Detection Rate of High-Grade Squamous Intraepithelial Lesions as a Quality Assurance Metric for High-Resolution Anoscopy in HIV-Positive Men. Issue 7 (July 2018)

• Record Type: Journal Article
• Authors: Siegenbeek van Heukelom, Matthijs L.; Marra, Elske; Cairo, Irina; Van Eeden, Arne; Schim van der Loeff, Maarten F.; De Vries, Henry J.C.; Prins, Jan M.
• Is Part Of: Diseases of the colon & rectum. Volume 61:Issue 7(2018)
• Publication Date: 2018-07
• Subjects: Anal intraepithelial neoplasia -- High-resolution anoscopy -- HIV infection -- Learning curve -- Prevalence squamous intraepithelial lesions; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000001039
• Languages: English
• ISSNs: 0012-3706

Abstract

Abstract : BACKGROUND: High-resolution anoscopy-guided biopsies are the gold standard for identifying anal intraepithelial neoplasia, but diagnosing high-grade squamous intraepithelial lesions depends on the skills of the anoscopist. OBJECTIVE: This study aims to validate the high-grade squamous intraepithelial lesion detection rate as a quality assurance metric for high-resolution anoscopy in HIV-positive men. DESIGN: This is a retrospective study. SETTING: This study was conducted at 3 HIV outpatient clinics in Amsterdam, The Netherlands. PATIENTS: HIV-positive men who have sex with men were selected for this study. MAIN OUTCOME MEASURES: We analyzed the high-grade squamous intraepithelial lesion detection rate per high-resolution anoscopy, the mean number of biopsies taken, and the mean high-grade squamous intraepithelial lesion rate per biopsy in time-subsequent groups for 7 anoscopists performing high-resolution anoscopy. RESULTS: Seven anoscopists performed high-resolution anoscopy in 1340 HIV-positive men who have sex with men. The overall high-grade squamous intraepithelial lesion detection rate for all 7 anoscopists combined increased significantly over time, from 27% to 40% ( p < 0.001; OR, 1.15; 95% CI, 1.08–1.23 per 50 high-resolution anoscopies). The mean number of biopsies increased significantly from 1.4 (22% high-grade squamous intraepithelial lesions per biopsy) to 2.0 biopsies per patient (29% high-grade squamous intraepithelial lesions per biopsy) ( p < 0.001). Three anoscopists showed a significant increase in proportion of high-grade squamous intraepithelial lesions per biopsy with increasing experience. LIMITATIONS: There were statistically significant differences, with limited clinical significance, in the characteristics of patient populations between anoscopists and clinics. CONCLUSIONS: We found significant variations in the high-grade squamous intraepithelial lesion detection rate among anoscopists performing high-resolution anoscopy in HIV-positive men who have sex with men. The high-grade squamous intraepithelial lesion detection rate and mean high-grade squamous intraepithelial lesion rate per biopsy can be used as a quality assurance metric to follow up the learning curve of high-resolution anoscopists. SeeVideo Abstract athttp://links.lww.com/DCR/A555 .