scholarly journals Comparing and contrasting clinical consensus and guidelines for anal intraepithelial neoplasia in different geographical regions

2021 ◽  
Author(s):  
Danielle R. L. Brogden ◽  
Micol E. E. Lupi ◽  
Oliver J. Warren ◽  
Christos Kontovounisios ◽  
Sarah C. Mills
Keyword(s):  
Clinical Guidelines ◽  
Intraepithelial Neoplasia ◽  
Evidence Base ◽  
Anal Intraepithelial Neoplasia ◽  
International Consensus ◽  
Significant Discrepancy ◽  
Anal Squamous Cell Carcinoma ◽  
Geographical Variations ◽  
Geographical Regions

AbstractAnal Squamous Cell Carcinoma (ASCC) is an uncommon cancer with a recognised precursor Anal Intraepithelial Neoplasia (AIN). Although there are consistent evidence-based guidelines for the management of ASCC, historically this has not been the case for AIN and as a result there have been geographical variations in the recommendations for the treatment of AIN. More recently there have been updates in the literature to the recommendations for the management of AIN. To assess whether we are now closer to achieving an international consensus, we have completed a systematic scoping review of available guidelines for the screening, treatment and follow-up of AIN as a precursor to ASCC. MEDLINE and EMBASE were systematically searched for available clinical guidelines endorsed by a recognised clinical society that included recommendations on either the screening, treatment or follow-up of AIN. Nine clinical guidelines from three geographical areas were included. The most recent guidelines agreed that screening for AIN in high-risk patients and follow-up after treatment was necessary but there was less consensus on the modality of screening. Six Guidelines recommended the treatment of high-grade AIN and four guidelines describe a follow-up protocol of patients diagnosed with AIN. There appears to be increasing consensus on the treatment and follow-up of patients despite a poor evidence base. There is still significant discrepancy in guidance on the method to identify patients at risk of ASCC and AIN despite consensus between geographical regions on which patient subgroups are at the highest risk.

Angiogenesis in anal warts, anal intraepithelial neoplasia and anal squamous cell carcinoma

2003 ◽  
Vol 5 (4) ◽  
pp. 353-357 ◽  
Author(s):  
J. Mullerat ◽  
L. F. Wong Te Fong ◽  
S. E. Davies ◽  
M. C. Winslet ◽  
C. W. Perrett
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Anal Squamous Cell Carcinoma ◽  
Anal Warts

24. Successful treatment of anal intraepithelial neoplasia by CO2 laser in a sexual health service

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 581
Author(s):  
Jenny McCloskey ◽  
Janelle Hall ◽  
Michael Phillips ◽  
Cecily Metcalf
Keyword(s):  
High Resolution ◽  
Co2 Laser ◽  
Preliminary Analysis ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Patient Demographics ◽  
Sexual Health Service ◽  
Before And After ◽  
Anal Disease

Background Treatments for anal intraepithelial neoplasia (AIN) are still being established. Methods: An audit of patients referred for treatment of anal disease by CO2 laser at a Perth SHS was performed. Patient demographics including sex, sexual preference, age, and HIV status were documented. Anal cytology, histopathology, and HPV testing before and after treatment were reviewed in this preliminary analysis. Initial diagnosis of anal disease including AIN was made by high-resolution anoscopy (HRA) and by histological examination. Patients were then referred for treatment. Six-monthly HRA review occurred after treatment and the original site of HGAIN was biopsied. Results: Preliminary analysis of 28 patients included 16 patients with AIN 2 and 12 with AIN 3. After laser treatment, 7 patients had no AIN, 3 had AIN 1, 10 had AIN 2 and 4 had AIN 3, indicating successful reduction in AIN status (Pearson χ2 = 15.2, P = 0.002). The incidence of AIN decreased over the 18 months of follow-up. Conclusions: Studies of CO2 laser ablation of the anal canal are ongoing and need further study. Table 1. High-resolution anoscopy follow up Rx, treatment

scholarly journals Basic Science, Epidemiology, and Screening for Anal Intraepithelial Neoplasia and Its Relationship to Anal Squamous Cell Cancer

2018 ◽  
Vol 31 (06) ◽  
pp. 368-378 ◽  
Author(s):  
Kurt Davis ◽  
Guy Orangio
Keyword(s):  
Squamous Cell Carcinoma ◽  
High Risk ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Productive Infection ◽  
High Risk Population ◽  
Natural Immunity ◽  
Anal Squamous Cell Carcinoma

