Vroegtijdige opsporing van voorstadia van een anaal carcinoom bij hiv-seropositieve patiënten

2021 ◽  
Author(s):  
E. GÖKCE ◽  
J. GELDOF ◽  
P. ROELANDT ◽  
J. VAN DORPE ◽  
S. CALLENS ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Digital Rectal Examination ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
High Grade ◽  
Anal Squamous Cell Carcinoma ◽  
Increased Risk ◽  
High Prevalence ◽  
Risk Patients ◽  
Hiv Seropositive

Early detection of precursor lesions of anal cancer in HIV-seropositive patients Although anal cancer is rare in the overall population, its incidence is increasing in the last decades. Especially HIV-seropositive patients have an increased risk of developing anal squamous cell carcinoma (SCC), mainly because of the high prevalence of high-grade anal intraepithelial neoplasia (AIN) among these patients. High-grade AIN is a precursor lesion for anal SCC associated with human papillomavirus (HPV) infection. Despite the lack of direct evidence demonstrating that AIN identification reduces the risk of anal cancer, experts think that screening and treatment of high-risk patients will prevent the disease. This article aims to review the current literature about AIN and discusses the screening options, including digital rectal examination, anal cytology and high-resolution anoscopy.

7. High prevalence of human papillomavirus (HPV) infection and high-grade anal intraepithelial neoplasia in HIV-seropositive women, the EVVA study

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 573
Author(s):  
Francois Coutlée ◽  
Sophie Rodrigues-Coutlée ◽  
Marie Munoz ◽  
Marie Helene Mayrand ◽  
Louise Charest ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Anal Intraepithelial Neoplasia ◽  
High Grade ◽  
Women Living With Hiv ◽  
Increased Risk ◽  
High Prevalence ◽  
Living With Hiv ◽  
Hiv Seropositive

Background Women living with HIV are at increased risk of anal HPV infection, anal intraepithelial neoplasia (AIN) and anal cancer. This study will describe the burden of infection and of high-grade AIN (AIN-2,3) in a population of HIV-infected women living in Montreal, Canada. Methods: HIV-seropositive women aged ≥18 years old are recruited in the cohort study EVVA. Participants are followed every 6 months for 2 years with questionnaires, cervical/anal HPV testing, cervical/anal cytology and high-resolution anoscopy (HRA). Results: Of the 116 first participants, 88 (75.9%, 95% confidence interval (CI) 67.3–82.8) were infected by HPV in the anal canal. In contrast, 58 of these participants (50%, 95% CI 41.1–59.0) had cervical HPV infection). The most frequent types were HPV16 (n = 19), HPV51 (n = 18), HPV81 and HPV62 (n = 15 each), and HPV45 and HPV58 (n = 14 for each). An average of 2.3 ± 3.1 HPV types (median of 1) were detected per anal sample. Of the 89 participants with satisfactory cytology, 5 had high-grade squamous intraepithelial lesions. HRA from 95 women revealed 17 AIN2,3 (17.9%, 95% confidence interval (CI) 11.4–26.9), 43 AIN1 (45.3%, 95% CI 35.6–55.3), and only 35 without AIN (36.8%, 95% CI 27.8–46.9). Biopsies from 4 women gave undetermined results. Conclusions: Our study revealed that anal HPV infection was more frequently detected than cervical infection in HIV-seropositive women. Prevalent AIN2,3 is a significant problem in women infected with HIV. Prospective follow-up of women with AIN1 will disclose the proportion of women with progressive AIN.

The Role of Early Colposcopy in the Management of Females with First Episode Anogenital Warts

1994 ◽  
Vol 5 (5) ◽  
pp. 343-345 ◽  
Author(s):  
K A Ward ◽  
J R Houston ◽  
B E Lowry ◽  
R D Maw ◽  
W W Dinsmore
Keyword(s):  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Cervical Cytology ◽  
First Episode ◽  
Low Grade ◽  
High Grade ◽  
Anogenital Warts ◽  
Cervical Smear ◽  
Cervical Lesions ◽  
Increased Risk

212 females attending a genitourinary medicine (GUM) clinic with first episode anogenital warts were screened by cervical cytology and colposcopy/histology for the presence of cervical epithelial abnormalities in keeping with infection by the human papillomavirus (HPV infection) and/or cervical intraepithelial neoplasia (CIN). The prevalence of cervical epithelial abnormalities detected by cervical cytology alone was 32%, rising to 56% after colposcopic examination. However, the majority of cervical lesions detected by colposcopy alone were of low grade (HPV infection and/or CIN I). Histologically confirmed high grade cervical lesions (CIN II or CIN III) were detected more frequently in those females in whom cervical cytological examination indicated dyskaryosis in keeping with any grade of CIN, compared to females without dyskaryotic changes on cervical smear ( P<0.05, chi-squared test with Yates' correction). Early colposcopy is indicated for females with anogenital warts in the presence of a cervical smear showing dyskaryosis in keeping with any grade of CIN, because of the statistically significant increased risk of detecting a potentially progressive high grade cervical lesion. In females without dyskaryotic changes on cervical smear, the value of early colposcopy is uncertain and warrants larger more long-term trials.

