Evaluation of Anal Cytology in Women with History of Abnormal Pap Smear, Cervical Intraepithelial Neoplasia, Cervical Cancer and High Risk HPV for Anogenital Dysplasia

Abstract

Background: Anal cancer is uncommon. Although uncommon, the incidence of anal cancer has increased among<br />the general population of the United States and other countries over the past 30 years. We evaluated anal cytology in<br />women with the history of abnormal pap smear, cervical intraepithelial neoplasia, cervical cancer and high risk HPV<br />for anogenital dysplasia. Methods: In this cross-sectional study, 153 patients over the age of 21 years, referred to Imam<br />Hossein Hospital in 1395-1396 who were being monitored due to abnormal pap smear, cervical cancer, CIN and high<br />risk HPV, were evaluated with anal cytology for anogenital dysplasia. Results: 153 patients were enrolled in four<br />main groups. Among those with a history of abnormal pap smear (39 patients), only 25% of the patients with HSIL<br />had abnormal anal pap smear, and the rest of them had negative anal smear. Among those with a history of CIN (61<br />patients), patients with CIN III, 30.8% had abnormal anal smear, while the rest had a negative anal smear. Among those<br />with a high risk of HPV (23 patients), 50% of the patients with concurrent positive HPV 16 and 18 had anal abnormal<br />smear. Patients with a history of cervical cancer (30 patients) who had radiotherapy with or without surgery showed a<br />negative anal smear. The ratio of anal SIL positive of individuals with a sexual partner was only 1.9%, while this ratio<br />was 27.3% for those with more than one partner and this difference was statistically significant (P <0.0001). 15.4%<br />of smokers had positive anal SIL test result, while, only 2.9% non-smokers had the same result, and this difference<br />was statistically significant (P = 0.03). 20% of the patients who had anal intercourse showed a positive anal SIL score<br />result, compared to 1% for those who did not. This difference was statistically significant (P <0.0001). Conclusion:<br />Among people with a history of abnormal cervical pap smear, CIN, cervical cancer and high-risk HPV during the last<br />6 months, abnormal anal tests are most commonly seen in patients who had risk factors such as anal sex, cigarette,<br />multi partner etc. with high grade interepithelial squamous cervix such as HSIL, CIN III, HPV 16 and 18; more studies<br />in larger sample size are needed to have the better conclusion.