German‐Austrian guidelines on anal dysplasia and anal cancer in HIV‐positive individuals: prevention, diagnosis, and treatment

Eßer, Stefan; Kreuter, Alexander; Oette, Mark; Gingelmaier, Andrea; Mosthaf, Franz; Sautter-Bihl, Marie-Luise; Jongen, Johannes; Brockmeyer, Norbert H.; Eldering, G.; Swoboda, Jochen; Postel, Nils; Degen, Olaf; Schalk, Horst; Jessen, Arne; Knechten, Heribert; Thoden, Jan; Stellbrink, Hans‐Jürgen; Schafberger, Armin; Wieland, Ulrike

doi:10.1111/ddg.12726

Cited by 52 publications

(69 citation statements)

References 156 publications

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“…With respect to typing based on fresh specimens, on the other hand, current guidelines for anogenital HPV infections contain strong consensus-based recommendations as to when HPV typing is indicated (including e. g. HIV infection, immunosuppression or intraepithelial neoplasia, and as a supplementary measure for primary cytological screening for cervical neoplasia in women above 30) or not (condylomata acuminata or anogenital warts in immunocompetent individuals, given that these kinds of HPV infections are frequently transient in immunocompetent young women and men, and the correlation between the development of other kinds of anogenital carcinoma and HPV is not as strong as for cervical cancer) [5] (refer to the AWMF homepage for S2 guidelines that have been published, are being developed, or under review: S2k guidelines for HPV-associated lesions of the external genital region and the anus -genital warts and precancerous lesions of vulva, penis, perianal, and intra-anal skin; S2 guidelines: Prevention, diagnosis, and treatment of HPV infection and pre-invasive lesions of the female genitalia; S2k guidelines "Genital and anal dysplasia and anal cancer in HIV-infected individuals: prevention, diagnosis, and treatment").…”

Section: Hpv Typing On Paraffin Sectionsmentioning

confidence: 99%

Molecular diagnosis of skin infections using paraffin‐embedded tissue – review and interdisciplinary consensus

Sunderkötter

Becker

Kutzner

et al. 2018

J Deutsche Derma Gesell

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Summary Nucleic acid amplification techniques (NATs), such as PCR, are highly sensitive and specific methods that have become valuable supplements to culture and serology in the diagnosis of infectious disorders. However, especially when using formalin‐fixed and paraffin‐embedded tissue, these techniques are associated with both false‐negative and false‐positive results, a pitfall that is frequently misjudged. Representatives of the German Society of Hygiene and Microbiology (DGHM) and the German Society of Dermatology (DDG) therefore set out to develop a consensus – in the form of a review article – on the appropriate indications for NATs using paraffin‐embedded tissue, its contraindications, and the key points to be considered in the pre‐ and post‐analytical phase. Given that fresh, naive tissue is preferably to be used in the workup of a suspected infection, PCR analysis on paraffin sections represents an exception. The latter may be considered if an infection is suspected at a later point in time and fresh tissue has not been preserved or can no longer be obtained. Potential indications include confirmation of histologically suspected infections with Leishmania spp., Bartonella spp., Rickettsia spp., or in case of ecthyma contagiosum. Infections with, for example, mycobacteria or RNA viruses, on the other hand, are not considered useful indications for NATs using paraffin sections. In order to avoid misinterpretation of test results, it is essential that laboratory reports on NATs using paraffin‐embedded tissue contain information on the indication/diagnostic circumstances, the required and chosen pre‐analytical steps, the limitations of the method, and on diagnostic alternatives.

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Section: Hpv Typing On Paraffin Sectionsmentioning

confidence: 99%

Molecular diagnosis of skin infections using paraffin‐embedded tissue – review and interdisciplinary consensus

Sunderkötter

Becker

Kutzner

et al. 2018

J Deutsche Derma Gesell

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“…This approach showed a similar diagnostic performance as HRA [45]. Both methods combined with targeted biopsies of suspect lesions are superior compared to conventional proctoscopy and cytology [10]. Due to the low specificity of cytology and visual impression, biopsy collection from areas with pathological staining patterns is mandatory [44].…”

Section: Diagnosismentioning

confidence: 88%

“…The clinical presentation of AIN is characterized by a variety of signs such as scaly, whitish, erythematous, eczematous, papillomatous, papular, pigmented, or fissured plaques [10,33]. Similar to intraepithelial neoplasia in other locations (e.g., penis, oral cavity), perianal AIN encompasses 4 clinical types: bowenoid, erythroplakic, verrucous, and leukoplakic lesions [27].…”

Section: Diagnosismentioning

confidence: 99%

“…Verrucous perianal AIN is often revealed by histology to be HGAIN. Differential diagnoses include psoriasis inversa, lichen simplex chronicus, nummular eczema, epidermal nevi, flat condyloma or condyloma acuminata and possibly also basal cell carcinoma, extra-mammary Paget's disease, and malignant melanoma [10]. The much more common intra-anal AIN are normally asymptomatic and cannot be detected by rectal-digital examination.…”

