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Screening for precancerous anal lesions with P16/Ki67 immunostaining in HIV-infected MSM.

Screening for precancerous anal lesions with P16/Ki67 immunostaining in HIV-infected MSM.
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Serrano-Villar S, Hernández-Novoa B, de Benito A, Del Romero J, Ocampo A, Blanco JR, Masiá M, Sendagorta E, Sanz G, Moreno S, Pérez-Molina JA,


Serrano-Villar S, Hernández-Novoa B, de Benito A, Del Romero J, Ocampo A, Blanco JR, Masiá M, Sendagorta E, Sanz G, Moreno S, Pérez-Molina JA, (click to view)

Serrano-Villar S, Hernández-Novoa B, de Benito A, Del Romero J, Ocampo A, Blanco JR, Masiá M, Sendagorta E, Sanz G, Moreno S, Pérez-Molina JA,

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PloS one 2017 11 3012(11) e0188851 doi 10.1371/journal.pone.0188851

Abstract
BACKGROUND
Screening of anal cancer in HIV-infected MSM with anal cytology results in high rates of false positive results and elevated burden of high-resolution anoscopies. High-risk HPV up-regulates p16 and Ki67 expression in epithelial cells. We assessed the usefulness of P16/Ki-67 immunostaining cytology for the diagnosis of precancerous anal lesions.

METHODOLOGY
Cross-sectional multicenter study. Concomitant anal liquid cytology with p16/Ki-67 immunostaining and HRA with biopsy of acetowhite lugol-negative lesions was performed in HIV-infected MSM. We compared the diagnostic performance of an abnormal anal cytology and p16/Ki-67 immunostaining relative to HRA-guided biopsy by logistic regression and comparison of ROC areas.

RESULTS
We included 328 HIV-infected MSM. HSIL was histologically diagnosed in 72 subjects (25.1%), and 2 (0.6%) were diagnosed with anal cancer. An abnormal cytology showed a sensitivity of 95.6% and a specificity of 58.8% for the diagnosis of biopsy-proven HSIL. P16/Ki67 positivity was associated with the presence of biopsy-proven HSIL (P trend = 0.004) but with low sensitivity (41.2%) and specificity (71%). The combination of standard cytology with P16/Ki67 immunostaining did not increment the predictive value of standard cytology alone (AUC 0.685 vs. 0.673, respectively, P = 0.688).

CONCLUSION
In HIV-infected MSM P16/Ki67 immunostaining does not improve the diagnostic accuracy of anal cytology, which shows a high sensitivity yet poor specificity. Other approaches aimed at improving the diagnostic accuracy of current techniques for the diagnostic of precancerous HSIL are warranted.

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