Elizabeth Y Chiao1, Shelly Y Lensing2, Dorothy J Wiley3, Ashish A Deshmukh4, Jeannette Lee2, Teresa M Darragh5, Mark H Einstein6, Naomi Jay7, John Michael Berry-Lawhorn7,8, Joel M Palefsky7,9, Timothy Wilkin10, Luis F Barroso11, Ross D Cranston12, Rebecca Levine13, Humberto M Guiot14,15, Audrey L French16, Deborah Citron17, Masoumeh Katayoon Rezaei18, Stephen E Goldstone19, Elizabeth A Stier20. 1. Department of Epidemiology and General Oncology, University of Texas- MD Anderson Cancer Center, Houston, Texas. 2. Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 3. School of Nursing, University of California, Los Angeles, Los Angeles, California. 4. Department of Management Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas. 5. Department of Pathology, UCSF Mt. Zion Medical Center, San Francisco, California. 6. Department of OB/GYN & Women's Health, Rutgers-NJMS, Newark, New Jersey. 7. Department of Medicine, Anal Neoplasia Clinic, Research, and Education Center. 8. Division of Hematology Oncology. 9. Department of Medicine, University of California, San Francisco, San Francisco, California. 10. Clinical Trials Unit, Department of Medicine, Cornell University, New York, New York. 11. Department of Internal Medicine (Infectious Diseases), Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA. 12. University of Vic, Hospital Germans Trias i Pujol, Barcelona, Spain. 13. Department of Surgery, Montefiore, Bronx, New York. 14. Department of Medicine. 15. Department of Microbiology & Medical Zoology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico. 16. Division of Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois. 17. Department of Pathology, Baylor College of Medicine, Houston, Texas. 18. Department of Pathology, George Washington University, Washington, District of Columbia. 19. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. 20. Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA.
Abstract
OBJECTIVE: HIV-infected women (WLHIV) have more than 10-fold higher risk for squamous cell cancer of the anus. Experts suggest cytology-based strategies developed for cervical cancer screening may prevent anal cancer by detecting anal cytologic or histological high-grade squamous intraepithelial lesion (hHSIL) for treatment. Currently, there is no consensus on anal-hHSIL screening strategies for WLHIV. DESIGN: Between 2014 and 2016, 276 WLHIV were recruited at 12 US AIDS Malignancy Consortium clinical trials sites to evaluate hHSIL prevalence and (test) screening strategies. METHODS: Participants completed detailed questionnaire, underwent anal assessments including high-risk human papillomavirus (hrHPV) testing using hrHPV-Hybrid Capture 2 (HC2) and hrHPV-APTIMA, anal cytology, and concurrent high-resolution anoscopy. Screening test characteristics for predicting hHSIL validated by central review of histologic diagnosis were estimated sensitivity, specificity, positive predictive value, and false-omission rate. Paired analyses compared sensitivity and specificity for hrHPV single tests to anal cytology alone. RESULTS: 83% (229/276) of enrolled WLHIV had complete anal assessment data and were included in this analysis. Mean age was 50, 62% black and 60 (26%) had hHSIL. Anal cyotology (>atypical squamous cells of undetermined significance), hrHPV-HC2, and hrHPV-APTIMA sensitivity estimates were similarly high (83, 77, and 75%, respectively, P values > 0.2). Specificity was higher for both hrHPV-APTIMA and hrHPV-HC2 compared with anal cytology (67 vs. 50%, P < 0.001) and (61 vs. 50%, P = 0.020), respectively. CONCLUSION: Anal hrHPV testing demonstrated similar sensitivity for anal cytology (>atypical squamous cells of undetermined significance) to predict anal hHSIL. Among tests with similar sensitivity, the specificity was significantly higher for hrHPV-APTIMA and hrHPV-HC2. Thus, anal hrHPV testing may be an important alternative strategy to anal cytology for anal hHSIL screening among WLHIV.
