1328. Cross sectional study of routine anoscopy assisted anal Pap smears (A-PAP) vs. traditional anal Pap smears (T-PAP) in HIV-infected individuals: Comparison of sample adequacy
Session: Poster Abstract Session: Clinical Trials
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDSAposter2.pdf (667.7 kB)
  • Background:

    There are no national guidelines for anal dysplasia screening. Traditional anal Pap smears (T-PAP) utilizing a cytobrush/dacron swab is the most common screening method but sample adequacy may be as low as 75%. We postulated that sample adequacy could be improved by direct visualization using the anoscope to obtain the sample.


    1. To compare sample adequacy and patient discomfort of Anoscopy assisted anal Pap smear (A-PAP) vs. T-PAP.
    2. To examine the association between self-reported discomfort and intent to comply with future screenings/follow-up.


    The study was approved by the IRB at Baystate Medical Center. Patients ≥18 years were recruited between October 15, 2012 - February 28, 2013. After obtaining informed consent, anal Pap smears were collected twice from each patient: once using a cytobrush; and once using the cytobrush PLUS the anoscope. Specimens were read by one of two cytopathologists blinded to sampling method. Cytology was labeled as adequate or inadequate; adequate samples were then interpreted using the Bethesda criteria. After each Pap smear method, patients completed a questionnaire assessing Likert-scaled discomfort and intentions to submit to future screenings.


    Seventy five patients were enrolled yielding 150 samples. Of 150 samples collected, 115 (77%) were considered adequate. Significantly fewer adequate samples were obtained by A-PAP than T-PAP (68% vs. 85%, conditional OR 0.18, 95% CI 0.05, 0.64).

    Among interpretable samples however, A-PAP results were more likely than T-PAP to be abnormal (81% in A-PAP vs. 67% in T-PAP, conditional OR = 2.2; 95% CI 0.6 to 7.8). Self-rated discomfort scales were similar for both methods (mean discomfort scale=1.3 out of 5 for both, paired t-test p=0.85) as was self-rated intention to follow-up (0.2 out of 5 for both, p=0.53) and likelihood of recommending anal Pap to another patient (0.9 for both methods, p=0.77).


    A-PAP resulted in significantly fewer adequate samples when compared to T-PAP; however, A-PAP more often resulted in abnormal cytology (non-significant trend). The level of discomfort associated with both procedures was similar and most participants would recommend anal pap to another patient. Because the A-PAP may be more sensitive than the T-PAP, further studies may be warranted to improve A-PAP’s yield of sample adequacy.

    Durane Walker, MD1, Sally Long, ANP2, Jennifer Friderici2, Daniel Skiest, MD1 and Kelly Tyler, MD3, (1)Infectious Diseases, Baystate Medical Center, Springfield, MA, (2)Baystate Medical Center, Springfield, MA, (3)General Surgery, Baystate Medical Center, Springfield, MA


    D. Walker, None

    S. Long, None

    J. Friderici, None

    D. Skiest, None

    K. Tyler, None

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