Anal Dysplasia - Explore the Science & Experts | ideXlab

Scan Science and Technology

Contact Leading Edge Experts & Companies

Anal Dysplasia

The Experts below are selected from a list of 1026 Experts worldwide ranked by ideXlab platform

Anal Dysplasia – Free Register to Access Experts & Abstracts

Craig Messick – One of the best experts on this subject based on the ideXlab platform.

  • 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, 2020
    Co-Authors: Craig Messick

    Abstract:

    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.

  • 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, 2019
    Co-Authors: Craig Messick

    Abstract:

    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 

  • Prevalence of high-grade Anal Dysplasia among women with high-grade lower genital tract Dysplasia or cancer: Results of a pilot study.
    Gynecologic Oncology, 2019
    Co-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. Schmeler

    Abstract:

    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.

  • Risk of Invasive Anal Cancer in HIV-Infected Patients With High-Grade Anal Dysplasia: A Population-Based Cohort Study.
    Diseases of the Colon & Rectum, 2019
    Co-Authors: Yotam Arens, Stephen E. Goldstone, Michael Gaisa, Yuxin Liu, Juan P. Wisnivesky, Carlie S. Sigel, Talia H. Swartz, Keith Sigel

    Abstract:

    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.

  • Testing for Human Papillomavirus Strains 16 and 18 Helps Predict the Presence of Anal High-Grade Squamous Intraepithelial Lesions.
    Diseases of the Colon & Rectum, 2018
    Co-Authors: Jacob A Sambursky, Joseph P. Terlizzi, Stephen E. Goldstone

    Abstract:

    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.

  • high rates of Anal Dysplasia in hiv infected men who have sex with men women and heterosexual men
    AIDS, 2014
    Co-Authors: Michael Gaisa, Keith Sigel, Jonathan Hand, Stephen E. Goldstone

    Abstract:

    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.

Richard H. Greenberg – One of the best experts on this subject based on the ideXlab platform.

  • Anal Dysplasia among solid organ transplant recipients; a cross sectional study
    Journal of Coloproctology, 2019
    Co-Authors: Aimal Khan, Thaer Obaid, Lawrence Cetrulo, Luanne Force, Roshmi Bhattacharya, Richard H. Greenberg

    Abstract:

    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.

  • Anal Dysplasia among solid organ transplant recipients; a cross sectional study
    Elsevier, 2019
    Co-Authors: Aimal Khan, Thaer Obaid, Lawrence Cetrulo, Luanne Force, Roshmi Bhattacharya, Richard H. Greenberg

    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. 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