Cho S David, Groves Emily, Lao Victoria V
Department of Surgery, Kaiser Permanente, Portland, Oregon.
Department of General Surgery, Oregon Health and Science University, Portland, Oregon.
Clin Colon Rectal Surg. 2018 Nov;31(6):336-346. doi: 10.1055/s-0038-1668103. Epub 2018 Nov 2.
High-resolution anoscopy (HRA) is a form of low-resolution anal microscopy currently utilized in the screening and management of anal squamous dysplasia. No randomized controlled trials, national or international guidelines exist on the use of HRA for this purpose. Much of our understanding of this entity has been adapted from the literature on cervical squamous dysplasia, including the technique of HRA itself. Epidemiologic evidence has shown that the prevalence and incidence of anal dysplasia is highest in HIV-positive populations. The history of this technique parallels the evolution of our understanding of anal dysplasia. To understand the history of the use of HRA and its place in the screening and management of anal squamous dysplasia, we discuss key advances in the understanding of human papillomavirus-related squamous dysplasia. We begin with early reports in the field establishing the link between this virus and squamous dysplasia, through the marked increase in anal cancer seen with the onset of the HIV epidemic, the identification of relevant populations at risk, the performance of the test itself, to its use today.
高分辨率肛门镜检查（HRA）是一种低分辨率肛门显微镜检查形式，目前用于肛门鳞状发育异常的筛查和管理。目前尚无关于将HRA用于此目的的随机对照试验、国家或国际指南。我们对该实体的许多理解都借鉴了关于宫颈鳞状发育异常的文献，包括HRA技术本身。流行病学证据表明，肛门发育异常的患病率和发病率在HIV阳性人群中最高。这项技术的历史与我们对肛门发育异常的理解演变并行。为了了解HRA的使用历史及其在肛门鳞状发育异常筛查和管理中的地位，我们讨论了在人乳头瘤病毒相关鳞状发育异常理解方面的关键进展。我们从该领域的早期报告开始，这些报告通过HIV流行开始时肛门癌的显著增加、确定相关高危人群、测试本身的执行情况，一直到其如今的使用，确立了这种病毒与鳞状发育异常之间的联系。
