Anal intraepithelial neoplasia: application of a diagnostic protocol in risk patients using anal cytology

Article information

Abstract

Introduction

Anal intraepithelial neoplasia is a precursor condition of squamous anal carcinoma. The groups at risk of this lesion are patients with anogenital condylomata, cervical dysplasia, human immunodeficiency virus infection and, in general, patients with HPV infection. The aim of this study was to analyse the results of a diagnostics protocol of anal intraepithelial neoplasia in high risk population using anal cytology.

Patients and method

The protocol is based on a visit in the outpatient department, clinical interview, physical examination, and anal cytology evaluated by Bethesda criteria. The cross-sectional observational study was designed to study the anal smear results and their relationship with risk factors.

Results

A total of 64 patients were included from January 2005 to December 2006. In the overall series, 25 patients have been diagnosed with abnormal anal cytology: 9 atypical squamous cells of undetermined significance (ASCUS), 15 low-grade, and 1 highgrade squamous intraepithelial lesions. There were no significant associations between abnormal cytology results and the presence of anal condyloma (P=.22). Neither were there statistical associations found with high risk-HPV infection (P=.84), HIV infection (P=.98), or tobacco use (P=.14).

Conclusions

Our diagnostic protocol of anal intraepithelial neoplasia revealed 25% of patients with pre-invasive lesions of squamous anal cancer.

Keywords:

Anal intraepithelial neoplasia

Diagnosis

Cytology

Risk factors

Resumen

Introducción

La neoplasia intraepitelial anal es una lesión precursora del carcinoma escamoso anal. Se considera población en riesgo de padecer esta lesión a los pacientes con condilomas anogenitales, historia previa de displasia de cérvix, infección por VIH y en general los pacientes con infección por el VPH. El objetivo de este estudio es analizar los resultados de la aplicación de un protocolo diagnóstico de neoplasia intraepitelial anal en población de riesgo mediante el empleo de citología anal.

Material y método

El protocolo diagnóstico de neoplasia intraepitelial anal consistió en realizar una anamnesis estructurada, exploración física y citología anal, la cual se interpretó mediante los criterios de Bethesda. En este estudio observacional de corte transversal se analizan los resultados de diagnóstico de neoplasia intraepitelial anal y su asociación con factores de riesgo.

Resultados

Se incluyó a 64 pacientes en los que se diagnosticaron 25 alteraciones citológicas: 9 alteraciones citológicas de significado incierto o ASCUS, 15 casos de neoplasia intraepitelial anal de bajo grado y 1 de alto grado. Al relacionar la presencia de alteraciones en la citología anal con los factores de riesgo conocidos, no hubo asociación estadísticamente significativa con la presencia de condilomas (p=0,22), infección por VPH de alto riesgo (p=0,84), infección por VIH (p=0,98) o tabaquismo (p=0,14).

Conclusiones

La aplicación de un protocolo de detección de neoplasia intraepitelial anal en población de riesgo ha permitido detectar un 25% de pacientes con lesiones precursoras de carcinoma anal.

Palabras clave:

Neoplasia intraepitelial anal

Diagnóstico

Citología

Factores de riesgo

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