Screening for Squamous Cell Anal Cancer in HIV Positive Patients: A Five-Year Experience. (3rd September 2018)

• Record Type: Journal Article
• Authors: Santorelli, Chiara; Leo, Cosimo Alex; Hodgkinson, Jonathan D.; Baldelli, Franco; Cantarella, Francesco; Cavazzoni, Emanuel
• Is Part Of: Journal of investigative surgery. Volume 31:Number 5(2018)
• Page Start: 378
• Page End: 384
• Publication Date: 2018-09-03
• Subjects: HIV -- HPV -- anal dysplasia -- high-resolution video-proctoscopy -- screening -- anal cancer; Surgery -- Research -- Periodicals; Research; Surgery; Surgical Procedures, Operative; 617.075
• DOI: 10.1080/08941939.2017.1334845
• Languages: English
• ISSNs: 0894-1939

Abstract

ABSTRACT: Aim : Potential screening modalities for early diagnosis of squamous cell anal cancer (SCC) in HIV patients include digital anorectal examination (DARE), anal Papanicolaou testing (Pap test), human papilloma virus (HPV) co-testing, and high-resolution anoscopy. The aim of this study was to demonstrate the results of a five-year screening program for SCC in HIV patients. Materials and Methods : We conducted a retrospective study on 204 HIV patients who underwent a screening program for SCC from October 2010 to January 2015. All patients were screened by DARE, anal Pap test, including HPV test and cytology, and high-resolution video-proctoscopy (HR-VPS) with and without acetic acid 3%. Depending on macroscopic appearance and biopsies, patients underwent observation or treatment. Median follow-up was 36 months. Results : Cytologic abnormalities (Cyt+) for high-risk HPV genotypes were recorded in 34% of patients. HR-VPS was positive in 59 patients (29%), of whom 13 patients (22%) were positive for warts; the rest have typical features of anal intraepithelial neoplasia (AIN). Sixteen (8%) patients had AIN (AIN I–III) and underwent wide local excision, ablation, or imiquimod. Absence of progression was recorded. Fourteen patients (7%) had SCC: eight (57%) with no evidence of recurrence, two (14%) had recurrence, and four (29%) died from metastatic disease. Conclusions : Our data demonstrated a successful screening program in preventing SCC in HIV patients. We demonstrate the advantages of progression towards SCC. Moreover, we used a new screening tool, the HR-VPS, a low-cost and manageable instrument to collect patients' long-term data.