Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Tech Coloproctol. 2021 Apr;25(4):461-466. doi: 10.1007/s10151-021-02416-9. Epub 2021 Feb 10.
The development of high-resolution anoscopy (HRA) has advanced our ability to detect anal dysplasia. Historically, HRA is performed in a clinical setting and subsequent ablation is performed in the clinical setting or operating room. The aim of this study was to determine the most effective venue for the performance of HRA.
Following institutional review board (IRB) approval, the correlation between anal cytology and HRA performed in the clinic versus in the operating room was evaluated. Data were extracted from our IRB-approved prospective HRA database over the time period of 2013-2017.
One hundred twenty-eight HRAs were compared (101 in the clinical setting, 27 in the operating room). There was a statistically significant difference in the correlation between anal cytology and HRA pathology for procedures performed in the clinical setting (55% [56/101]) versus those performed in the operating room (82% [22/27]) (p = 0.014). More biopsies were obtained in the operating room than in the clinic setting (3 vs. 1, p < 0.0001). The majority of patients who had HRA in a clinical setting with subsequent HRA in the operating room stated that they preferred to have their HRAs performed in the operating room due to discomfort from the HRA procedure.
Detection rates for anal dysplasia on HRA, are significantly higher when performed in the operating room. To prevent discomfort in the clinical setting, patients with high-grade dysplasia on anal pap testing may benefit from proceeding directly to the operating room for concurrent HRA and ablation.
高分辨率肛门镜检查（HRA）的发展提高了我们检测肛门发育不良的能力。历史上，HRA 在临床环境中进行，随后的消融在临床环境或手术室中进行。本研究的目的是确定进行 HRA 的最佳场所。
在获得机构审查委员会（IRB）批准后，评估了在临床环境与手术室中进行的肛门细胞学检查与 HRA 之间的相关性。我们从 2013 年至 2017 年期间经 IRB 批准的前瞻性 HRA 数据库中提取数据。
比较了 128 次 HRA（101 次在临床环境中，27 次在手术室中）。在临床环境中进行的手术（55%[56/101]）与在手术室中进行的手术（82%[22/27]）之间，肛门细胞学检查与 HRA 病理学之间的相关性存在统计学差异（p=0.014）。手术室中活检的数量多于临床环境（3 次与 1 次，p<0.0001）。大多数在临床环境中进行 HRA 检查并随后在手术室中进行 HRA 检查的患者表示，由于 HRA 检查过程中的不适，他们更喜欢在手术室中进行 HRA 检查。
当在手术室中进行时，HRA 检测到肛门发育不良的检出率显著更高。为了防止在临床环境中引起不适，肛门巴氏涂片检查显示高级别发育不良的患者可能会受益于直接在手术室中进行同时的 HRA 和消融术。
