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Anal intraepithelial neoplasia III (AIN III) is a risk factor for anal cancer with poor curative results and high morbidity. High-resolution anoscopy (HRA) is a minimally invasive means of identifying and treating AIN III early. We retrospectively reviewed HRA in the treatment of AIN III in a community setting. From January 2002 through November 2005, 76 patients with AIN III diagnosed by anal Pap smear, colposcopy, or biopsy underwent HRA for diagnosis and treatment. Twenty-one patients with AIN III on initial HRA underwent follow-up HRA for reassessment and treatment at 6 months. Recurrence/persistence of disease was recorded and compared with patient characteristics. Of 21 patients with repeat HRA, four were HIV-negative and 17 were HIV-positive. Twelve of 21 (57%) had intraanal recurrence/persistence; nine of 21 (43%) had no AIN III. Eleven (92%) with recurrence were HIV-positive; one (8%) was HIV-negative. Three (75%) HIV-negative patients had no recurrence/persistence; one of four (25%) had recurrence; and 11 of 17 (65%) HIV-positive patients had persistence of disease. HRA is an alternative tool to treat AIN III and can be performed in a community setting yielding results comparable to the university setting. As the prevalence of AIN III increases, it will be more important for community surgeons to treat AIN III with HRA.
It is well established that since the introduction of cervical cancer screening with the cervical Pap smear, the destruction of high-grade cervical dysplasia has reduced the number of deaths from cervical cancer by 70 per cent.1, 2 Human papilloma virus, the known causative factor for the development of cervical cancer, is also implicated in the development of anal cancer. Recent literature strongly supports that cervical and anal cancer have similar causative mechanisms.3-6 Based on this analogy, techniques for screening and treatment of cervical dysplasia have been applied to the identification and treatment of anal dysplasia.
Before the development of anal cancer screening with anal Pap smears and anal colposcopy, treatment of anal cancer was primarily afforded to those diagnosed with clinically significant anal disease.7 Screening with anal Pap smears and anal colposcopy has resulted in the identification of intraepithelial neoplasia in the absence of obvious clinical evidence of anal pathology. Treatment of anal high-grade intraepithelial neoplasia has varied from observation to wide local excision. The...