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

Joël Fokom Domgue, Craig Messick, Andrea Milbourne, Ming Guo, Mila P. Salcedo, Kristina R Dahlstrom, Elizabeth Y. Chiao, Ashish A. Deshmukh, Erich M Sturgis, Kathleen M Schmeler

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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.

Original languageEnglish (US)
Pages (from-to)266-270
Number of pages5
JournalGynecologic oncology
Volume153
Issue number2
DOIs
StatePublished - May 1 2019

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Vulva
Epithelial Cells
Cell Biology
Vagina
Cervix Uteri
Neoplasms
Vaginal Diseases
Anus Neoplasms
Colorectal Surgery
Histology
Cross-Sectional Studies
Squamous Intraepithelial Lesions of the Cervix
Guidelines
Carcinoma
Biopsy
Population

Keywords

  • Anal dysplasia
  • Anal screening
  • Cervical dysplasia or cancer
  • Prevalence
  • Vaginal dysplasia or cancer
  • Vulvar dysplasia or cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Prevalence of high-grade anal dysplasia among women with high-grade lower genital tract dysplasia or cancer : Results of a pilot study. / Fokom Domgue, Joël; Messick, Craig; Milbourne, Andrea; Guo, Ming; Salcedo, Mila P.; Dahlstrom, Kristina R; Chiao, Elizabeth Y.; Deshmukh, Ashish A.; Sturgis, Erich M; Schmeler, Kathleen M.

In: Gynecologic oncology, Vol. 153, No. 2, 01.05.2019, p. 266-270.

Research output: Contribution to journalArticle

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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.",
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AU - Fokom Domgue, Joël

AU - Messick, Craig

AU - Milbourne, Andrea

AU - Guo, Ming

AU - Salcedo, Mila P.

AU - Dahlstrom, Kristina R

AU - Chiao, Elizabeth Y.

AU - Deshmukh, Ashish A.

AU - Sturgis, Erich M

AU - Schmeler, Kathleen M

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AB - 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.

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KW - Cervical dysplasia or cancer

KW - Prevalence

KW - Vaginal dysplasia or cancer

KW - Vulvar dysplasia or cancer

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