Rastreamento de lesões intraepiteliais anais em mulheres imunocompetentes portadoras de lesão intraepitelial de alto grau e câncer de colo uterino

Abstract

The incidence and mortality of anal cancer has progressed worldwide since 1975, reaching 2.06 per 100,000 women. It is associated with Human Papillomavirus infection in 90% of cases, being preceded by high-grade anal intraepithelial lesions. Anal cytology is the main screening test. High-resolution anoscopy with biopsy is the gold standard for diagnosis. The aim of the study was to determine the prevalence and possible variables associated with anal intraepithelial neoplasia and anal cancer in immunocompetent women with high-grade cervical intraepithelial neoplasia, as well as the agreement between diagnostic methods. A cross-sectional study in immunocompetent women with histological diagnosis of high-grade cervical intraepithelial neoplasia and cancer, between January 2016 and September 2020, was performed. All participants were submitted to anal cytology and to a characterization and potential risk factors questionnaire. Women with altered anal cytology were submitted to anoscopy and biopsy. 69 women completed the study. Of these, 7 (10.1%) had abnormal anal cytology (high-grade lesion, atypical squamous cells of undetermined significance and atypical squamous cells, cannot exclude high-grade lesions: 2.9% each; low-grade lesion:1.4%). Of the anoscopies, 3 (42.8%) showed alterations. One biopsy reported low-grade anal intraepithelial neoplasia. The mean number of pregnancies, vaginal deliveries and abortions was associated with abnormal anal cytology. The highest mean of cesarean sections was associated with normal anal cytology. The prevalence of anal intraepithelial neoplasia was compatible with data from the literature, mainly in Brazil. Opportunistic screening for anal intraepithelial neoplasia in this high risk patient population should be considered. Anal cytology proved to be adequate for this purpose, due to its low cost and feasibility in public health services. However, the ideal method of screening still needs to be addressed in future studies.