Elizabeth A. Stier (United States of America)

Boston University School of Medicine Obstetrics and Gynecology

Presenter of 1 Presentation

 Conference Calendar
Clinical Research / Diagnosis and Management of Anal Cancer and Its’ Precursors ePoster

SCREENING STRATEGIES FOR ANAL HISTOLOGIC HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (HHSIL) DETECTION IN WOMEN LIVING WITH HIV (WLHIV) – AIDS MALIGNANCY CONSORTIUM (AMC)-084 (ID 638)

Session Date
07/21/2020
Session Time
10:00 - 17:00
Room
ePoster
Session Type
Poster Viewing - 20-24 July
Session Name
Clinical Research / Diagnosis and Management of Anal Cancer and Its’ Precursors
Lecture Time
10:09 - 10:10
Presenter
Authors

Abstract

Introduction

Compared to U.S. women WLHIV have >10-fold higher risk for anal squamous cell carcinoma (a-SCCA). Strategies to prevent a-SCCA include detection and treatment of anal hHSIL. Currently, there is no consensus on anal-hHSIL screening strategies for WLHIV.

Methods

256 WLHIV were enrolled in AMC-084. Evaluations included anal high-risk (hr)HPV testing, using hrHPV-HC2TM and APTIMATM, anal cytology (anal-cyt) and concurrent high-resolution anoscopy, where >2 biopsies were obtained. Screening test characteristics for predicting anal hHSIL, validated by central pathology, were estimated: sensitivity (SN), specificity (SP), positive predictive value (PPV) and false-omission rate. Paired and clustered analyses compared screening test characteristics for (1) hrHPV single tests to anal-cyt (2) triage (both anal-cyt>ASC-US and hrHPV tests positive) to single test strategies. P values <0.05 were considered significant.

Results

229 (89%) of 256 enrolled WLHIV had complete anal assessment data and were included in this analysis. Mean age was 50, 62% were Black, 22% Hispanic, and 60 (26%) had hHSIL. Anal-cyt>ASC-US, hrHPV-HC2, and APTIMA SN estimates were similarly high (83%, 75%, 77% respectively) and the false-omission rates were similarly low (11-13%). The SP for APTIMA (67%) and hrHPV-HC2 (61%) were higher than SP for anal-cyt (83%). the PPV for APTIMA (45%) was higher than PPV for anal-cyt (37%), but PPV for hrHPV-HC2 (41%) was not. Anal-cyt of ASC-H/HSIL showed the highest SP (97%) and lowest SN (27%) compared with other screening tests. Triage strategies (anal-cyt>ASC-US and hr-HPV test) had significantly higher SP (73-76%) and PPV (46-51%), and significantly lower SN (65-70%) compared with single test strategies.

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Conclusions

Anal hrHPV testing demonstrated similar SN for anal-cyt>ASC-US in predicting anal hHSIL. SP was highest for triage strategies and higher for hrHPV single tests compared to anal-cyt. Thus, anal hrHPV testing appears to be an alternative single test strategy or effective triage for anal-cyt>ASC-US for anal hHSIL screening among WLHIV.

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