Evaluation of anal cytology and dysplasia in women with a history of lower genital tract dysplasia and malignancy

• AIN is a known precursor lesion for anal carcinoma.
• Women with lower genital tract dysplasia and malignancy had high rates of abnormal anal cytology.
• Identifying who is at high risk for anal dysplasia and warrants screening is important.

ObjectiveTo compare the prevalence of abnormal anal cytology, high-risk anal HPV and biopsy proven anal dysplasia among women with a history of lower genital tract malignancy compared to those with dysplasia.MethodsA prospective cohort study was performed from December 2012 to February 2014 at outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal dysplasia, or malignancy were recruited. Anal cytology and HPV genotyping were performed. All women with abnormal anal cytology were referred for high-resolution anoscopy and biopsy.ResultsSixty-seven women had a lower genital tract malignancy and 123 had a history of genital dysplasia. Average age in the malignancy group was 52.6 years (range 27–86) versus 43.5 years (range 21–81) in the dysplasia group (p < 0.0002). Similar rates of anal dysplasia were seen in both groups, 12.99% (10 cases) in the malignancy group, versus 12.20% (15) in the dysplasia group (p = 1.0). Six women in the malignancy group had anal intraepithelial neoplasia (AIN2 +) compared to 2 in the dysplasia group (p = 0.03).ConclusionsWe found high rates of abnormal anal cytology and HPV in women with lower genital tract dysplasia and malignancy. We also found high rates of anal dysplasia in both groups with a trend towards increased rate in those women with history of genital malignancy. Since precancerous anal lesions are detectable and treatable, anal cancer screening may be potentially useful in both of these higher risk groups.