Amit C Achhra, Elizabeth Chan, Serina Applebaum, Maggie Guerrero, Ritche Hao, Haddon Pantel, Michael Virata, Margaret Fikrig, Lydia Barakat
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We evaluate (i) 5-year uptake of cytology based SCCA screening in eligible population; (ii) estimate HSIL detection rate based on our current low-threshold criteria, and if high-threshold criteria were used for HRA referral.</p><p><strong>Results: </strong>Of 432 eligible individuals, only 219 (50.7%) had at least one, and only 113 (26%) had >1 SCCA screening tests in a median followup of 4 years. N=74 (17.1%) of individuals had at least one abnormal anal cytology during follow-up, of which 56 (75.6%) received HRA. Increasing age (≥57 years) and history of smoking negatively correlated with ever receiving screening. Anal cytology (365 tests in 206 individuals) showed: 17.5% 'unsatisfactory', and 26.8% with any abnormal cytology (zero with HSIL) triggering HRA referral. Only 34 individuals (7.8% of screening eligible) were ever detected with HSIL. Strictly using high-threshold criterion for HRA referral would have led to no HRA or HSIL detection.</p><p><strong>Conclusions: </strong>We noted poor uptake of screening over time, particularly in older age groups. Importantly, anal cytology performed poorly as a triage test for HRA referral: high rates of 'unsatisfactory' samples and low sensitivity for detecting HSIL.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":8.2000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Five-year evaluation of Anal Cancer Screening Program in Men Who Have Sex With Men with HIV at Two Academic Center Clinics.\",\"authors\":\"Amit C Achhra, Elizabeth Chan, Serina Applebaum, Maggie Guerrero, Ritche Hao, Haddon Pantel, Michael Virata, Margaret Fikrig, Lydia Barakat\",\"doi\":\"10.1093/cid/ciae541\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Guidelines recommend annual anal cytology-based squamous cell carcinoma of anus (SCCA) screening for men who have sex with men (MSM) with HIV aged ≥35 years (eligible population). Recommended threshold for high resolution anoscopy (HRA) depends on its availability: low-threshold (any abnormal cytology) if availability is high, and high-threshold (High-Grade Squamous Intraepithelial Lesion (HSIL) on cytology) if availability is low.</p><p><strong>Methods: </strong>Retrospective chart review (2018-2022) at academic HIV clinics. We evaluate (i) 5-year uptake of cytology based SCCA screening in eligible population; (ii) estimate HSIL detection rate based on our current low-threshold criteria, and if high-threshold criteria were used for HRA referral.</p><p><strong>Results: </strong>Of 432 eligible individuals, only 219 (50.7%) had at least one, and only 113 (26%) had >1 SCCA screening tests in a median followup of 4 years. N=74 (17.1%) of individuals had at least one abnormal anal cytology during follow-up, of which 56 (75.6%) received HRA. Increasing age (≥57 years) and history of smoking negatively correlated with ever receiving screening. Anal cytology (365 tests in 206 individuals) showed: 17.5% 'unsatisfactory', and 26.8% with any abnormal cytology (zero with HSIL) triggering HRA referral. Only 34 individuals (7.8% of screening eligible) were ever detected with HSIL. Strictly using high-threshold criterion for HRA referral would have led to no HRA or HSIL detection.</p><p><strong>Conclusions: </strong>We noted poor uptake of screening over time, particularly in older age groups. 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引用次数: 0
摘要
背景：指南建议每年对年龄≥35 岁感染艾滋病毒的男男性行为者（MSM）（合格人群）进行基于肛门细胞学的肛门鳞状细胞癌（SCCA）筛查。高分辨肛门镜检查（HRA）的推荐阈值取决于其可用性：如果可用性高，则为低阈值（任何异常细胞学检查）；如果可用性低，则为高阈值（细胞学检查显示高级别鳞状上皮内病变（HSIL））：方法：对学术性 HIV 诊所进行回顾性病历审查（2018-2022 年）。我们评估：(i) 符合条件的人群中基于细胞学的 SCCA 筛查的 5 年接受率；(ii) 基于我们目前的低阈值标准估计 HSIL 的检出率，以及是否使用高阈值标准进行 HRA 转诊：在 432 名符合条件的患者中，只有 219 人（50.7%）至少接受过一次 SCCA 筛查，其中只有 113 人（26%）在中位随访 4 年期间接受过 >1 次 SCCA 筛查。74人（17.1%）在随访期间至少有一次肛门细胞学检查异常，其中56人（75.6%）接受了HRA检查。年龄的增长（≥57 岁）和吸烟史与是否接受过筛查呈负相关。肛门细胞学检查（共对 206 人进行了 365 次检查）显示17.5%为 "不满意"，26.8%为细胞学异常（零例为HSIL），引发HRA转诊。只有 34 人（占筛查合格人数的 7.8%）被检测出患有 HSIL。如果严格按照 HRA 转诊的高阈值标准进行筛查，则不会发现任何 HRA 或 HSIL：我们注意到，随着时间的推移，筛查的接受率很低，尤其是在老年群体中。重要的是，肛门细胞学作为 HRA 转诊的分流检查效果不佳："不满意 "样本率高，检测 HSIL 的灵敏度低。
Five-year evaluation of Anal Cancer Screening Program in Men Who Have Sex With Men with HIV at Two Academic Center Clinics.
Background: Guidelines recommend annual anal cytology-based squamous cell carcinoma of anus (SCCA) screening for men who have sex with men (MSM) with HIV aged ≥35 years (eligible population). Recommended threshold for high resolution anoscopy (HRA) depends on its availability: low-threshold (any abnormal cytology) if availability is high, and high-threshold (High-Grade Squamous Intraepithelial Lesion (HSIL) on cytology) if availability is low.
Methods: Retrospective chart review (2018-2022) at academic HIV clinics. We evaluate (i) 5-year uptake of cytology based SCCA screening in eligible population; (ii) estimate HSIL detection rate based on our current low-threshold criteria, and if high-threshold criteria were used for HRA referral.
Results: Of 432 eligible individuals, only 219 (50.7%) had at least one, and only 113 (26%) had >1 SCCA screening tests in a median followup of 4 years. N=74 (17.1%) of individuals had at least one abnormal anal cytology during follow-up, of which 56 (75.6%) received HRA. Increasing age (≥57 years) and history of smoking negatively correlated with ever receiving screening. Anal cytology (365 tests in 206 individuals) showed: 17.5% 'unsatisfactory', and 26.8% with any abnormal cytology (zero with HSIL) triggering HRA referral. Only 34 individuals (7.8% of screening eligible) were ever detected with HSIL. Strictly using high-threshold criterion for HRA referral would have led to no HRA or HSIL detection.
Conclusions: We noted poor uptake of screening over time, particularly in older age groups. Importantly, anal cytology performed poorly as a triage test for HRA referral: high rates of 'unsatisfactory' samples and low sensitivity for detecting HSIL.
期刊介绍：
Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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