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CROI 2013: Random anal biopsies improve detection of high-grade precancerous lesions

With the increased risk of HPV-related anal carcinoma in people with HIV disease, current prevention strategies include screening with anal pap tests in which abnormal cytology is followed by high-resolution anoscopy (HRA) to biopsy suspicious-looking tissue. But can this strategy to identify precancerous high-grade squamous intraepithelial lesions (HSIL) via HRA be improved by adding random samples of otherwise normal-looking anal tissue?

Richard Silvera, a second-year medical student at the Mount Sinai School of Medicine in NYC reported the work of Drs. Goldstone and Gaisa, in which random anal biopsies were taken from quadrants free of the tissue changes required for standard biopsy. Inclusion in the study required ≥1 random biopsy per subject. Variables included provider, sex, ethnicity, race, HIV status, HAART, prior HSIL or condyloma screening and disease, monogamy, anal sex, tobacco, and condom use.

Of the 519 patients screened, 372 enrolled (mean age 44.6 years) with 1669 intra-anal biopsies, of which 853 were random. Most patients were male (87.4%), non-Hispanic (70.2%), white (62.1%), and HIV-positive (72.3%) with 69.1% receiving HAART.

Of 124 patients with HSIL (240 separate lesions), 30 HSIL and 11 patients were diagnosed by random biopsy. HSIL diagnosis with any biopsy was significantly associated with oncogenic HPV infection, HIV-positivity without HAART, and history of prior HSIL treatment. Using multivariate logistic regression, sexual orientation, smoking, HIV status were not significant-- only oncogenic HPV infection remained a significant predictor of HSIL. HSIL on random biopsy was significantly associated with prior treatment for HSIL, and greater total number of HSIL. In multivariate logistic regression only greater total number of HSIL remained significant.

In this study, the use of random biopsy significantly increased total number of HSIL identified per patient and significantly increased the number of patients diagnosed with HSIL, suggesting that random biopsy should be added to standard HRA.

Silvera R, Gaisa M, and Goldstone S. Random biopsy Increases diagnostic rate and total anal high-grade squamous intraepithelial lesions found by high-resolution anoscopy. Presented March 6, 2013 at the 20th CROI, Atlanta Georgia. Oral Abstract #142.

Source: Reporting from Atlanta for PRN News: James F Braun, DO