The correlation Between anal pap cytology and histologic outcomes in HIV-Positive males

Anal intraepithelial neoplasia is a precursor to anal carcinoma. The use of anal pap cytology has been accepted as a screening method for anal carcinoma, however sensitivity and specificity vary. Retrospective cohort study involving 155 HIV-positive males with abnormal anal cytology and surgical resection. 155 patients met inclusion criteria. 31.6% were diagnosed with atypical cytology, 61.9% with low-grade cytology, and 6.4% with high-grade cytology. At surgery, 19.4% were diagnosed with condylomata, 34.8% with anal intraepithelial neoplasia 1, 17.4% with anal intraepithelial neoplasia 2, 27.1% with anal intraepithelial neoplasia 3 and 1.3% with anal carcinoma. There was a positive correlation between high-grade anal cytology and high-grade histology (r = 0.27; p = 0.0008). Comparison of risk factors showed no significant association. Anal cytology has a significant correlation with surgical histology. There were still instances of high-grade lesions being found after low-grade cytology. This highlights the necessity of patients with low-grade cytology undergoing anoscopic evaluation. •Anal cytology has a significant correlation with surgical histology.•No risk factors other than anal cytology predict more advanced surgical histology.•There were instances of high-grade lesions found after low-grade anal cytology.•Patients with low-grade anal cytology should be referred for anoscopic evaluation.