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Craig Messick - One of the best experts on this subject based on the ideXlab platform.
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treatment efficacy for human papillomavirus related Anal squamous cell Dysplasia in an under represented population human immunodeficiency negative non men having sex with men and non transplant population
Colorectal Disease, 2020Co-Authors: Craig MessickAbstract:AIM Human papillomavirus (HPV)-related Anal squamous cell Dysplasia has been well-reported in high-risk (HR) patients [human immunodeficiency virus (HIV)-positive, men having sex with men (MSM) or immune-suppressed transplant recipients]. However, data are extremely limited for all other patients. This study reports treatment outcomes for HPV-related Dysplasia in a population of non-HR patients. METHOD A retrospective study was performed to review treatment efficacy in non-HR patients diagnosed with Anal Dysplasia or superficially invasive squamous cell carcinoma of the anus (SISCCA) with at least 12-months' follow-up; HR patients were excluded. Medical records were reviewed for demographics, pathology, cytopathology, treatment and recurrences. RESULTS Forty-one patients were identified (34 women). The median age at diagnosis was 58 years (range 26-85) and median follow-up was 26 months (range 12-51). At diagnosis, 36 patients had Anal Dysplasia and five patients had SISCCA. Treatment outcomes (resolved versus recurrent) differed between treatment modalities (P = 0.014). Topical and fulguration-only treatment modalities were superior to wide local excision (WLE) (P < 0.006 and P < 0.008, respectively). Fourteen (39%) patients had recurrent Dysplasia at a median of 14 months (range 4-62); eight patients developed a second recurrence at a median of 14 months (range 11-26). No SISCCA patient had a recurrence, but two patients progressed to Anal cancer after treatment. CONCLUSION The behaviour of Anal Dysplasia reported in this under-represented, small group of non-HR patients reveals that treatment for Anal Dysplasia is not necessarily a single event and nonexcisional treatments may be favourable to WLE. Though the true denominator of this population is unknown, treatment may not prevent the recurrence of Dysplasia or progression to cancer, warranting close follow-up.
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Treatment efficacy for human papillomavirus-related Anal squamous cell Dysplasia in an under-represented population: human immunodeficiency-negative, non-men having sex with men, and non-transplant population.
Colorectal Disease, 2019Co-Authors: Craig MessickAbstract:AIM Human papillomavirus (HPV)-related Anal squamous cell Dysplasia has been well-reported in high-risk (HR) patients [human immunodeficiency virus (HIV)-positive, men having sex with men (MSM) or immune-suppressed transplant recipients]. However, data are extremely limited for all other patients. This study reports treatment outcomes for HPV-related Dysplasia in a population of non-HR patients. METHOD A retrospective study was performed to review treatment efficacy in non-HR patients diagnosed with Anal Dysplasia or superficially invasive squamous cell carcinoma of the anus (SISCCA) with at least 12-months' follow-up; HR patients were excluded. Medical records were reviewed for demographics, pathology, cytopathology, treatment and recurrences. RESULTS Forty-one patients were identified (34 women). The median age at diagnosis was 58 years (range 26-85) and median follow-up was 26 months (range 12-51). At diagnosis, 36 patients had Anal Dysplasia and five patients had SISCCA. Treatment outcomes (resolved versus recurrent) differed between treatment modalities (P = 0.014). Topical and fulguration-only treatment modalities were superior to wide local excision (WLE) (P
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Prevalence of high-grade Anal Dysplasia among women with high-grade lower genital tract Dysplasia or cancer: Results of a pilot study.
