The incidence of anal squamous neoplasms has been increasing, especially in men who have sex with men and in women with multicentric genital tract squamous lesions. The etiology and pathogenesis of anal squamous neoplasia are similar to that of cervical squamous neoplasia, including an association with HPV, which has been identified in 91% of anal squamous cancers in reported studies.
Although there are no official guidelines regarding anal-rectal cytology screening for anal squamous intraepithelial lesions, smears of the anorectal junction are being done with increasing frequency on high-risk patients. Taking an anal “Pap” is a fairly simple procedure, and samples are handled in a similar fashion to cervical-vaginal Pap smears. Healthcare providers should check with their laboratories for specific handling instructions.
Ask the patient to remove clothing from the waist down. Provide appropriate covering.
Place the patient on the side with the knees drawn up to the chest.
Gently insert a polyester tipped swab or cytobrush into the anus to a distance of 2–3 cm, ensuring sampling of the anorectal junction by passing and including the dentate line.
Rotate the swab or cytobrush 360° while gently pulling back and forth.
Transfer the sample by inserting the swab or brush into a vial of fixative fluid and gently agitate or, if the laboratory prefers, directly apply the sample to a glass slide, which is then placed in 95% alcohol or spray-fixed.
Label specimen with the patient’s name, date, and test(s) ordered; seal the sample vial in a biohazard bag; and forward to the laboratory with a properly completed requisition.
See Chapter 1 guidelines for intratest care.
Abnormal results are indicative of abnormal cytology, anal squamous intraepithelial lesions, or malignancy.
Anoscopic and histologic assessment of anal lesions is critical to classify lesions accurately. Any cytologic abnormality should be followed with high-resolution anoscopy, and any lesion should be biopsied to confirm the grade of dysplasia.
Pretest Patient Preparation
Explain the purpose of the test and the collection procedure. Tell the patient to avoid rectal suppositories before the day of obtaining the smear.
Advise that there may be a slight discomfort (e.g., pressure sensation) during insertion and rotation of swab.
Follow guidelines in Chapter 1 for safe, effective, and informed pretest care.
Posttest Patient Care
Give the patient a moist towelette after the procedure to absorb any bleeding or drainage.
Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient appropriately regarding subsequent testing (anoscopy and biopsy) if an abnormal result is received and there is a possible need for treatment (i.e., excisional procedures).
Follow Chapter 1 guidelines for safe, effective, informed posttest care.