Detection of Oncogenic Human Papillomavirus and Other Predictors of Anal High-Grade Dysplasia in Men Who Have Sex with Men with Abnormal Cytology

PURPOSE: The incidence of anal high-grade dysplasia in men who have sex with men is increasing. Anal cytology that shows atypical squamous cells of undetermined significance is common, nonspecific, and rarely predicts high-grade squamous intraepithelial lesion. We want to know whether Hybrid-Capture II (R) testing for oncogenic human papillomavirus (human papillomavirus+) in men who have sex with men with atypical squamous cells of undetermined significance is beneficial and whether other predictors of high-grade squamous intraepithelial lesion exist. METHODS: We performed a retrospective chart review of men who have sex with men undergoing anal screening with atypical squamous cells of undetermined significance cytology, Hybrid-Capture (R) II testing, and biopsy. Records were analyzed for all screenings. RESULTS: A total of 597 men who have sex with men enrolled and had 1,015 atypical squamous cells of undetermined significance cytology results: 185 (18.2 percent) had high-grade squamous intraepithelial lesion and 156 (84 percent) were human papillomavirus+. The rates for sensitivity, specificity, positive predictive value, and negative predictive value were 84, 53, 29, and 94 percent, respectively. Of 390 low-grade squamous intraepithelial lesion cytology results, high-grade squamous intraepithelial lesion was found in 141 and 127 (90 percent) were human papillomavirus+. Those with previous high-grade squamous intraepithelial lesions or human immunodeficiency virus had increased risk of high-grade squamous intraepithelial lesion (hazard ratio = 2.2 and hazard ratio = 1.95, respectively). Age was not a factor. CONCLUSIONS: Hybrid-Capture II (R) testing is useful in men who have sex with men with atypical squamous cells of undetermined significance. Referring only those with oncogenic human papillomavirus for biopsy reduces the number requiring this by almost half but some high-grade squamous intraepithelial lesions are missed. History of high-grade squamous intraepithelial lesion and human immunodeficiency virus are predictors of high-grade squamous intraepithelial lesion while screening intervals might be lengthened absent oncogenic human papillomavirus or in those free of high-grade squamous intraepithelial lesion for long periods.