Gynecologic Oncology, 2019Co-Authors: Joël Fokom Domgue, Craig Messick, Andrea Milbourne, Ming Guo, Mila P. Salcedo, Kristina R. Dahlstrom, Elizabeth Y. Chiao, Ashish A. Deshmukh, Erich M. Sturgis, Kathleen M. SchmelerAbstract:Abstract Objective To estimate the prevalence of high-grade Anal Dysplasia in women with high-grade Dysplasia or carcinoma of the cervix, vagina or vulva. Methods In this cross-sectional study, participants underwent Anal cytology, Anal HPV testing with Cervista HPV16/18 and high-resolution anoscopy (HRA). Patients with HSIL (high-grade squamous cell intraepithelial lesion) or greater on Anal cytology or Anal biopsy were referred to a colorectal surgery specialist for further evaluation. Results Seventy-five women were enrolled in the study, including 47 with cervical (cervix group), 10 with vaginal (vagina group), 15 with vulvar (vulva group), 1 with cervical and vaginal, and 2 with vulvar and vaginal disease. The median age in the cervix group (40 years (range 26–69)) was substantially younger than in the vagina (60 years (38–69)) and the vulva (59 years (36–75)) groups. Anal HSIL based on composite endpoints of the most severe cytology or histology result was diagnosed in 6 patients (8.0%). Anal cytology revealed HSIL in 2 (2.7%), atypical squamous cells of undetermined significance (ASCUS) in 12 (16.0%), low-grade squamous cell intraepithelial lesion (LSIL) in 2 (2.7%), and was normal in 59 (78.7%) patients. Anal HPV16/18 test was positive in 15 (20.0%), negative in 48 (64.0%) and insufficient in 12 (16.0%) patients. Of the 6 women with high-grade Anal Dysplasia, three (50%) had a positive Anal HPV16/18 test. No case of Anal cancer was observed. Conclusion Our results suggest that the prevalence of Anal HSIL is elevated among women with HPV-related lower genital tract Dysplasia or cancer. To further support the inclusion of this high-risk group into screening guidelines for Anal Dysplasia, further studies are necessary to determine what screening strategy is suited to this population.
Stephen E. Goldstone - One of the best experts on this subject based on the ideXlab platform.
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Risk of Invasive Anal Cancer in HIV-Infected Patients With High-Grade Anal Dysplasia: A Population-Based Cohort Study.
Diseases of the Colon & Rectum, 2019Co-Authors: Yotam Arens, Stephen E. Goldstone, Michael Gaisa, Yuxin Liu, Juan P. Wisnivesky, Carlie S. Sigel, Talia H. Swartz, Keith SigelAbstract:Background The progression rate and predictors of Anal dysplastic lesions to squamous cell carcinoma of the anus remain unclear. Characterizing these parameters may help refine Anal cancer screening guidelines. Objective This study aimed to determine the rate of progression of high-grade Anal Dysplasia to invasive carcinoma in HIV-infected persons. Design Using the Surveillance, Epidemiology, and End Results database linked to Medicare claims from 2000 to 2011, we identified HIV-infected subjects with incident Anal intraepithelial neoplasia III. To estimate the rate of progression of Anal intraepithelial neoplasia III to invasive cancer, we calculated the cumulative incidence of Anal cancer in this cohort. We then fitted Poisson models to evaluate the potential risk factors for incident Anal cancer. Settings This is a population-based study. Patients Included were 592 HIV-infected subjects with incident Anal intraepithelial neoplasia III. Main outcome measures The primary outcome measured was incident squamous cell carcinoma of the anus. Results Study subjects were largely male (95%) with a median age of 45.7 years. Within the median follow-up period of 69 months, 33 subjects progressed to Anal cancer. The incidence of Anal cancer was 1.2% (95% CI, 0.7%-2.5%) and 5.7% (95% CI, 4.0%-8.1%) at 1 and 5 years, following a diagnosis of Anal intraepithelial neoplasia III. Risk of progression did not differ by Anal intraepithelial neoplasia III treatment status. On unadjusted Analysis, black race (p = 0.02) and a history of anogenital condylomata (p = 0.03) were associated with an increased risk of Anal cancer incidence, whereas prior Anal cytology screening was associated with a decreased risk (p = 0.04). Limitations The identification of some incident cancer episodes used surrogate measures. Conclusions In our population-based cohort of HIV-infected subjects with long-term follow-up, the risk of progression from Anal intraepithelial neoplasia III to Anal squamous cell carcinoma was higher than reported in other studies and was not associated with the receipt of Anal intraepithelial neoplasia III treatment. See Video Abstract at http://links.lww.com/DCR/A933.
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Testing for Human Papillomavirus Strains 16 and 18 Helps Predict the Presence of Anal High-Grade Squamous Intraepithelial Lesions.
