High-Resolution Anoscopy or Expectant Management for Anal Intraepithelial Neoplasia for the Prevention of Anal Cancer. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Crawshaw, Benjamin P.; Russ, Andrew J.; Stein, Sharon L.; Reynolds, Harry L.; Marderstein, Eric L.; Delaney, Conor P.; Champagne, Bradley J.
• Is Part Of: Diseases of the colon & rectum. Volume 58:Issue 1(2015:Jan.)
• Publication Date: 2015-01
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000000267
• Languages: English
• ISSNs: 0012-3706

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND:</title> <p>High-resolution anoscopy has been shown to improve identification of anal intraepithelial neoplasia but a reduction in progression to anal squamous-cell cancer has not been substantiated when serial high-resolution anoscopy is compared with traditional expectant management.</p> </sec> <sec> <title>OBJECTIVE:</title> <p>The aim of this study was to compare high-resolution anoscopy versus expectant management for the surveillance of anal intraepithelial neoplasia and the prevention of anal cancer.</p> </sec> <sec> <title>DESIGN:</title> <p>This is a retrospective review of all patients who presented with anal squamous dysplasia, positive anal Pap smears, or anal squamous-cell cancer from 2007 to 2013.</p> </sec> <sec> <title>SETTING:</title> <p>This study was performed in the colorectal department of a university-affiliated, tertiary care hospital.</p> </sec> <sec> <title>PATIENTS:</title> <p>Included patients had biopsy-proven anal intraepithelial neoplasia from 2007 to 2013.</p> </sec> <sec> <title>INTERVENTIONS:</title> <p>Patients were treated with high-resolution anoscopy with ablation or standard anoscopy with ablation. Both groups were treated with imiquimod and followed every 6 months indefinitely.</p> </sec> <sec> <title>MAIN OUTCOME MEASURES:</title> <p>The incidence of anal squamous-cell cancer in each group was the primary end point.</p> </sec> <sec> <title>RESULTS:</title> <p>From 2007 to 2013, 424 patients with anal squamous dysplasia were seen in the clinic (high-resolution anoscopy, 220; expectant management, 204). Three patients (high-resolution anoscopy, 1; expectant management, 2) progressed to anal squamous-cell cancer; 2 were noncompliant with follow-up and with HIV treatment, and the third was allergic to imiquimod and refused to take topical 5-fluorouracil. The 5-year progression rate was 6.0% (95% CI, 1.5–24.6) for expectant management and 4.5% (95% CI, 0.7–30.8) for high-resolution anoscopy (<italic>p</italic> = 0.37).</p> </sec> <sec> <title>LIMITATIONS:</title> <p>This was a retrospective review. There is potential for selection and referral bias. Because of the rarity of the outcome, the study may be underpowered.</p> </sec> <sec> <title>CONCLUSIONS:</title> <p>Patients with squamous-cell dysplasia followed with expectant management or high-resolution anoscopy rarely develop squamous-cell cancer if they are compliant with the protocol. The cost, morbidity, and value of high-resolution anoscopy should be further evaluated in lieu of these findings.</p> </sec> </abstract>