Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
JAMA Surg. 2015 Jun;150(6):563-9. doi: 10.1001/jamasurg.2015.28.
High-resolution anoscopy (HRA) is becoming increasingly advocated as a method of screening for anal dysplasia in high-risk patients.
To describe, through HRA findings, the association between patient symptomatology and anal dysplasia among patients at high risk for anal dysplasia.
DESIGN, SETTING, AND PARTICIPANTS: Univariable and multivariable analyses were conducted of data from a prospectively maintained HRA database on all patients undergoing HRA with biopsy from November 1, 2011, to March 13, 2014, at a tertiary care HRA clinic. Data included demographics, medical history and comorbidities, HIV status and related measures (CD4 cell counts, HIV viral load, and use of highly active antiretroviral therapy), sexual orientation (when available), patient symptoms at initial presentation, physical examination findings, anal Papanicolaou (Pap) smear findings.
High-resolution anoscopy diagnosis of high- vs low-grade dysplasia or no dysplasia.
One hundred sixty-one HRA biopsy specimens (mean [SEM], 1.77 [0.11] biopsy specimens per patient) were obtained from 91 patients (mean [SEM] age, 45.7 [1.2] years; 61 men [67%]; 47 black patients [52%]; and 70 human immunodeficiency virus-positive patients [77%]). Twenty-seven patients (30%) had high-grade dysplasia, 26 had low-grade dysplasia (29%), and 38 had no dysplasia (42%). The majority of patients (63 [69%]) were asymptomatic (anal pain, 11 [12%]; bleeding, 14 [15%]; and pruritus, 10 [11%]). Forty-one patients (45%) presented with anal pain (odds ratio, 5.25; 95% CI, 1.44-21.82; P = .02), and patients with either high- or low-grade dysplasia were more likely to present with anal lesions on physical examination compared with patients without dysplasia (odds ratio, 4.34; 95% CI, 1.78-11.20; P = .002). Multivariable analysis suggested that anal pain was independently associated with high-grade dysplasia (odds ratio, 6.42; 95% CI, 1.18-43.3; P = .03).
Anal dysplasia is a silent disease that is frequently asymptomatic. However, patients with anal pain, anal lesions, and other high-risk factors are at increased risk of having high-grade anal dysplasia. These patients may benefit from routine screening with HRA.
高分辨率肛门镜检查（HRA）作为一种筛查高危患者肛门发育不良的方法，越来越受到推崇。
通过 HRA 检查结果，描述高危人群中患者症状与肛门发育不良之间的关系。
设计、地点和参与者：对 2011 年 11 月 1 日至 2014 年 3 月 13 日在一家三级保健 HRA 诊所接受 HRA 检查和活检的所有患者的前瞻性维护的 HRA 数据库中的数据进行了单变量和多变量分析。数据包括人口统计学资料、病史和合并症、HIV 状况和相关指标（CD4 细胞计数、HIV 病毒载量和使用高效抗逆转录病毒治疗）、性取向（如有）、初次就诊时的患者症状、体格检查结果、肛门巴氏涂片检查结果。
高分辨率肛门镜检查诊断为高级别或低级别发育不良或无发育不良。
91 例患者（平均[SEM]年龄 45.7[1.2]岁；61 例男性[67%]；47 例黑人患者[52%]；70 例 HIV 阳性患者[77%]）共获得 161 例 HRA 活检标本（平均[SEM]每例患者 1.77[0.11]活检标本）。27 例（30%）患者有高级别发育不良，26 例有低级别发育不良（29%），38 例无发育不良（42%）。大多数患者（63[69%]）无症状（肛门疼痛 11[12%]；出血 14[15%]；瘙痒 10[11%]）。41 例（45%）患者有肛门疼痛（比值比，5.25；95%CI，1.44-21.82；P = .02），与无发育不良的患者相比，有高级别或低级别发育不良的患者更有可能在体格检查时出现肛门病变（比值比，4.34；95%CI，1.78-11.20；P = .002）。多变量分析表明，肛门疼痛与高级别发育不良独立相关（比值比，6.42；95%CI，1.18-43.3；P = .03）。
肛门发育不良是一种无声无息的疾病，常无症状。然而，有肛门疼痛、肛门病变和其他高危因素的患者发生高级别肛门发育不良的风险增加。这些患者可能受益于 HRA 的常规筛查。