Section: Diagnosismentioning

confidence: 99%

“…Normal epithelium of the anal canal stores glycogen which stains dark brown after iodine application. Dysplastic epithelium or metaplasia contains little or no glycogen and thus turns yellow or orange [10,27]. Optical magnification can be performed with a modern flexible chip camera endoscope and a spacer cap (anal chromoendoscopy, ACE) [44].…”

Section: Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

HIV-Associated Anal Dysplasia and Anal Carcinoma

Oette¹,

Mosthaf²,

Sautter-Bihl³

et al. 2017

Oncol Res Treat

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Anal carcinoma shows an increasing incidence in people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in whom it is also much more common compared to the HIV-negative population. Human papillomavirus infection is the etiological basis of malignant development in the anal epithelium. Therefore, adequate diagnosis and treatment of the precursor lesions (anal intraepithelial neoplasia) is of clinical importance. In cases with preserved immune function, anal cancer can be treated according to guidelines issued for HIV-negative patients. This review summarizes the current knowledge regarding anal malignancies in HIV-positive patients.

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High-grade Dysplasia in Anogenital Warts of HIV-Positive Men

et al. 2016

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IMPORTANCE Human papillomavirus (HPV)-induced anogenital lesions are very frequent in men who have sex with men (MSM) who are HIV-positive (HIV+). Anogenital warts (AGWs) are considered benign lesions caused by low-risk HPV-types, whereas anogenital dysplasias are potential cancer precursors associated with high-risk HPV-types. Both types of lesions can usually be distinguished clinically. OBJECTIVE To describe a case series of HIV+ MSM with typical AGW that harbored different grades of dysplasia. DESIGN, SETTING, AND PARTICIPANTS For this retrospective virological analysis, we recruited 25 HIV+ MSM with AGWs (n = 38) harboring areas of dysplasia and 22 patients who were HIV-negative (HIV−) with AGWs seen between February 2013 and March 2015 at a tertiary dermatological referral center for anal cancer screening. Dysplasia-containing AGW tissue of HIV+ MSM were compared with randomly selected AGWs of patients who were HIV−. MAIN OUTCOMES AND MEASURES Histopathological analysis, immunohistochemical staining for p16 INK4a and Ki67, HPV-typing, and viral load determination in AGWs of HIV+ compared with patients who were HIV−. RESULTS Overall, 25 HIV+ MSM with AGWs (mean [SD] age, 47.3 [11.1] years) harboring areas of dysplasia and 22 patients who were HIV− (5 women, 17 men; mean [SD] age, 35.5 [12.8] years) with AGWs were included in this study. The 38 dysplasia-containing AGWs of HIV+ MSM harbored low-grade dysplasia in 6 cases (16%), high-grade dysplasia in 31 cases (81%), and areas of invasive anal carcinoma in 1 (3%) case. With the exception of 1 biopsy, all low-grade lesions were p16 INK4a-negative, whereas 25 of 31 (81%) AGWs with high-grade lesions or an anal carcinoma were p16 INK4a-positive. Only low-risk HPV-types were present in 11 samples (29%; 2 low-grade lesions and 9 high-grade lesions), low-risk and high-risk types were found in 19 samples (50%; 1 low-grade lesion and 18 high-grade lesions), and only high-risk HPV-types were present in 8 samples (21%; 3 low-grade lesions, 4 high-grade lesion, and 1 cancer-containing lesion). High low-risk HPV DNA loads were found in low-grade and high-grade lesions, while high high-risk HPV DNA loads were only found in AGWs harboring high-grade lesions. The 22 AGWs of patients who were HIV− showed no signs of dysplasia, and p16 INK4a-staining was always negative. All of these samples carried low-risk HPV types, and in 2 cases high-risk HPV-types were detected additionally. CONCLUSIONS AND RELEVANCE In contrast to immunocompetent patients, AGWs of HIV+ MSM may harbor high-grade dysplasia or even invasive squamous cell carcinoma. A substantial proportion of these lesions may only contain low-risk HPV-types. Anogenital warts in patients who are HIV+ should be evaluated histopathologically to exclude cancer precursors.

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German‐Austrian guidelines on anal dysplasia and anal cancer in HIV‐positive individuals: prevention, diagnosis, and treatment

Cited by 52 publications

References 156 publications

Molecular diagnosis of skin infections using paraffin‐embedded tissue – review and interdisciplinary consensus

Molecular diagnosis of skin infections using paraffin‐embedded tissue – review and interdisciplinary consensus

HIV-Associated Anal Dysplasia and Anal Carcinoma

High-grade Dysplasia in Anogenital Warts of HIV-Positive Men

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