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Conference
"Diagnosis and Management of Anal Dysplasia" Dr. Robert Taylor (biography) English - 2003-03-30 - 33 minutes
Summary : Extent of the problem
It is only in recent years that the problem of anal dysplasia has come to the fore. Both underlying HPV infection and immunosuppression are factors in this rise of importance. Anal dysplasia can be classified as low grade or high grade. Although there are not yet conclusive studies, there is mounting evidence that high grade anal dysplasia is a precursor to anal cancer, in the same way that the comparable lesion in the cervix is a known precursor to cervical cancer. Certainly, there is evidence that the incidence of anal cancer among high-risk groups, including persons with HIV, is significantly higher than in the general population.
Those at Risk
Knowing of the role of both HPV infection and immunosuppression in the development of anal dysplasia, the groups at risk are not surprising: persons with HIV, persons who have practiced anal receptive intercourse, persons with anal condylomata acuminata, persons who are recipients of organ transplantation, women who have been diagnosed with cervical cancer or high grade dysplasia.
Methods of Diagnosis
An Awareness of persons at risk is the first step. Condylomata or persistant symptoms may draw attention to the area but a routine anorectal exam, even by those experienced in doing it, will not pick up anal dysplasia. It requires special techniques. The first of these is screening cytology. As in cervical PAP smears, anal cytology smears reveal underlying dysplasia. For positive screens the next step is high resolution anoscopy (HRA) with biopsy of visualized lesions. Most of these lesions in the anus are only viable with HRA magnification after chemical staining (acetic acid, Lugol’s solution). This requires a dedicated set-up and experience. Biopsy confirms the diagnosis and grades it.
Management
Management depends upon the characteristics of the lesion: size (<1 cm larger, or extensive), grade (low or high), location (perianal or anal canal) and presence of symptoms (bleeding, pain, pruritis). When to treat, modality options and follow-up protocol was presented during the talk.
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