The Changing Picture of High-grade Anal Intraepithelial Neoplasia in Men Who Have Sex With Men: The Effects of 10 Years of Experience Performing High-resolution Anoscopy.

Published: July 7, 2011

Abstract

BACKGROUND:

Ten years ago, we published findings from anal dysplasia screening in a metropolitan surgical practice where the majority of men who have sex with men had biopsy-proven high-grade anal intraepithelial neoplasia.

OBJECTIVE:

This study aimed to determine the effect of 10 years of experience in anal dysplasia screening on the prevalence of high-grade anal intraepithelial neoplasia.

DESIGN:

A retrospective chart review was performed of all anal cytology results of 1189 men who have sex with men screened in a 1-year period, with subsequent high-resolution anoscopy and biopsy as necessary.

PATIENTS:

The patients studied were men who have sex with men.

MAIN OUTCOME MEASURE:

The main outcome measure was biopsy-proven high-grade anal intraepithelial neoplasia.

RESULTS:

There were 315 (37.2%) biopsy-verified instances of high-grade anal intraepithelial neoplasia. Regression analysis determined that age, HIV status, infection by high-risk human papillomavirus, and abnormal cytology results were significant predictors of high-grade anal intraepithelial neoplasia. In a 1-year period, the number of men who have sex with men screened was nearly 7 times greater than in the 2-year period studied 10 years earlier.

LIMITATIONS:

We did not separately analyze patients who had previously been treated for high-grade anal intraepithelial neoplasia.

CONCLUSIONS:

Severity of cytology and infection with high-risk human papillomavirus are the most significant predictors of high-grade anal intraepithelial neoplasia, underscoring the importance of anal dysplasia screening. Our ability to identify high-grade anal intraepithelial neoplasia has improved with 10 years of experience performing high-resolution anoscopy.

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