Dorothy J. Wiley, School of Nursing, University of California Los Angeles, Los Angeles, California
Hilary K. Hsu, School of Nursing, University of California Los Angeles, Los Angeles, California
Martha A. Ganser, School of Nursing, University of California Los Angeles, Los Angeles, California
Jenny Brook, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
David A. Elashoff, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
Stephen A. Young, Tricore Reference Laboratories, University of New Mexico, Albuquerque, New Mexico
Nancy E. Joste, Tricore Reference Laboratories, University of New Mexico, Albuquerque, New Mexico
Ronald Mitsuyasu, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
Teresa M. Darragh, Department of Pathology, University of California San Francisco, San Francisco, California
David H. Morris, Desert AIDS Project, Palm Springs, California
Otoniel M. Martínez-Maza, Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
Roger Detels, Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
Jian Yu Rao, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
Robert K. Bolan, Los Angeles LGBT Center, Los Angeles, California
Eric T. Shigeno, School of Nursing, University of California Los Angeles, Los Angeles, California
Ernesto Rodriguez, School of Nursing, University of California Los Angeles, Los Angeles, California
Matthrew G. Moran, School of Nursing, University of California Los Angeles, Los Angeles, California,Desert AIDS Project, Palm Springs, California

Document Type

Article

Publication Date

4-1-2019

Abstract

BACKGROUND: An anal histological high-grade squamous intraepithelial lesion (hHSIL) is an anal cancer precursor. Experts recommend Dacron swab anal cytology as a primary screen for anal hHSILs, especially among human immunodeficiency virus-infected and -uninfected men who have sex with men (MSM). Studies have shown that Dacron cytology inaccurately predicts anal hHSILs and results in unnecessary diagnostic procedures. Nylon-flocked (NF) swabs have been shown to trap pathogens and cells well. Thus, this study compared test characteristics of anal cytology using NF and Dacron swab collection protocols to predict anal hHSILs.

METHODS: A single-visit, randomized clinical trial compared NF and Dacron swab anal cytology specimens to predict high-resolution anoscopy and biopsy-diagnosed anal hHSILs. Data for 326 gay men, bisexual men, other MSM, and male-to-female transgender women contributed descriptive and tabular statistics with which unadjusted and fully adjusted logistic regression models were constructed. The models estimated the odds of hHSILs, test accuracy (area under the curve [AUC]) and sensitivity, and specificity as well as the positive and negative predictive values of abnormal NF and Dacron cytology for predicting hHSILs.

RESULTS: In the fully adjusted model, the sensitivities for NF and Dacron cytology were nearly equal (48% vs 47%), but the specificity was higher with NF cytology (76% vs 69%). Comparisons of the areas under receiver operating characteristic curves showed that NF cytology alone predicted hHSILs better than the covariate model (AUC, 0.69 vs 0.63; P = .02), but NF and Dacron cytology comparisons showed no statistically significant differences (AUC, 0.69 vs 0.67; P = .3).

CONCLUSIONS: NF cytology and Dacron cytology provide modest sensitivity, but NF cytology has higher specificity and accuracy, and this is important for lowering the costs of population-based screening.

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