Ability to detect high-grade squamous anal intraepithelial lesions at high resolution anoscopy improves over time
Richard J. Hillman A B C F , Manoji P. W. Gunathilake A , Fengyi Jin C , Winnie Tong D , Andrew Field E and Andrew Carr DA Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW 2150, Australia.
B Sydney Medical School – Westmead, University of Sydney, NSW 2006, Australia.
C The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia.
D Centre for Applied Medical Research – Clinical Research Program, St Vincent’s Hospital, Darlinghurst, Sydney, NSW 2010, Australia.
E Department of Anatomical Pathology, St Vincent’s Hospital, Darlinghurst, Sydney, NSW 2010, Australia.
F Corresponding author. Email: Richard.Hillman@sydney.edu.au
Sexual Health 13(2) 177-181 https://doi.org/10.1071/SH15170
Submitted: 24 August 2015 Accepted: 2 December 2015 Published: 1 February 2016
Abstract
Background: Anal cancer is increasing in incidence, has very high rates in specific populations and shares many similarities with cervical cancer. High-grade squamous intraepithelial lesions (HSIL) are regarded as precursors to anal cancer. High resolution anoscopy (HRA), which is derived from colposcopy, is the only currently available tool that can identify areas of the anal canal for targeted biopsy and identification of HSIL. Methods: This study investigated the ability over a period of time of a single anoscopist to identify and adequately biopsy HSIL, correlating with contemporary anal cytological findings. Results: Four hundred paired cytology and histology samples collected from 283 patients over a 7-year period from 2004 to 2010 were compared. There was a significant increase in HSIL detection rates when anal squamous cells of undetermined significance (ASC-US; 38.6–66.0%) or low-grade squamous intra-epithelial lesion (38.8–68.3%) were taken as cut-off points (P < 0.001 for both). Detection rates did not change significantly when atypical squamous cells-cannot exclude HSIL (ASC-H) or a higher grade lesion (70–76.6%) was taken as the cut-off point. Conclusions: The increase in ability to detect histological HSIL over time and with increasing experience has the potential to impact on delivery of clinical services and the interpretation of clinical trial data. Further studies are required to determine the extent of this effect on other clinicians practising HRA.
Additional keywords: anal cancer, human papillomavirus, impact of experience, screening.
References
[1] Grulich AE, Poynten IM, Machalek DA, Jin F, Templeton DJ, Hillman RJ. The epidemiology of anal cancer. Sex Health 2012; 9 504–8.| The epidemiology of anal cancer.Crossref | GoogleScholarGoogle Scholar | 22958581PubMed |
[2] Welton ML, Sharkey FE, Kahlenberg MS. The etiology and epidemiology of anal cancer. Surg Oncol Clin N Am 2004; 13 263–75.
| The etiology and epidemiology of anal cancer.Crossref | GoogleScholarGoogle Scholar | 15137956PubMed |
[3] Jin F, Stein AN, Conway EL, Regan DG, Law M, Brotherton JM, Hocking J, Grulich AE. Trends in anal cancer in Australia, 1982–2005. Vaccine 2011; 29 2322–7.
| Trends in anal cancer in Australia, 1982–2005.Crossref | GoogleScholarGoogle Scholar | 21255682PubMed |
[4] Darragh TM, Winkler B. Anal cancer and cervical cancer screening: key differences. Cancer Cytopathol 2011; 119 5–19.
| Anal cancer and cervical cancer screening: key differences.Crossref | GoogleScholarGoogle Scholar | 21319310PubMed |
[5] Roberts JM, Ekman D. The reporting of anal cytology and histology samples: establishing terminology and criteria. Sex Health 2012; 9 562–7.
| The reporting of anal cytology and histology samples: establishing terminology and criteria.Crossref | GoogleScholarGoogle Scholar | 22951231PubMed |
[6] Darragh TM, Winkler B. Screening for anal neoplasia: anal cytology – sampling, processing and reporting. Sex Health 2012; 9 556–61.
| Screening for anal neoplasia: anal cytology – sampling, processing and reporting.Crossref | GoogleScholarGoogle Scholar | 22950982PubMed |
[7] Darragh TM, Colgan TJ, Thomas Cox J, Heller DS, Henry MR, Luff RD, McCalmont T, Nayar R, Palefsky JM, Stoler MH, Wilkinson EJ, Zaino RJ, Wilbur DC, for Members of the LAST Project Work Groups The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol 2013; 32 76–115.
| The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology.Crossref | GoogleScholarGoogle Scholar | 23202792PubMed |
[8] Palefsky JM. Practising high-resolution anoscopy. Sex Health 2012; 9 580–6.
| Practising high-resolution anoscopy.Crossref | GoogleScholarGoogle Scholar | 23380236PubMed |
[9] Roberts JM, Thurloe JK. Comparison of the performance of anal cytology and cervical cytology as screening tests. Sex Health 2012; 9 568–73.
