C M Vajdic1, J S Anderson, R J Hillman, G Medley, A E Grulich. 1. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, 2010, Australia. cvajdic@nchecr.unsw.edu.au
Abstract
OBJECTIVES: Anal cytology smears are either collected "blind" (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability. METHODS: Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure. RESULTS: Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as "unsatisfactory" for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p < 0.001). CONCLUSIONS: Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.
RCT Entities:
OBJECTIVES: Anal cytology smears are either collected "blind" (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability. METHODS: Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure. RESULTS: Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as "unsatisfactory" for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p < 0.001). CONCLUSIONS: Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.
Authors: D Caussy; J J Goedert; J Palefsky; J Gonzales; C S Rabkin; R A DiGioia; W C Sanchez; R J Grossman; G Colclough; S Z Wiktor Journal: Int J Cancer Date: 1990-08-15 Impact factor: 7.396
Authors: M Melbye; J Palefsky; J Gonzales; L P Ryder; H Nielsen; O Bergmann; J Pindborg; R J Biggar Journal: Int J Cancer Date: 1990-08-15 Impact factor: 7.396
Authors: N B Kiviat; C W Critchlow; K K Holmes; J Kuypers; J Sayer; C Dunphy; C Surawicz; P Kirby; R Wood; J R Daling Journal: AIDS Date: 1993-01 Impact factor: 4.177
Authors: Isabella Rosa-Cunha; Vincent A Degennaro; Rene Hartmann; Clara Milikowski; Andres Irizarry; Brenda Heitman; Orlando Gómez-Marín; Gordon M Dickinson Journal: AIDS Patient Care STDS Date: 2011-03-02 Impact factor: 5.078
Authors: Anna-Barbara Moscicki; Teresa M Darragh; J Michael Berry-Lawhorn; Jennifer M Roberts; Michelle J Khan; Lori A Boardman; Elizabeth Chiao; Mark H Einstein; Stephen E Goldstone; Naomi Jay; Wendy M Likes; Elizabeth A Stier; Mark L Welton; Dorothy J Wiley; Joel M Palefsky Journal: J Low Genit Tract Dis Date: 2015-07 Impact factor: 1.925