Epidemiology, natural history and risk factors for anal intraepithelial neoplasia

Sexual Health ◽  
2012 ◽  
Vol 9 (6) ◽  
pp. 547 ◽  
Author(s):  
François Coutlée ◽  
Alexandra de Pokomandy ◽  
Eduardo L. Franco
Keyword(s):  
Natural History ◽  
Intraepithelial Neoplasia ◽  
Anal Intercourse ◽  
Hpv Infection ◽  
Anal Intraepithelial Neoplasia ◽  
Receptive Anal Intercourse ◽  
High Grade ◽  
Cell Counts ◽  
Sex With Men ◽  
Hiv Seropositive

Studies conducted in HIV-seropositive individuals have enhanced our understanding of the natural history of anal intraepithelial neoplasia (AIN) and of factors predictive of progression to high-grade AIN, the immediate precursor to anal cancer. AIN is frequently detected in HIV-seropositive individuals. Factors that increase the risk for AIN include HIV infection, low current or nadir blood CD4+ cell counts, receptive anal intercourse, oncogenic human papillomavirus (HPV) infection, persistent anal HPV infection, multiple HPV type infections and high anal HPV viral load. This review confirms the importance of high-grade AIN in HIV-seropositive individuals and HIV-seronegative men having sex with men.

Geographical clustering of anal cancer incidence in Australia

Sexual Health ◽  
2012 ◽  
Vol 9 (6) ◽  
pp. 509 ◽  
Author(s):  
I. Mary Poynten ◽  
Alicia N. Stein ◽  
E. Lynne Conway ◽  
Garrett Prestage ◽  
David G. Regan ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Cancer Incidence ◽  
Age Groups ◽  
Incidence Rates ◽  
Homosexual Men ◽  
Male Population ◽  
Anal Squamous Cell Carcinoma ◽  
Increased Risk ◽  
High Prevalence ◽  
Homosexual Identity

Introduction: Homosexual men are at an increased risk of anal cancer. We aimed to establish the burden of anal squamous cell carcinoma (SCC) in those parts of Australia where homosexual men are most likely to live. Methods: Data on the proportion of homosexual male residents were obtained from published estimates. Men were categorised into three postcode groups by prevalence of men reporting homosexual identity. Male population data in age groups were extracted for each postcode group and analyses of cancer incidence were performed by postcode group. The analyses were restricted to 2000–2005. Results: Eight postcodes had populations where more than 10% of males reported homosexual identity (high prevalence) and 4–10% of men reported homosexual activity in a further 19 postcodes (medium prevalence). From 2000 to 2005, the average annual age-standardised incidence rates of anal SCC in males was 7.61 per 100 000 (95% confidence interval (CI): 4.68–10.55) and 2.21 per 100 000 (95% CI: 1.05–3.37) in high and medium prevalence postcodes, respectively. The corresponding incidence rate ratios compared with low prevalence postcodes (less than 4% of males reported homosexual identity) were 9.6 (95% CI: 6.6–14.1) for the high prevalence and 2.4 (95% CI: 1.4–4.1) for the medium prevalence postcodes. Conclusion: A substantial concentration of the burden of anal cancer occurred among areas where large proportions of homosexual men reside. These results should guide the prioritisation of health service investment in anal cancer treatment and prevention to appropriate geographical areas.

High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-Infected Women Screened for Anal Cancer

2012 ◽  
Vol 60 (2) ◽  
pp. 169-172 ◽  
Author(s):  
June Y. Hou ◽  
David Smotkin ◽  
Robert Grossberg ◽  
Mark Suhrland ◽  
Rebecca Levine ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
High Grade ◽  
High Prevalence

scholarly journals Triage of human papillomavirus infected women by methylation analysis in first-void urine

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Severien Van Keer ◽  
Annina P. van Splunter ◽  
Jade Pattyn ◽  
Annemie De Smet ◽  
Sereina A. Herzog ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Host Cell ◽  
Intraepithelial Neoplasia ◽  
Underlying Disease ◽  
Hpv Infection ◽  
Molecular Testing ◽  
High Grade ◽  
Methylation Analysis ◽  
Hpv Dna ◽  
Screening Attendance

AbstractHost cell DNA methylation analysis in urine provides promising triage markers for women diagnosed with a high-risk (HR) human papillomavirus (HPV) infection. In this study, we have investigated a panel of six host cell methylation markers (GHSR, SST, ZIC1, ASCL1, LHX8, ST6GALNAC5) in cervicovaginal secretions collected within the first part of the urine void (FVU) from a referral population. Cytology, histology, and HPV DNA genotyping results on paired FVU and cervical samples were available. Urinary median methylation levels from HR-HPV (n = 93) positive women were found to increase for all markers with severity of underlying disease. Significantly elevated levels were observed for GHSR and LHX8 in relation to high-grade cervical intraepithelial neoplasia (CIN2 +; n = 33), with area under de curve values of 0.80 (95% Confidence Interval (CI) 0.59–0.92) and 0.76 (95% CI 0.58–0.89), respectively. These findings are the first to support the assertion that methylation analysis of host cell genes is feasible in FVU and holds promise as molecular, triage strategy to discern low- from high-grade cervical disease in HR-HPV positive women. Molecular testing on FVU may serve to increase cervical cancer screening attendance in hard-to-reach populations whilst reducing loss to follow-up and await further optimization and validation studies.