Diseases of the Colon & Rectum, 2018Co-Authors: Jacob A Sambursky, Joseph P. Terlizzi, Stephen E. GoldstoneAbstract:BACKGROUND More than 90% of Anal cancers are caused by human papillomavirus, and human papillomavirus strains 16 and 18 are the most oncogenic. Anal high-grade squamous intraepithelial lesions are cancer precursors. Treating these high-grade intraepithelial lesions likely reduces the risk of cancer, but cytology is an imperfect screening test. OBJECTIVE The purpose of this study was to determine whether human papillomavirus 16 and/or 18 testing better predicts the presence of high-grade squamous intraepithelial lesions. DESIGN In this retrospective study, 894 consecutive patients underwent Anal Dysplasia screening with digital anorectal examination, Anal cytology, high-risk human papillomavirus testing, and high-resolution anoscopy with biopsy. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of each test and for a novel screening protocol. The absolute and relative risk of high-grade squamous intraepithelial lesions for all of the cytology/human papillomavirus combinations were also calculated. SETTINGS The study was conducted at a single practice specializing in Anal Dysplasia. PATIENTS Ninety-two percent of participants were men who have sex with men. Forty-four percent were HIV-positive individuals who were well controlled on antiretroviral therapy. The median age was 50 years. MAIN OUTCOME MEASURES The presence of high-grade squamous intraepithelial lesions as a function of human papillomavirus and the cytology results were measured. RESULTS High-risk human papillomavirus testing alone demonstrated better sensitivity (96% vs 89%; p = 0.03) and negative predictive value (99% vs 96%; p = 0.008) over cytology. Human papillomavirus 16/18 testing increased specificity (48% to 71%; p < 0.0001) and positive predictive value (24% to 37%; p = 0.003) over testing for all of the high-risk strains. For each cytology category, high-grade squamous intraepithelial lesions were more prevalent when human papillomavirus 16/18 was detected. Benign cytology with 16/18 had a 31-fold increased risk of high-grade squamous intraepithelial lesions. LIMITATIONS This study was conducted in a single private practice specializing in Anal Dysplasia screening with a mostly male population, and results might not be generalizable. CONCLUSIONS Testing of high-risk human papillomavirus strains 16/18 improves specificity and positive predictive value over cytology for Anal Dysplasia screening. Patients testing positive for strains 16/18 are at a high risk for high-grade squamous intraepithelial lesions and should undergo high-resolution anoscopy regardless of the cytology result. See Video Abstract at http://links.lww.com/DCR/A654.
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high rates of Anal Dysplasia in hiv infected men who have sex with men women and heterosexual men
AIDS, 2014Co-Authors: Michael Gaisa, Keith Sigel, Jonathan Hand, Stephen E. GoldstoneAbstract:Objective: To determine rates of Anal Dysplasia in a cohort of HIV-infected men who have sex with men (MSM), women, and heterosexual men with abnormal Anal cytology. Design/methods: We evaluated histologic findings in 728 HIV-infected MSM, women, and heterosexual men referred for high-resolution anoscopy (HRA) after abnormal Anal cytology in a single-center cohort study. Using multivariable logistic regression, we evaluated predictors of high-grade squamous intraepithelial lesion (HSIL) histology or invasive carcinoma including age, sexual behavior, receptive Anal intercourse (RAI), anogenital warts, smoking status, antiretroviral therapy, CD4+ T-cell count, and HIV-1 plasma viral load. Results: A total of 2075 HIV-positive patients were screened with Anal cytology and 62% of MSM, 42% of women, and 29% of heterosexual men had abnormal findings (P <0.001). Of the 728 HIV-infected patients with abnormal Anal cytology who underwent HRA, 71% were MSM, 23% women, and 6% heterosexual men. HSIL/cancer was found in 32% of MSM, 26% of women, and 23% of heterosexual men (P = 0.3). There were five cases of Anal squamous cell carcinoma (0.7%), four in MSM and one in a heterosexual man. In a multivariable adjusted Analysis, biopsy-proven HSIL/cancer was associated with RAI [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.3–3.7]. CD4+ T-cell counts more than 500/µl conferred a lower risk of HSIL/cancer (OR 0.5; 95% CI 0.3–0.9). Conclusion: Rates of Anal HSIL histology are high in HIV-infected patients of all sexual risk groups with abnormal Anal cytology. Consequently, all HIV-infected patients may warrant Anal cancer screening.
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Are colon and rectal surgeons ready to screen for Anal Dysplasia? Results of a survey on attitudes and practice.