| Comparison of the performance of anal cytology and cervical cytology as screening tests.Crossref | GoogleScholarGoogle Scholar | 22951325PubMed |
[10] Chiao EY, Giordano TP, Palefsky JM, Tyring S, El Serag H. Screening HIV-infected individuals for anal cancer precursor lesions: a systematic review. Clin Infect Dis 2006; 43 223–33.
| Screening HIV-infected individuals for anal cancer precursor lesions: a systematic review.Crossref | GoogleScholarGoogle Scholar | 16779751PubMed |
[11] Salit IE, Lytwyn A, Raboud J, Sano M, Chong S, Diong C, et al The role of cytology (Pap tests) and human papillomavirus testing in anal cancer screening. AIDS 2010; 24 1307–13.
| 20442633PubMed |
[12] Berry JM, Palefsky JM, Jay N, Cheng SC, Darragh TM, Chin-Hong PV. Performance characteristics of anal cytology and human papillomavirus testing in patients with high-resolution anoscopy-guided biopsy of high-grade anal intraepithelial neoplasia. Dis Colon Rectum 2009; 52 239–47.
| Performance characteristics of anal cytology and human papillomavirus testing in patients with high-resolution anoscopy-guided biopsy of high-grade anal intraepithelial neoplasia.Crossref | GoogleScholarGoogle Scholar | 19279418PubMed |
[13] Nathan M, Singh N, Garrett N, Hickey N, Prevost T, Sheaff M. Performance of anal cytology in a clinical setting when measured against histology and high-resolution anoscopy findings. AIDS 2010; 24 373–9.
| Performance of anal cytology in a clinical setting when measured against histology and high-resolution anoscopy findings.Crossref | GoogleScholarGoogle Scholar | 20057313PubMed |
[14] Mathews WC, Sitapati A, Caperna JC, Barber RE, Tugend A, Go U. Measurement characteristics of anal cytology, histopathology, and high-resolution anoscopic visual impression in an anal dysplasia screening program. J Acquir Immune Defic Syndr 2004; 37 1610–5.
| Measurement characteristics of anal cytology, histopathology, and high-resolution anoscopic visual impression in an anal dysplasia screening program.Crossref | GoogleScholarGoogle Scholar | 15577418PubMed |
[15] Richel O, Prins JM, de Vries HJ. Screening for anal cancer precursors: what is the learning curve for high-resolution anoscopy? AIDS 2014; 28 1376–7.
| Screening for anal cancer precursors: what is the learning curve for high-resolution anoscopy?Crossref | GoogleScholarGoogle Scholar | 24932502PubMed |
[16] Tong WW, Jin F, McHugh LC, Maher T, Sinclair B, Grulich AE, Hillman RJ, Carr A. Progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions in HIV-infected and uninfected men. AIDS 2013; 27 2233–43.
| Progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions in HIV-infected and uninfected men.Crossref | GoogleScholarGoogle Scholar | 24157904PubMed |
[17] Ogilvie JW, Park IU, Downs LS, Anderson KE, Hansberger J, Madoff RD. Anal dysplasia in kidney transplant recipients. J Am Coll Surg 2008; 207 914–21.
| Anal dysplasia in kidney transplant recipients.Crossref | GoogleScholarGoogle Scholar | 19183539PubMed |
[18] Koppe DC, Bandeira CB, Rosa MR, Cambruzzi E, Meurer L, Fagundes RB. Prevalence of anal intraepithelial neoplasia in women with genital neoplasia. Dis Colon Rectum 2011; 54 442–5.
| Prevalence of anal intraepithelial neoplasia in women with genital neoplasia.Crossref | GoogleScholarGoogle Scholar | 21383564PubMed |
[19] British Society for Colposcopy and Cervical Pathology (BSCCP). Colposcopy training; 2013. Available online at: https://www.bsccp.org.uk/healthcare-professionals/colposcopy-training/trainer-trainee-guidelines/ [verified February 2014].
[20] American Society for Colposcopy and Cervical Pathology (ASCCP). ASCCP Colposcopy Mentorship Program; 2014. Available online at: www.asccp.org/Education/Education-eLearning/Colposcopy-Mentorship-Program-CMP [verified February 2014].
[21] Fox PA. Treatment options for anal intraepithelial neoplasia and evidence for their effectiveness. Sex Health 2012; 9 587–92.
| Treatment options for anal intraepithelial neoplasia and evidence for their effectiveness.Crossref | GoogleScholarGoogle Scholar | 22951292PubMed |
[22] Macaya A, Munoz-Santos C, Balaguer A, Barbera MJ. Interventions for anal canal intraepithelial neoplasia. Cochrane Database Syst Rev 2012; 12 CD009244
| 23235673PubMed |