OBJECTIVE: HIV-infected women (WLHIV) have more than 10-fold higher risk for squamous cell cancer of the anus. Experts suggest cytology-based strategies developed for cervical cancer screening may prevent anal cancer by detecting anal cytologic or histological high-grade squamous intraepithelial lesion (hHSIL) for treatment. Currently, there is no consensus on anal-hHSIL screening strategies for WLHIV. DESIGN: Between 2014 and 2016, 276 WLHIV were recruited at 12 US AIDS Malignancy Consortium clinical trials sites to evaluate hHSIL prevalence and (test) screening strategies. METHODS: Participants completed detailed questionnaire, underwent anal assessments including high-risk human papillomavirus (hrHPV) testing using hrHPV-Hybrid Capture 2 (HC2) and hrHPV-APTIMA, anal cytology, and concurrent high-resolution anoscopy. Screening test characteristics for predicting hHSIL validated by central review of histologic diagnosis were estimated sensitivity, specificity, positive predictive value, and false-omission rate. Paired analyses compared sensitivity and specificity for hrHPV single tests to anal cytology alone. RESULTS: 83% (229/276) of enrolled WLHIV had complete anal assessment data and were included in this analysis. Mean age was 50, 62% black and 60 (26%) had hHSIL. Anal cyotology (>atypical squamous cells of undetermined significance), hrHPV-HC2, and hrHPV-APTIMA sensitivity estimates were similarly high (83, 77, and 75%, respectively, P values > 0.2). Specificity was higher for both hrHPV-APTIMA and hrHPV-HC2 compared with anal cytology (67 vs. 50%, P < 0.001) and (61 vs. 50%, P = 0.020), respectively. CONCLUSION: Anal hrHPV testing demonstrated similar sensitivity for anal cytology (>atypical squamous cells of undetermined significance) to predict anal hHSIL. Among tests with similar sensitivity, the specificity was significantly higher for hrHPV-APTIMA and hrHPV-HC2. Thus, anal hrHPV testing may be an important alternative strategy to anal cytology for anal hHSIL screening among WLHIV.
Authors: Fengyi Jin; Andrew E Grulich; I Mary Poynten; Richard J Hillman; David J Templeton; Carmella L H Law; Annabelle Farnsworth; Suzanne M Garland; Christopher K Fairley; Jennifer M Roberts Journal: Cancer Cytopathol Date: 2016-02-24 Impact factor: 5.284
Authors: Dorothy A Machalek; Mary Poynten; Fengyi Jin; Christopher K Fairley; Annabelle Farnsworth; Suzanne M Garland; Richard J Hillman; Kathy Petoumenos; Jennifer Roberts; Sepehr N Tabrizi; David J Templeton; Andrew E Grulich Journal: Lancet Oncol Date: 2012-03-23 Impact factor: 41.316
Authors: Elizabeth A Stier; Shelly Y Lensing; Teresa M Darragh; Ashish A Deshmukh; Mark H Einstein; Joel M Palefsky; Naomi Jay; J Michael Berry-Lawhorn; Timothy Wilkin; Dorothy J Wiley; Luis F Barroso; Ross D Cranston; Rebecca Levine; Humberto M Guiot; Audrey L French; Deborah Citron; M Katayoon Rezaei; Stephen E Goldstone; Elizabeth Chiao Journal: Clin Infect Dis Date: 2020-04-10 Impact factor: 9.079
Authors: Vivian Colón-López; Meredith S Shiels; Mark Machin; Ana P Ortiz; Howard Strickler; Philip E Castle; Ruth M Pfeiffer; Eric A Engels Journal: J Clin Oncol Date: 2017-11-15 Impact factor: 44.544
Authors: Michael J Silverberg; Bryan Lau; Chad J Achenbach; Yuezhou Jing; Keri N Althoff; Gypsyamber D'Souza; Eric A Engels; Nancy A Hessol; John T Brooks; Ann N Burchell; M John Gill; James J Goedert; Robert Hogg; Michael A Horberg; Gregory D Kirk; Mari M Kitahata; Philip T Korthuis; William C Mathews; Angel Mayor; Sharada P Modur; Sonia Napravnik; Richard M Novak; Pragna Patel; Anita R Rachlis; Timothy R Sterling; James H Willig; Amy C Justice; Richard D Moore; Robert Dubrow Journal: Ann Intern Med Date: 2015-10-06 Impact factor: 25.391
Authors: Diane Solomon; Diane Davey; Robert Kurman; Ann Moriarty; Dennis O'Connor; Marianne Prey; Stephen Raab; Mark Sherman; David Wilbur; Thomas Wright; Nancy Young Journal: JAMA Date: 2002-04-24 Impact factor: 56.272
Authors: João Carlos N Gonçalves; Ana C L Macedo; Kristian Madeira; Daniela Vicente Bavaresco; Eduardo Ronconi Dondossola; Antônio José Grande; Maria Inês da Rosa Journal: Dis Colon Rectum Date: 2019-01 Impact factor: 4.585
Authors: Grant B Ellsworth; Elizabeth A Stier; Elizabeth Y Chiao; Shelly Y Lensing; Teresa Darragh; Naomi Jay; J Michael Berry-Lawhorn; Mark Einstein; Luis F Barroso; Ross D Cranston; Rebecca Levine; Humberto M Guiot; Audrey L French; Stephen E Goldstone; Wolfgang Preiser; Mathilda Claassen; Joel M Palefsky; Timothy J Wilkin Journal: J Acquir Immune Defic Syndr Date: 2021-07-01 Impact factor: 3.771