Performance characteristics of anal cytology and human papillomavirus testing in patients with high-resolution anoscopy-guided biopsy of high-grade anal intraepithelial neoplasia

Dis Colon Rectum. 2009 Feb;52(2):239-47. doi: 10.1007/DCR.0b013e31819793d9.


Purpose: High-resolution anoscopy is colposcopy of the anus after applying 3 percent acetic acid. High-resolution anoscopy with biopsy was used as the standard for detecting high-grade anal neoplasia and was compared to detection of high-grade anal neoplasia by anal cytology, human papillomavirus testing, or the combination.

Methods: A total of 125 men who have sex with men (MSM) were enrolled from a group of MSM identified by random digit dialing: HIV-negative = 85, HIV-positive = 35, and unknown status = 5. A specimen was taken for anal cytology and human papillomavirus testing, followed by high-resolution anoscopy with biopsy of any lesions.

Results: Ninety-one percent of HIV-positive and 57 percent of HIV-negative MSM had anal human papillomavirus infection. In HIV-positive men the sensitivity of abnormal cytology to detect high-grade anal neoplasia was 87 percent, and in HIV-negative MSM it was 55 percent. Among HIV-negative men, 9 of 20 cases of high-grade anal neoplasia would have been missed because cytology was negative, but the addition of human papillomavirus positivity increased sensitivity for the combination to 90 percent.

Conclusions: Sensitivity and specificity of anal cytology and human papillomavirus testing are different in HIV-positive and HIV-negative MSM for detecting high-grade anal neoplasia when patients have high-resolution anoscopy-guided biopsy of lesions. The optimum use of human papillomavirus testing has yet to be defined. High-resolution anoscopy is an effective tool for diagnosing high-grade anal neoplasia.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anal Canal / pathology*
  • Anal Canal / virology
  • Anus Diseases / diagnosis
  • Anus Diseases / virology
  • Anus Neoplasms / diagnosis*
  • Anus Neoplasms / pathology
  • Anus Neoplasms / virology
  • Biopsy
  • Carcinoma in Situ / diagnosis*
  • Carcinoma in Situ / pathology
  • Carcinoma in Situ / virology
  • Cytodiagnosis
  • Endoscopy, Gastrointestinal*
  • HIV Seronegativity
  • HIV Seropositivity / complications
  • Homosexuality
  • Humans
  • Male
  • Middle Aged
  • Papillomaviridae / isolation & purification*
  • Papillomavirus Infections / diagnosis*
  • Polymerase Chain Reaction
  • Precancerous Conditions / diagnosis
  • Predictive Value of Tests
  • Sensitivity and Specificity