The first 2 authors contributed equally to this article.
Interrater agreement of anal cytology†
Article first published online: 18 JUL 2012
Copyright © 2012 American Cancer Society
Volume 121, Issue 2, pages 72–78, February 2013
How to Cite
Darragh, T. M., Tokugawa, D., Castle, P. E., Follansbee, S., Borgonovo, S., LaMere, B. J., Schwartz, L., Gage, J. C., Fetterman, B., Lorey, T. and Wentzensen, N. (2013), Interrater agreement of anal cytology. Cancer Cytopathology, 121: 72–78. doi: 10.1002/cncy.21218
This article is a US government work and, as such, is in the public domain in the United States of America.
- Issue published online: 5 FEB 2013
- Article first published online: 18 JUL 2012
- Manuscript Revised: 25 MAY 2012
- Manuscript Accepted: 25 MAY 2012
- Manuscript Received: 11 APR 2012
- anal cancer screening;
- human papillomavirus (HPV);
- human immunodeficiency virus (HIV);
- men who have sex with men (MSM);
The majority of anal cancers are caused by persistent infections with carcinogenic human papillomaviruses (HPV). Similar to cervical carcinogenesis, the progression from HPV infection to anal cancer occurs through precancerous lesions that can be treated to prevent invasion. In analogy to cervical cytology, anal cytology has been proposed as a screening tool for anal cancer precursors in high-risk populations.
The authors analyzed the interobserver reproducibility of anal cytology in a population of 363 human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). Liquid-based cytology (LBC) specimens were collected in the anal dysplasia clinic before the performance of high-resolution anoscopy on all patients. Papanicolaou-stained LBC slides were evaluated by 2 cytopathologists, each of whom was blinded to the clinical outcome and the other pathologist's results, using the revised Bethesda terminology.
Overall agreement between the 2 observers was 66% (kappa, 0.54; linear-weighted kappa, 0.69). Using dichotomizing cytology results (atypical squamous cells of undetermined significance [ASC-US] or worse vs less than ASC-US), the agreement increased to 86% (kappa, 0.69). An increasing likelihood of testing positive for markers associated with HPV-related transformation, p16/Ki-67, and HPV oncogene messenger RNA was observed, with increasing severity of cytology results noted both for individual cytologists and for consensus cytology interpretation (P value for trend [ptrend] < .0001 for all).
Moderate to good agreement was observed between 2 cytopathologists evaluating anal cytology samples collected from HIV-positive MSM. A higher severity of anal cytology was associated with biomarkers of anal precancerous lesions. Anal cytology may be used for anal cancer screening in high-risk populations, and biomarkers of HPV-related transformation can serve as quality control for anal cytology. Cancer (Cancer Cytopathol) 2013. Published 2012 by the American Cancer Society.