Sexually Transmitted Diseases, 2014Co-Authors: Amy Cooperstein, Guilherme A. Pereira, Stephen E. GoldstoneAbstract:Background Colorectal surgeons are ideal referral sources to screen for and treat high-grade Anal Dysplasia (high-grade squamous intraepithelial lesion [HSIL]) and Anal cancer. Anal cytology and high-resolution anoscopy (HRA) using acetic acid and magnification are optimal methods for screening. We endeavored to determine US colorectal surgeons’ attitudes and practices regarding HSIL screening. Methods An Internet-based survey with questions related to clinician demographics and attitudes and practices regarding Anal Dysplasia was sent to US members of the American Society of Colon and Rectal Surgeons. Results Of 1655 requests, 290 (18%) eligible participants responded. Most were white (83%), male (76%), board-certified colorectal surgeons (89%), and graduating medical school after 1990 (54%), almost all treated patients at risk for Anal cancer and had read research on HSIL. Approximately one-third of respondents had performed Anal cytology, and one-third had performed HRA. When evaluating patients for HSIL in surgery, only 31% use acetic acid with magnification. Of 99 participants who perform HRA, 46% were formally trained, 83% primarily do HRA primarily in the operating room, and 82% use acetic acid with magnification. Knowledge of HSIL risk factors was not associated with screening. Women, more recent graduates, and surgeons with higher percentages of HIV-infected patients were more likely to screen. Screening barriers included no training (52%), not a priority (23%), lack of evidence (21%), and cost (8%). Conclusions American Society of Colon and Rectal Surgeons members responding to the survey by and large do not screen for Anal Dysplasia. Those that do are often not formally trained and use inadequate technique.
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High rates of Anal Dysplasia in HIV-infected men who have sex with men, women, and heterosexual men.
AIDS, 2014Co-Authors: Michael Gaisa, Keith Sigel, Jonathan Hand, Stephen E. GoldstoneAbstract:Objective: To determine rates of Anal Dysplasia in a cohort of HIV-infected men who have sex with men (MSM), women, and heterosexual men with abnormal Anal cytology. Design/methods: We evaluated histologic findings in 728 HIV-infected MSM, women, and heterosexual men referred for high-resolution anoscopy (HRA) after abnormal Anal cytology in a single-center cohort study. Using multivariable logistic regression, we evaluated predictors of high-grade squamous intraepithelial lesion (HSIL) histology or invasive carcinoma including age, sexual behavior, receptive Anal intercourse (RAI), anogenital warts, smoking status, antiretroviral therapy, CD4+ T-cell count, and HIV-1 plasma viral load. Results: A total of 2075 HIV-positive patients were screened with Anal cytology and 62% of MSM, 42% of women, and 29% of heterosexual men had abnormal findings (P
Richard H. Greenberg - One of the best experts on this subject based on the ideXlab platform.
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Anal Dysplasia among solid organ transplant recipients; a cross sectional study
Journal of Coloproctology, 2019Co-Authors: Aimal Khan, Thaer Obaid, Lawrence Cetrulo, Luanne Force, Roshmi Bhattacharya, Richard H. GreenbergAbstract:Abstract Introduction The incidence of Anal cancer in United States has increased over of the last few decades impacting immunosuppressed populations like solid organ transplant recipients, in particular. The aim of this study was to evaluate the prevalence of Anal Dysplasia among solid organ transplant patients. We also attempted to identify factors that predispose solid organ transplant recipients to developing Anal Dysplasia. Methods and materials Patients presenting to transplant office for routine care were recruited to participate in the study. All Anal cytology specimens were collected using standard Anal pap technique. The results were assessed using Bethesda classification. Information on perceived risk factors for development of Anal Dysplasia among our subjects was obtained. Results Among 80 patients approached, 47 agreed to participate in the study. Of all the samples 19.1% had an inadequate amount of specimen to perform any Analysis. Dysplastic cells were found in 10.5% of the specimens available for Analysis. We were not able to identify any risk factors including age, gender distribution, smoking, and duration of immunosuppression that were statistically significant different between patients with Anal Dysplasia versus those without Anal Dysplasia. Conclusions The rate of Anal Dysplasia detectable on cytology is high enough to warrant Anal Dysplasia screening in transplant recipients, which can then be followed up with high-resolution anoscopy with biopsy. Defining a cohort of patients among solid organ transplant recipients who are at an increased risk for the development of Anal Dysplasia mandating screening continues to be a challenge.