AbstractDespite the progress made in the reduction of squamous cell carcinoma of the cervix, the incidence of anal squamous cell carcinoma (ASCC) has been increasing since 1992. While it remains an uncommon disease, the prevalence is climbing steadily. Among human immunodeficiency virus (HIV)-infected adults, especially men who have sex with men, ASCC is one of the more common non-AIDS-defining malignancies. The precursor lesion, anal intraepithelial neoplasia (AIN), is prevalent in the HIV-infected population. More than 90% of ASCCs are related to human papilloma virus (HPV), oncogenic types (HPV 16, 18). While the biology of HPV-related intraepithelial neoplasia is consistent in the anogenital area, the natural history of AIN is poorly understood and is not identical to cervical intraepithelial neoplasia (CIN). CIN is also considered an AIDS-defining malignancy, and the methods for screening and prevention of AIN are derived from the CIN literature. This article will discuss the epidemiology of ASCC and its association with HPV and the life cycle of the HPV, and the molecular changes that lead to clearance, productive infection, latency, and persistence. The immunology of HPV infection will discuss natural immunity, humoral and cellular immunity, and how the HPV virus evades and interferes with these mechanisms. We will also discuss high-risk factors for developing AIN in high-risk patient populations with relation to infections (HIV, HPV, and chlamydia infections), prolonged immunocompromised people, and sexual behavior and tobacco abuse. We will also discuss the pre- and post-HAART era and its effect on AINs and ASCC. Finally, we will discuss the importance of anal cytology and high-resolution anoscopy with and without biopsy in this high-risk population.

Anal Intraepithelial Neoplasia Screening With Anal Pap Tests: Follow-up and Corresponding Histology

2019 ◽  
Vol 244 ◽  
pp. 117-121 ◽  
Author(s):  
Cristina B. Geltzeiler ◽  
Joohee Son ◽  
Evie H. Carchman ◽  
Elise H. Lawson ◽  
Bruce A. Harms ◽  
...  
Keyword(s):  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Pap Tests

scholarly journals Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review

2020 ◽  
Author(s):  
Danielle R. L. Brogden ◽  
Una Walsh ◽  
Gianluca Pellino ◽  
Christos Kontovounisios ◽  
Paris Tekkis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Hpv Vaccination ◽  
Intraepithelial Neoplasia ◽  
Surgical Excision ◽  
Anal Intraepithelial Neoplasia ◽  
Response To Treatment ◽  
Treatment Modalities ◽  
Recurrence Rates ◽  
Anal Squamous Cell Carcinoma

Abstract Purpose Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN. Methods MEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included. Results Thirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison. Conclusions Although the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC.

scholarly journals Anal Intraepithelial Neoplasia and Squamous Cell Cancer of the Anus

2018 ◽  
Vol 31 (06) ◽  
pp. 347-352 ◽  
Author(s):  
Rebecca Hoedema
Keyword(s):  
Squamous Cell ◽  
Incidental Finding ◽  
Topical Therapy ◽  
Treatment Options ◽  
Cell Cancer ◽  
High Risk Patient ◽  
Expectant Management ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Anal Squamous Cell Carcinoma

AbstractAnal intraepithelial neoplasia (AIN) is the premalignant condition of the anal squamous tissue. It is associated with the human papilloma virus and is considered the transition prior to the invasive anal squamous cell carcinoma. It is typically asymptomatic and can be either an incidental finding after anorectal surgery or identified when high-risk patient populations are screened. Once AIN is diagnosed, the optimal management remains controversial, partly because the natural history of the disease is unclear. Surgical management of the disease has essentially been replaced by more conservative treatment options and can range from expectant management to topical therapy to photodynamic therapy. The aim of this article is to review the varied treatment options and to briefly review prevention strategies.

scholarly journals Anal Intraepithelial Neoplasia from a Pathologists Point of View

2018 ◽  
Vol 31 (06) ◽  
pp. 328-335 ◽  
Author(s):  
Keegan Lyons ◽  
Samantha Butler
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cellular Proliferation ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Point Of View ◽  
Classification Systems ◽  
Anal Squamous Cell Carcinoma ◽  
Associated Lesions

AbstractAnal squamous cell carcinoma is a relatively rare diagnosis, but its incidence has continued to rise. Anal squamous cell carcinoma and its precursor lesion, anal intraepithelial neoplasia (AIN), are human papillomavirus (HPV)-associated squamous neoplasias. High-risk HPV subtypes cause cellular proliferation in the anal transformation zone mucosa leading to similar dysplastic changes as seen in the cervix. Unified cytologic and histologic classification systems have emerged for all HPV-associated squamous lesions of the lower anogenital tract due to recent advancements in the understanding of these lesions. P16 immunohistochemical stain, a biomarker for HPV, is recommended in the diagnosis of HPV-associated lesions. The unity of terminology will aid in communication between pathologists and clinicians, ultimately leading to improved patient care.

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