Icahn School of Medicine at Mount Sinai, New York, NY.
J Acquir Immune Defic Syndr. 2014 Jan 1;65(1):65-71. doi: 10.1097/QAI.0b013e3182a9b3d3.
Random biopsy (RB) of normal appearing cervix during colposcopy increases high-grade dysplasia (HSIL) diagnosis but has not been studied in high-resolution anoscopy (HRA), that is, colposcopy transferred to the anal canal. We investigated the utility of RB during HRA.
At HRA, the anal canal was divided into 4 quadrants. Areas suspicious for HSIL had standard biopsy (SB); random biopsies were taken from quadrants without apparent HSIL. Inclusion required ≥1 RB. Two providers performed all procedures (S.E.G., >10 years experience; M.M.G. 3 years experience).
Overall, 391 participants enrolled (mean age, 44.7 years); most were male (87.2%), non-Hispanic (69.8%), white (62.7%), and HIV positive (72.9%). Of 1761 biopsies, 883 were RBs (mean, 2.26/participant). HSIL was identified in 252 lesions, and in 132 participants (33.8%). Thirty-two HSILs (12.7%) and 13 participants (9.8%) were diagnosed by RB. RB increased total HSILs identified per participant (mean, 0.65 vs. 0.56; P < 0.001) and participants with HSIL (P < 0.001). Histologically, HSIL diagnoses via SB were no more dysplastic than random biopsies (relative risk, 0.82; range, 0.37-1.8). In multivariable analysis, factors affecting adjusted relative risk (ARR) of HSIL with any biopsy were provider [S.E.G vs. M.M.G.; ARR, 5.9; 95% confidence interval (CI), 1.3 to 25.8] and oncogenic human papillomaviral infection (ARR, 24.3; 95% CI, 2.8 to 213.3). Risk of HSIL on RB alone in multivariate analysis was associated with HSIL via SB (ARR, 3.4; 95% CI, 1.6 to 7.1 or ARR, 1.4; 95% CI, 1.1 to 1.9 per standard HSIL). Provider, HIV status, detectable viral load, age, or prior screening for or treatment of HSIL did not affect the utility of RB.
Addition of RB to HRA significantly increased both the number of HSILs and participants with HSIL identified.
阴道镜下对外观正常的宫颈进行随机活检（RB）可提高高级别上皮内瘤变（HSIL）的诊断率，但尚未在高分辨率肛门镜（HRA）中进行研究，即阴道镜检查转移到肛门管。我们研究了 HRA 期间 RB 的效用。
在 HRA 中，将肛门管分为 4 个象限。疑似 HSIL 的区域进行标准活检（SB）；从没有明显 HSIL 的象限中进行随机活检。需要至少有 1 个 RB 才能纳入。两名提供者（SEG，>10 年经验；MMG，3 年经验）进行所有操作。
总体而言，391 名参与者入组（平均年龄 44.7 岁）；大多数为男性（87.2%），非西班牙裔（69.8%），白人（62.7%），HIV 阳性（72.9%）。在 1761 个活检中，883 个为 RB（平均每个参与者 2.26 个）。在 252 个病变和 132 名参与者中发现了 HSIL（33.8%）。32 个 HSIL（12.7%）和 13 名参与者（9.8%）通过 RB 诊断。RB 增加了每个参与者的总 HSIL 检出率（平均，0.65 比 0.56；P<0.001）和 HSIL 患者（P<0.001）。从组织学上看，SB 下的 HSIL 诊断与随机活检一样不具有异型性（相对风险，0.82；范围，0.37-1.8）。多变量分析显示，影响任何活检 HSIL 调整相对风险（ARR）的因素包括提供者[SEG 与 MMG；ARR，5.9；95%置信区间（CI），1.3 至 25.8]和致癌性人乳头瘤病毒感染（ARR，24.3；95%CI，2.8 至 213.3）。多变量分析中，单独进行 RB 的 HSIL 风险与 SB 下的 HSIL 相关（ARR，3.4；95%CI，1.6 至 7.1 或 ARR，1.4；95%CI，1.1 至 1.9 每个标准 HSIL）。提供者、HIV 状态、可检测病毒载量、年龄或先前筛查或治疗 HSIL 均未影响 RB 的效用。
将 RB 添加到 HRA 中可显著增加 HSIL 的数量和 HSIL 患者的检出率。