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Anal Dysplasia among solid organ transplant recipients; a cross sectional study
Elsevier, 2019Co-Authors: Aimal Khan, Thaer Obaid, Lawrence Cetrulo, Luanne Force, Roshmi Bhattacharya, Richard H. GreenbergAbstract:Introduction: The incidence of Anal cancer in United States has increased over of the last few decades impacting immunosuppressed populations like solid organ transplant recipients, in particular. The aim of this study was to evaluate the prevalence of Anal Dysplasia among solid organ transplant patients. We also attempted to identify factors that predispose solid organ transplant recipients to developing Anal Dysplasia. Methods and materials: Patients presenting to transplant office for routine care were recruited to participate in the study. All Anal cytology specimens were collected using standard Anal pap technique. The results were assessed using Bethesda classification. Information on perceived risk factors for development of Anal Dysplasia among our subjects was obtained. Results: Among 80 patients approached, 47 agreed to participate in the study. Of all the samples 19.1% had an inadequate amount of specimen to perform any Analysis. Dysplastic cells were found in 10.5% of the specimens available for Analysis. We were not able to identify any risk factors including age, gender distribution, smoking, and duration of immunosuppression that were statistically significant different between patients with Anal Dysplasia versus those without Anal Dysplasia. Conclusions: The rate of Anal Dysplasia detectable on cytology is high enough to warrant Anal Dysplasia screening in transplant recipients, which can then be followed up with high-resolution anoscopy with biopsy. Defining a cohort of patients among solid organ transplant recipients who are at an increased risk for the development of Anal Dysplasia mandating screening continues to be a challenge. Resumo: Introdução: A incidência de câncer Anal nos Estados Unidos aumentou nas últimas décadas, afetando populações imunossuprimidas, especialmente receptores de órgãos sólidos. O objetivo deste estudo foi avaliar a prevalência de displasia Anal entre pacientes que receberam transplante de órgãos sólidos. Os autores buscaram identificar fatores que predispõem os receptores de transplante de órgãos sólidos a desenvolverem displasia Anal. Métodos e materiais: Pacientes que se apresentaram ao consultório de transplante para acompanhamento de rotina foram recrutados para participar do estudo. Todos os espécimes de citologia foram coletados usando a técnica padrão de Papanicolau Anal. Os resultados foram avaliados usando a classificação de Bethesda. Foram coletados dados sobre os fatores de risco percebidos para o desenvolvimento de displasia Anal entre os participantes. Resultados: Dos 80 pacientes abordados, 47 concordaram em participar do estudo. Do total de amostras, 19,1% tinham uma quantidade inadequada para realizar qualquer análise. Células displásicas foram encontradas em 10,5% dos espécimes disponíveis para análise. Não foi possível identificar quaisquer fatores de risco, incluindo idade, distribuição de gênero, tabagismo e duração da imunossupressão, que foram estatisticamente diferentes entre pacientes com displasia Anal e aqueles sem displasia Anal. Conclusões: A taxa de displasia Anal detectável na citologia é alta o suficiente para justificar a triagem em receptores de transplante, que pode então ser acompanhada com anuscopia de alta resolução com biópsia. A definição de triagem para uma coorte de pacientes entre os receptores de transplantes de órgãos sólidos que apresentam risco aumentado para o desenvolvimento displasia Anal continua a ser um desafio. Keywords: Anal cancer, Anal Dysplasia screening, Immunosupressed, Transplant recipients, Palavras-chave: Câncer Anal, Triagem de displasia Anal, Imunossuprimido, Receptores de transplante
Mark L. Welton - One of the best experts on this subject based on the ideXlab platform.
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Incorporating Anal Dysplasia screening and management into a surgical practice
Seminars in Colon and Rectal Surgery, 2017Co-Authors: Mark L. Welton, Harry A. Oberhelman, Amy L. LightnerAbstract:Abstract Screening practices for Anal Dysplasia with the use of Anal cytology and high-resolution anoscopy (HRA) has become a topic of increased interest to colon and rectal surgeons. However, screening continues to be practiced by a minority of clinicians. One major hurdle is how to incorporate Anal cytology screening programs into busy colorectal surgical practices. In this article, I highlight my early experience treating Anal Dysplasia and review my current approach and practice pattern for treating Anal Dysplasia. I also suggest a few paradigms for implementing screening into various clinical settings, and offer surveillance algorithms for individual patients with Anal Dysplasia based on risk factors.