scholarly journals The Prognostic Value of the New Combined Hemo-Eosinophil Inflammation Index (HEI Index): A Multicenter Analysis of Anal Cancer Patients Treated with Concurrent Chemo-Radiation

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 671
Author(s):  
Margherita Rimini ◽  
Pierfrancesco Franco ◽  
Berardino De Bari ◽  
Maria Giulia Zampino ◽  
Stefano Vagge ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Anal Cancer ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
External Validation ◽  
Risk Groups ◽  
Anal Squamous Cell Carcinoma ◽  
Predictors Of Response ◽  
Risk Patients

Anal squamous cell carcinoma (SCC) is a rare tumor, and bio-humoral predictors of response to chemo-radiation (CT-RT) are lacking. We developed a prognostic score system based on laboratory inflammation parameters. We investigated the correlation between baseline clinical and laboratory variables and disease-free (DFS) and overall (OS) survival in anal SCC patients treated with CT-RT in five institutions. The bio-humoral parameters of significance were included in a new scoring system, which was tested with other significant variables in a Cox’s proportional hazard model. A total of 308 patients was included. We devised a prognostic model by combining baseline hemoglobin level, SII, and eosinophil count: the Hemo-Eosinophils Inflammation (HEI) Index. We stratified patients according to the HEI index into low- and high-risk groups. Median DFS for low-risk patients was not reached, and it was found to be 79.5 months for high-risk cases (Hazard Ratio 3.22; 95% CI: 2.04–5.10; p < 0.0001). Following adjustment for clinical covariates found significant at univariate analysis, multivariate analysis confirmed the HEI index as an independent prognostic factor for DFS and OS. The HEI index was shown to be a prognostic parameter for DFS and OS in anal cancer patients treated with CT-RT. An external validation of the HEI index is mandatory for its use in clinical practice.

The reporting of anal cytology and histology samples: establishing terminology and criteria

Sexual Health ◽  
2012 ◽  
Vol 9 (6) ◽  
pp. 562 ◽  
Author(s):  
Jennifer Margaret Roberts ◽  
Deborah Ekman
Keyword(s):  
Reporting System ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Classification Systems ◽  
Low Grade ◽  
Evidence Based ◽  
High Grade ◽  
Anal Neoplasia ◽  
Anal Cytology ◽  
Bethesda System

Our understanding of the human papillomavirus (HPV) related cytomorphology and histopathology of the anal canal is underpinned by our knowledge of HPV infection in the cervix. In this review, we utilise cervical reporting of cytological and histological specimens as a foundation for the development of standardised and evidence-based terminology and criteria for reporting of anal specimens. We advocate use of the Australian Modified Bethesda System 2004 for reporting anal cytology. We propose the use of a two-tiered histological reporting system for noninvasive disease – low-grade and high-grade anal intraepithelial neoplasia. These classification systems reflect current understanding of the biology of HPV and enhance diagnostic reproducibility. Biomarkers such as p16INK4A may prove useful in further improving diagnostic accuracy. Standardisation is important because it will increase the value of the data collected as Australian centres develop programs for screening for anal neoplasia.

29. WHAT DO ANAL CYTOLOGY RESULTS MEAN?

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 296
Author(s):  
R. Hillman
Keyword(s):  
Anal Cancer ◽  
Screening Program ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Screening Programs ◽  
Anal Dysplasia ◽  
Anal Swab

Background: Between 1970 and 2000 in Australia, anal cancer rates have increased over fourfold. Furthermore, the prevalence rate of anal cancer in MSM is approximately 35 cases/100�000, comparable to that of cervical cancer in women prior to the introduction of the national cervical screening program. These observations have led to calls for the introduction of targeted anal cytological screening program for MSMs. Our study examined the effectiveness of anal cytological testing in detecting histologically proven high grade anal intraepithelial neoplasia (HGAIN, also known as AIN2 & 3). Methods: A retrospective case note review of people attending an anal dysplasia clinic from July 2002 to May 2007 was performed. Cytological results of anal swabs were compared to results of biopsies obtained through high resolution anoscopy. Results: 436 anal cytological results were identified. Of these, 5% were unsatisfactory, 51% showed low grade changes and 44% showed high grade changes. 185 cases were then paired with corresponding histological results. Analysing the data from the perspective of diagnosing histologically proven HGAIN, anal swab cytological abnormalities revealed a sensitivity of 54% and specificity of 90% for the most recent cytological test and 83% and 39% respectively, when analysed according to most serious cytological result ever. Conclusions: Our sensitivities of 54-83% and specificities of 39-90% are consistent with those found with cervical cytology, but emphasize the need for caution in their interpretation. However, before any anal cytological screening programs are introduced, it is important to also establish that treatment of any high grade anal dysplasia detected by such screening is of value in preventing progression to cancer.

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