Risk factors and cytology performance for high-grade anal intraepithelial neoplasia in young adults: a cohort study.

Cancer research · Anal squamous cell carcinoma

Anal cytology had low‑moderate sensitivity (55 %) and specificity (82 %), but an acceptable negative predictive value of 96 % for HSIL on the reference standard (ref‑HSIL).

This cohort study examined risk factors for high-grade anal intraepithelial neoplasia (AIN) and assessed the diagnostic performance of anal cytology in adults aged 18‑45 years. Among 238 participants (191 with HIV), anal cytology demonstrated a sensitivity of 55 % and specificity of 82 % for histopathologically confirmed HSIL, with an NPV of 96 %. In the overall cohort, ASC‑H or HSIL cytology (adjusted odds ratio 5.95, p < 0.001) were independent predictors of HSIL. In persons with HIV, a nadir CD4 count < 300 cells/µL was associated with higher HSIL risk (adjusted hazard ratio 0.43 per 100 cells/µL, p = 0.002), and current smoking increased progression risk (aHR 5.09, p = 0.05). The findings indicate that anal cytology alone has limited sensitivity for HSIL detection in younger adults and that low nadir CD4 counts and current smoking signal the need for closer surveillance.

Accurate cytologic screening of anal dysplasia is essential for timely intervention. Demonstrating that anal cytology’s moderate sensitivity limits early detection in high‑risk populations highlights the need for improved surveillance strategies and informs clinical decision‑making regarding screening intervals.

Evidence level: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.

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