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Prevalence of Anal Dysplasia in Patients With Inflammatory Bowel Disease
Clinical Gastroenterology and Hepatology, 2015Co-Authors: Shamita B. Shah, Carlos E. Pineda, Danielle M. Pickham, Hiwot Araya, Ahmad Kamal, Saif Ghole, Lauren Shih, Christina S. Kong, Reet Pai, Mark L. WeltonAbstract:Background & Aims Although the prevalence of Anal Dysplasia is higher in some immunosuppressed populations, the prevalence in patients with inflammatory bowel disease (IBD) is unknown. We examined the prevalence of abnormal Anal cytology among IBD patients, and its relation to the human papilloma virus (HPV). Methods Adults with IBD and age-matched healthy controls (HC) were recruited. IBD patients were categorized as nonimmunosuppressed (IBD-N) or immunosuppressed (IBD-I). Anal Papanicolaou tests were performed for HPV testing and classification by a cytopathologist as follows: negative, atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, cancer, or unsatisfactory. Results A total of 270 subjects (100 IBD-I, 94 IBD-N, and 76 HC) were recruited. ASC-US were detected in 19 subjects, with a trend toward a higher prevalence among IBD subjects compared with HC (8.8% vs 2.6%; P = .10). The prevalence did not differ with respect to immunosuppression. Crohn's disease (CD) subjects had a higher prevalence of ASC-US compared with others with IBD ( P = .02). Among those with CD, female sex and disease duration longer than 10 years were risk factors. There were no cases of low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or Anal cancer in the cohort. HPV was present in 5.3% and 1.5% of subjects with and without ASC-US, respectively ( P = .26). Conclusions Although there was a trend toward abnormal Anal Papanicolaou tests in IBD subjects compared with HC, there was no difference based on immunosuppression. The presence of HPV did not correlate with abnormal Anal cytology. Risk factors associated with this increased trend include female CD subjects and those with a longer duration of CD. ClinicalTrials.gov number: NCT01860963; https://clinicaltrials.gov/ct2/show/NCT01860963.
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High Resolution Anoscopy in the Planned Staged Treatment of Anal Squamous Intraepithelial Lesions in HIV-Negative Patients
Journal of Gastrointestinal Surgery, 2007Co-Authors: Carlos E. Pineda, J. Michael Berry, Joel M. Palefsky, Mark L. WeltonAbstract:Anal Dysplasia (low-grade squamous intraepithelial lesions, LSIL; high-grade squamous intraepithelial lesions, HSIL) is a challenging disease for the surgeon. We reviewed 42 patients that underwent high-resolution anoscopy (HRA)-targeted surgical therapy of Anal Dysplasia in the past 10 years. Patients were followed up in the Anal Neoplasia Clinic with physical examination, cytology, HRA, and biopsy if indicated. Patients with disease amenable to local therapy were treated with office-based HRA-directed therapies. There were 30 men (mean age 39 years, range 21–63) and 12 women (mean age 50 years, range 31–71) included in the study. HSIL was present in 33, with four undergoing planned staged treatment due to circumferential disease. HSIL recurred in 45%, and most were re-treated successfully in-office. Progression to HSIL was seen in one patient with LSIL and to squamous cell carcinoma in one patient with HSIL despite therapy. No patients with LSIL had Dysplasia at last follow-up. Minor complications occurred in three patients. HRA-targeted surgical therapy coupled with surveillance and re-treatment with office-based therapies offered an effective method in controlling Anal Dysplasia in the immunocompetent patient. Morbidity is minimal, and our progression to cancer rate is low (2.4%).
Aimal Khan - One of the best experts on this subject based on the ideXlab platform.
