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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(07): 678-685
DOI: 10.1055/s-0042-1743163
Original Article
Lower Genital Tract Diseases

Cytology-based Screening for Anal Intraepithelial Neoplasia in Immunocompetent Brazilian Women with a History of High-Grade Cervical Intraepithelial Neoplasia or Cancer

Triagem citológica de neoplasia intraepitelial anal em mulheres brasileiras imunocompetentes com histórico de neoplasia intraepitelial cervical de alto grau ou câncer
Vivian de Oliveira Rodrigues Brum 
1   Lower Genital Tract Pathology and Colposcopy Service, Gynecology Department, Hospital Universitário da Universidade Federal de Juiz de Fora (UH-UFJF), Juiz de Fora, MG, Brazil
,
Alessandra de Souza Oliveira Tricoti 
1   Lower Genital Tract Pathology and Colposcopy Service, Gynecology Department, Hospital Universitário da Universidade Federal de Juiz de Fora (UH-UFJF), Juiz de Fora, MG, Brazil
,
Gabriel Duque Pannain 
1   Lower Genital Tract Pathology and Colposcopy Service, Gynecology Department, Hospital Universitário da Universidade Federal de Juiz de Fora (UH-UFJF), Juiz de Fora, MG, Brazil
,
Denise Gasparetii Drumond 
1   Lower Genital Tract Pathology and Colposcopy Service, Gynecology Department, Hospital Universitário da Universidade Federal de Juiz de Fora (UH-UFJF), Juiz de Fora, MG, Brazil
,
Isabel Cristina Gonçalves Leite 
1   Lower Genital Tract Pathology and Colposcopy Service, Gynecology Department, Hospital Universitário da Universidade Federal de Juiz de Fora (UH-UFJF), Juiz de Fora, MG, Brazil
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Abstract

Objective To determine the prevalence and possible variables associated with anal intraepithelial neoplasia and anal cancer in immunocompetent women with high-grade cervical intraepithelial neoplasia.

Methods A cross-sectional study involving immunocompetent women with a histological diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, conducted between January 2016 and September 2020. All women underwent anal cytology and answered a questionnaire on characterization and potential risk factors. Women with altered cytology were submitted to anoscopy and biopsy.

Results A total of 69 women were included in the study. Of these, 7 (10.1%) had abnormal anal cytology results: (high-grade lesion, atypical squamous cells of undetermined significance, and atypical squamous cells, cannot exclude high-grade lesions: 28,5% each; low grade lesion: 14,3%). Of the anoscopies, 3 (42.8%) showed alterations. Of the 2 (28,5% of all abnormal cytology results) biopsies performed, only 1 showed low-grade anal intraepithelial neoplasia. The average number of pregnancies, vaginal deliveries, and abortions was associated with abnormal anal cytology. However, the highest mean regarding the cesarean sections was associated with normal cytology.

Conclusion The prevalence of anal intraepithelial neoplasia was compatible with data from recent studies, especially those conducted in Brazil. Opportunistic screening for anal intraepithelial neoplasia in this high-risk population should be considered. Anal cytology is suitable for this purpose, due to its low cost and feasibility in public health services.

Resumo

Objetivo Determinar a prevalência e as possíveis variáveis associadas à neoplasia intraepitelial anal e ao câncer anal em mulheres imunocompetentes com neoplasia intraepitelial cervical de alto grau.

Métodos Estudo transversal em mulheres imunocompetentes com diagnóstico histológico de neoplasia intraepitelial cervical de alto grau e câncer cervical, feito entre janeiro de 2016 e setembro de 2020. Todas as mulheres foram submetidas a citologia anal e responderam a um questionário de caracterização e potenciais fatores de risco. Mulheres com citologia alterada foram submetidas a anuscopia e biópsia.

Resultados No total, 69 mulheres foram incluídas no estudo. Destas, 7 (10,1%) tiveram resultados anormais de citologia anal (lesão de alto grau, células escamosas atípicas de significado indeterminado, e células escamosas atípicas, não se pode excluir lesões de alto grau: 28,5% cada; lesão de baixo grau: 14,3%). Das anuscopias, 3 (42,8%) demonstraram alterações. Das 2 biópsias realizadas, apenas 1 apresentou neoplasia intraepitelial anal de baixo grau. O número médio de gestações, partos vaginais e abortos estava associado à citologia anal anormal. No entanto, a maior média de partos cesáreos estava associada à citologia normal.

Conclusão A prevalência de neoplasia intraepitelial anal foi compatível com dados de estudos recentes, principalmente daqueles feitos no Brasil. O rastreamento oportunista para neoplasia intraepitelial anal nesta população de alto risco deve ser considerado. A citologia anal é adequada para esse fim, devido ao seu baixo custo e viabilidade nos serviços públicos de saúde.

Keywords

anal cancer - high-grade squamous intraepithelial lesion - human papillomavirus - screening

Palavras-chave

câncer anal - lesão intraepitelial escamosa de alto grau - vírus do papiloma humano - triagem

Contributions

VORB; ICGL; DGD; and ASOT: designed the study. VORB; ASOT; and GDP: performed all the data collection. VORB; ICGL; and DGD: analyzed and interpreted the data. VORB: drafed the article. ICGL; and DGD: performed the critical revision of the article. All authors approved the final version to be published.




Publication History

Received: 09 August 2021

Accepted: 17 December 2021

Article published online:
08 August 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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