Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
BC Centre for Disease Control, University of British Columbia, Vancouver, British Columbia, Canada.
J Low Genit Tract Dis. 2019 Oct;23(4):265-271. doi: 10.1097/LGT.0000000000000490.
The primary obkective was to determine the prevalence of (a) a positive anal cancer screen and (b) histological anal high-grade squamous intraepithelial lesion (HSIL) in women undergoing surveillance for previously diagnosed and treated human papillomavirus (HPV)-associated vulvar HSIL. The secondary objective was to determine the patients' acceptability of the screen.
This is a single-institution, cross-sectional pilot study. Women, aged 30 to 80 years, with a history of biopsy-proven vulvar HSIL were invited to undergo screening for anal cancer. Positive screen characterized by abnormalities in any of the following: anal high-risk HPV (HR-HPV); anal cytology; and digital anorectal examination. All women with an abnormal screen were referred for high-resolution anoscopy. All women completed a postscreen questionnaire.
Fifty-seven patients were recruited. The median (interquartile range) age was 61.5 (51.0-68.0) years. The prevalence of a positive screen was 56.1% (95% CI = 43.3%-68.2%). Of the 32 screen-positive patients, 12 had both abnormal cytology and HR-HPV, 3 had positive HR-HPV alone, and 17 had abnormal cytology alone. Of the 29 patients with a positive screen who went on to anoscopy, the prevalence of anal HSIL was 33.3% (95% CI = 19.2%-51.2%). The prevalence of anal HSIL among all of those who had screening (N = 57) was 18.2% (95% CI = 10.2%-30.3%). The examination was well tolerated with 100% of patients, indicating that they would have the screening again.
Women with vulvar HSIL have an increased risk of developing anal HSIL. Larger studies are needed to define optimal screening protocols as well as algorithms for management in high-risk populations.
主要目的是确定（a）接受过先前诊断和治疗的人乳头瘤病毒（HPV）相关外阴高级别鳞状上皮内病变（HSIL）监测的女性中，肛门癌筛查呈阳性的比例，以及（b）肛门组织学高级别鳞状上皮内病变（HSIL）的比例。次要目的是确定该筛查的患者可接受性。
这是一项单机构、横断面的试点研究。邀请年龄在 30 至 80 岁之间、有活检证实的外阴 HSIL 病史的女性接受肛门癌筛查。阳性筛查的特征是以下任何一项异常：肛门高危型 HPV（HR-HPV）；肛门细胞学；和数字肛肠检查。所有异常筛查的女性均转诊进行高分辨率肛门镜检查。所有女性均完成了筛查后问卷调查。
共招募了 57 名患者。中位（四分位间距）年龄为 61.5（51.0-68.0）岁。阳性筛查率为 56.1%（95%CI=43.3%-68.2%）。在 32 名筛查阳性的患者中，12 名同时有异常细胞学和 HR-HPV，3 名仅有 HR-HPV 阳性，17 名仅有细胞学异常。在 29 名筛查阳性且进行肛门镜检查的患者中，肛门 HSIL 的患病率为 33.3%（95%CI=19.2%-51.2%）。所有接受筛查的 57 名患者中，肛门 HSIL 的患病率为 18.2%（95%CI=10.2%-30.3%）。该检查耐受性良好，100%的患者表示会再次接受筛查。
外阴 HSIL 患者发生肛门 HSIL 的风险增加。需要更大规模的研究来确定最佳筛查方案以及高危人群的管理算法。
