Patients to screen for anal intraepithelial neoplasia (Palefsky et al, 1997):
(1) men who have sex with men
(2) women with cervical cancer
(3) women with high grade VIN or cancer
(4) HIV positive men and women
(5) patients with perianal condyloma acuminata
(6) transplant recipients
where:
• These might be extended to include women with CIN III and women having anal intercourse.
The first step is to perform screening anal cytology.
If cytology is negative, then the patient is monitored with repeat cytologies:
(1) every 12 months if HIV positive
(2) every 2-3 years if HIV negative (depending on risk)
If cytology is positive (ASCUS, LGSIL, HGSIL) then high-resolution anoscopy is performed with biopsy. If a lesion is identified then it should be characterized as:
(1) intra-anal and/or perianal
(2) small, medium or large
(3) asymptomatic or symptomatic
|
Findings on Anoscopy
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Management
|
|
no lesion seen
|
Monitor as above for negative cytology.
|
|
AIN I
|
Followup every 6 months.
|
|
AIN II or AIN III
|
Treat
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where:
• I would think routine monitoring would be appropriate for when no lesion was seen and screening cytology showed ASCUS. If dysplasia was seen then I would think a repeat followup at 6 months (or sooner) would be appropriate.
• I would think another finding on screening cytology would be squamous carcinoma.
