High-resolution anoscopy or expectant management for anal intraepithelial Neoplasia for the prevention of anal cancer

Is there really a difference?

Benjamin P. Crawshaw, Andrew Russ, Sharon L. Stein, Harry L. Reynolds, Eric L. Marderstein, Conor P. Delaney, Bradley J. Champagne

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: 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. OBJECTIVE: The aim of this study was to compare highresolution anoscopy versus expectant management for the surveillance of anal intraepithelial neoplasia and the prevention of anal cancer. DESIGN: 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. SETTING: This study was performed in the colorectal department of a university-affiliated, tertiary care hospital. PATIENTS: Included patients had biopsy-proven anal intraepithelial neoplasia from 2007 to 2013. INTERVENTIONS: Patients were treated with highresolution anoscopy with ablation or standard anoscopy with ablation. Both groups were treated with imiquimod and followed every 6 months indefinitely. MAIN OUTCOME MEASURES: The incidence of anal squamous-cell cancer in each group was the primary end point. RESULTS: From 2007 to 2013, 424 patients with anal squamous dysplasia were seen in the clinic (highresolution 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 (p = 0.37). LIMITATIONS: 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. CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalDiseases of the Colon and Rectum
Volume58
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Anus Neoplasms
Squamous Cell Neoplasms
imiquimod
Neoplasms
Papanicolaou Test
Selection Bias
Tertiary Healthcare
Tertiary Care Centers
Fluorouracil
Referral and Consultation
Epithelial Cells
Outcome Assessment (Health Care)
HIV
Morbidity
Biopsy
Costs and Cost Analysis
Incidence

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

High-resolution anoscopy or expectant management for anal intraepithelial Neoplasia for the prevention of anal cancer : Is there really a difference? / Crawshaw, Benjamin P.; Russ, Andrew; Stein, Sharon L.; Reynolds, Harry L.; Marderstein, Eric L.; Delaney, Conor P.; Champagne, Bradley J.

In: Diseases of the Colon and Rectum, Vol. 58, No. 1, 01.01.2015, p. 53-59.

Research output: Contribution to journalArticle

Crawshaw, Benjamin P. ; Russ, Andrew ; Stein, Sharon L. ; Reynolds, Harry L. ; Marderstein, Eric L. ; Delaney, Conor P. ; Champagne, Bradley J. / High-resolution anoscopy or expectant management for anal intraepithelial Neoplasia for the prevention of anal cancer : Is there really a difference?. In: Diseases of the Colon and Rectum. 2015 ; Vol. 58, No. 1. pp. 53-59.
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T2 - Is there really a difference?

AU - Crawshaw, Benjamin P.

AU - Russ, Andrew

AU - Stein, Sharon L.

AU - Reynolds, Harry L.

AU - Marderstein, Eric L.

AU - Delaney, Conor P.

AU - Champagne, Bradley J.

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N2 - BACKGROUND: 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. OBJECTIVE: The aim of this study was to compare highresolution anoscopy versus expectant management for the surveillance of anal intraepithelial neoplasia and the prevention of anal cancer. DESIGN: 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. SETTING: This study was performed in the colorectal department of a university-affiliated, tertiary care hospital. PATIENTS: Included patients had biopsy-proven anal intraepithelial neoplasia from 2007 to 2013. INTERVENTIONS: Patients were treated with highresolution anoscopy with ablation or standard anoscopy with ablation. Both groups were treated with imiquimod and followed every 6 months indefinitely. MAIN OUTCOME MEASURES: The incidence of anal squamous-cell cancer in each group was the primary end point. RESULTS: From 2007 to 2013, 424 patients with anal squamous dysplasia were seen in the clinic (highresolution 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 (p = 0.37). LIMITATIONS: 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. CONCLUSIONS: 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.

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