Retrospective Analysis of the Anal Cytology with Concurrent HR-HPV (High-Risk Human Papilloma Virus) Testing in a High-Risk Population in a Tertiary Care Center

Summary: Introduction: Currently, there is no consensus in national and international guidelines regarding anal HPV-related disease screening. Recommendations regarding HPV testing are either conflicting or have low strength of evidence. Materials and Methods: To review the utility of concurrent HR-HPV testing with anal cytology we performed a retrospective analysis of 55 anal cytology cases that were received in the cytology division from January 2023 to April 2024. After preparation of a ThinPrep all specimens underwent concurrent cobas® HR-HPV testing (HPV16/18 and HR-HPV-OHR (other high-risk types). ThinPreps underwent screening by cytotechnologists, with final diagnoses rendered by the cytopathologist. Results: The median age of the 55 patients was 49 years (range: 30-76), with a male-to-female ratio of 26.5:1. (53 males and 2 females). Of these 53 (96.3%) were HIV positive. On review of anal cytology, 10(18%) were categorized as unsatisfactory cases, 17 (30.9%) as NILM (Negative for intraepithelial lesion/ malignancy), 12 (21.8%) as LSIL (Low grade squamous intraepithelial lesion), and 1 (1.8%) as HSIL (High grade squamous intraepithelial lesion). HR-HPV-OHR was positive in 40 cases (72.7%) of which only 12 (80%) had ASCUS/ASCH cytology, 12 (70.5%) were NILM and 4 (40%) were unsatisfactory. In contrast HPV16/18 was positive only in 11 (20%) cases, of which 5 (33.3%) were ASCUS/ASCH on cytology, 2 (20%) were unsatisfactory and 1(5.8%) was NILM. (Table.1). There were 8 cases (14.5%) with concurrent HPV16/18 and OHR positivity. Conclusions: In our study, HR-HPV-OHR is almost equally positive in negative and atypical anal cytology. However, HPV 16/18 is present significantly more in cases with atypical cytology. It is also worth noting that 2 cases with unsatisfactory cytology were positive for the 16/18 genotype, which highlights the importance of repeat cytology screening. Though our data is small the findings support concurrent HPV16/18 testing with anal cytology including the unsatisfactory specimens.