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Anal Dysplasia among solid organ transplant recipients; a cross sectional study
Journal of Coloproctology, 2019Co-Authors: Aimal Khan, Thaer Obaid, Lawrence Cetrulo, Luanne Force, Roshmi Bhattacharya, Richard H. GreenbergAbstract:Abstract Introduction The incidence of Anal cancer in United States has increased over of the last few decades impacting immunosuppressed populations like solid organ transplant recipients, in particular. The aim of this study was to evaluate the prevalence of Anal Dysplasia among solid organ transplant patients. We also attempted to identify factors that predispose solid organ transplant recipients to developing Anal Dysplasia. Methods and materials Patients presenting to transplant office for routine care were recruited to participate in the study. All Anal cytology specimens were collected using standard Anal pap technique. The results were assessed using Bethesda classification. Information on perceived risk factors for development of Anal Dysplasia among our subjects was obtained. Results Among 80 patients approached, 47 agreed to participate in the study. Of all the samples 19.1% had an inadequate amount of specimen to perform any Analysis. Dysplastic cells were found in 10.5% of the specimens available for Analysis. We were not able to identify any risk factors including age, gender distribution, smoking, and duration of immunosuppression that were statistically significant different between patients with Anal Dysplasia versus those without Anal Dysplasia. Conclusions The rate of Anal Dysplasia detectable on cytology is high enough to warrant Anal Dysplasia screening in transplant recipients, which can then be followed up with high-resolution anoscopy with biopsy. Defining a cohort of patients among solid organ transplant recipients who are at an increased risk for the development of Anal Dysplasia mandating screening continues to be a challenge.
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Anal Dysplasia among solid organ transplant recipients; a cross sectional study
Elsevier, 2019Co-Authors: Aimal Khan, Thaer Obaid, Lawrence Cetrulo, Luanne Force, Roshmi Bhattacharya, Richard H. GreenbergAbstract:Introduction: The incidence of Anal cancer in United States has increased over of the last few decades impacting immunosuppressed populations like solid organ transplant recipients, in particular. The aim of this study was to evaluate the prevalence of Anal Dysplasia among solid organ transplant patients. We also attempted to identify factors that predispose solid organ transplant recipients to developing Anal Dysplasia. Methods and materials: Patients presenting to transplant office for routine care were recruited to participate in the study. All Anal cytology specimens were collected using standard Anal pap technique. The results were assessed using Bethesda classification. Information on perceived risk factors for development of Anal Dysplasia among our subjects was obtained. Results: Among 80 patients approached, 47 agreed to participate in the study. Of all the samples 19.1% had an inadequate amount of specimen to perform any Analysis. Dysplastic cells were found in 10.5% of the specimens available for Analysis. We were not able to identify any risk factors including age, gender distribution, smoking, and duration of immunosuppression that were statistically significant different between patients with Anal Dysplasia versus those without Anal Dysplasia. Conclusions: The rate of Anal Dysplasia detectable on cytology is high enough to warrant Anal Dysplasia screening in transplant recipients, which can then be followed up with high-resolution anoscopy with biopsy. Defining a cohort of patients among solid organ transplant recipients who are at an increased risk for the development of Anal Dysplasia mandating screening continues to be a challenge. Resumo: Introdução: A incidência de câncer Anal nos Estados Unidos aumentou nas últimas décadas, afetando populações imunossuprimidas, especialmente receptores de órgãos sólidos. O objetivo deste estudo foi avaliar a prevalência de displasia Anal entre pacientes que receberam transplante de órgãos sólidos. Os autores buscaram identificar fatores que predispõem os receptores de transplante de órgãos sólidos a desenvolverem displasia Anal. Métodos e materiais: Pacientes que se apresentaram ao consultório de transplante para acompanhamento de rotina foram recrutados para participar do estudo. Todos os espécimes de citologia foram coletados usando a técnica padrão de Papanicolau Anal. Os resultados foram avaliados usando a classificação de Bethesda. Foram coletados dados sobre os fatores de risco percebidos para o desenvolvimento de displasia Anal entre os participantes. Resultados: Dos 80 pacientes abordados, 47 concordaram em participar do estudo. Do total de amostras, 19,1% tinham uma quantidade inadequada para realizar qualquer análise. Células displásicas foram encontradas em 10,5% dos espécimes disponíveis para análise. Não foi possível identificar quaisquer fatores de risco, incluindo idade, distribuição de gênero, tabagismo e duração da imunossupressão, que foram estatisticamente diferentes entre pacientes com displasia Anal e aqueles sem displasia Anal. Conclusões: A taxa de displasia Anal detectável na citologia é alta o suficiente para justificar a triagem em receptores de transplante, que pode então ser acompanhada com anuscopia de alta resolução com biópsia. A definição de triagem para uma coorte de pacientes entre os receptores de transplantes de órgãos sólidos que apresentam risco aumentado para o desenvolvimento displasia Anal continua a ser um desafio. Keywords: Anal cancer, Anal Dysplasia screening, Immunosupressed, Transplant recipients, Palavras-chave: Câncer Anal, Triagem de displasia Anal, Imunossuprimido, Receptores de transplante
