Cervical dysplasia or cancer; Prevalence; Vaginal dysplasia or cancer; Vulvar dysplasia or cancer.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Anal Canal / diagnostic imaging
  • Anal Canal / pathology*
  • Anal Canal / virology
  • Cross-Sectional Studies
  • Endoscopy, Gastrointestinal
  • Female
  • Genital Neoplasms, Female / epidemiology*
  • Genital Neoplasms, Female / pathology
  • Genital Neoplasms, Female / virology
  • Genitalia, Female / pathology
  • Genitalia, Female / virology
  • Humans
  • Middle Aged
  • Papillomaviridae / isolation & purification*
  • Papillomavirus Infections / diagnostic imaging
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / virology
  • Pilot Projects
  • Prevalence
  • Risk Factors
  • Squamous Intraepithelial Lesions of the Cervix / epidemiology*
  • Squamous Intraepithelial Lesions of the Cervix / pathology
  • Squamous Intraepithelial Lesions of the Cervix / virology