An Update on the Current Role of High Resolution Anoscopy in Patients With Anal Dysplasia

Abstract

The incidence of anal squamous cell carcinoma (ASCC) in the U.S. is increasing, particularly in immunocompromised patients. Preventative screening is used to monitor precancerous dysplasia known as anal intraepithelial neoplasia (AIN), which can progress to ASCC. High Resolution Anoscopy (HRA) is one screening procedure that uses a colposcope with acetic acid and Lugol's iodine solution to visualize the anal epithelium for AIN. HRA has offered potential in managing AIN, but as more evidence emerges it is unclear whether HRA provides definitive benefit. This narrative review updates readers on the efficacy of HRA in screening AIN, compares HRA to other techniques, compares the use of HRA in various high-risk populations, and offers practical information on the use of HRA. Keyword searches were conducted using MEDLINE, Web of Science, and Cochrane Library. Current literature is mixed regarding the utility of HRA. Further randomized controlled trials are needed to definitively assess the role of HRA.

Clinical characteristics and prognosis of anal squamous cell carcinoma: a retrospective audit of 144 patients from 11 cancer hospitals in southern China

“…Some measures such as high resolution anoscopy (HRA), anal Papanicolau (Pap) smears, and regular digital anorectal examination (DARE) should be implemented in high-risk populations to improve early diagnosis rate of anal SCC [33][34][35][36][37][38]. HRA is identified as the gold standard for anal cancer screening [34][35][36]. Anal Pap smears may increase the probability for early diagnosis of anal lesions [37,38].…”

“That’s Only for Women”: The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA)

“… 38 , 39 Patients at risk for anal dysplasia are typically first screened through self- or practitioner-collected anal/rectal swabs, and those with abnormal cytological results, including high-grade squamous intraepithelial lesions (HSIL), low-grade squamous intraepithelial lesions (LSIL), or atypical squamous cells of undetermined significance (ASCUS), are referred for further evaluation using high-resolution anoscopy (HRA). 32 , 33 , 38 During HRA, the practitioner inserts an anoscope into the anus and a colposcope is used to examine the transformation zone of the anus, including the squamocolumnar junction, using acetic acid and Lugol’s solution. 40 Suspicious lesions are then biopsied, and those demonstrating significant dysplasia can be ablated or removed during subsequent HRAs, or treated with topical creams.…”

“…[21][22][23][24][25] Recently, researchers have begun to focus on the role of anal HPV screening and secondary prevention for HIV-positive and HIV-negative MSM as a method of reducing anorectal neoplasm morbidity and mortality. 7,9,[26][27][28][29][30][31][32][33][34] Though no national guidelines regarding who should be screened, how often screening should occur, or the optimal treatment modalities for anal dysplasia exist, 14,[35][36][37] the currently accepted approach to anal HPV screening and management is modeled after approaches taken to screening and management for cervical dysplasia, which is accomplished through routine Papanicolaou cytological screening ("Pap smears") followed by colposcopy of the cervix to visualize and treat dysplastic lesions. 38,39 Patients at risk for anal dysplasia are typically first screened through self-or practitioner-collected anal/rectal swabs, and those with abnormal cytological results, including high-grade squamous intraepithelial lesions (HSIL), low-grade squamous intraepithelial lesions (LSIL), or atypical squamous cells of undetermined significance (ASCUS), are referred for further evaluation using high-resolution anoscopy (HRA).…”

ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM

“…According to our findings, screening programs for HIV+MSM should include a PCR study of those with normal cytology results to definitively rule out HSIL+. The high frequency of false-negative anal cytology findings in intraepithelial neoplasia screening has led to proposals for the direct performance of HRA [38]; although a recent systematic review called for further research to compare the effectiveness of HRA with that of other techniques in populations at risk [39].…”

“…Both samples were immersed in thinlayer liquid medium and sent to the pathology laboratory of the hospital. Genotypes 16,18,26,31,33,35,39,45,[51][52][53]56,58,59,66,68,73, and 82 were considered to be HR-HPV genotypes. Genotypes 6,11,34,40,[42][43][44]54,55,57,61,[70][71][72]81,83,84, and 89 were considered to be low-risk (LR-HPV) genotypes.…”