French study reports wide variability in detecting anal pre-cancerous lesions

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Screening procedures and results for anal pre-cancerous lesions differed significantly among six study sites in France. Quality control measures and additional training could help reduce missed diagnoses of high-grade squamous intraepithelial lesions (HSIL).

About This Study

Cumulative detection of anal high-grade squamous intraepithelial lesions over two-year follow-up in men who have sex with men living with HIV in France“ was published online on Nov. 16, 2023, in The Journal of Infectious Diseases. The lead author is Jean-Damien Combes, M.D., Ph.D., of the Early Detection, Prevention, and Infections Branch at the International Agency for Research on Cancer (IARC/WHO) in Lyon, France.

Key Research Findings

Study sites were six teaching hospitals in France that screened 513 men for HSIL. Participants were men who have sex with men who are living with HIV. The analysis included only the 410 men who completed three visits over two years, from 2014-2016.

Overall, detection of HSIL was observed in 33% of participants, but that rate varied between 13% and 51% of participants, depending on study site. Sample sizes ranged from 23 participants to 110 participants per site.

Screening procedures varied by center, with biopsies performed on 23%-84% of participants at the sites. Higher biopsy rates were associated with a higher proportion of HSIL detected by histology.

The best predictor of HSIL was infection with human papillomavirus (HPV) type 16 at baseline.

Sites also differed significantly in histological confirmation of initial cytology results. A study panel reviewing results found significant additional HSIL diagnoses among samples considered non-HSIL by the local pathologist. Repeating cytology and high-resolution anoscopy improved HSIL detection but did not entirely remedy the observed between-site differences.

Discussion Highlights and Implications for Practice

Study limitations included small sample sizes for some potential determinants of HSIL detection and the fact that > 100 initial participants did not attend all visits and were excluded from analysis.

HPV testing in this population could identify men at higher risk for anal cancer who may benefit from annual proctology exams. Quality assurance measures, especially when staff have limited high-resolution anoscopy experience, could help reduce missed HSIL, as could further training in anal cytology.

By Barbara Jungwirth


Source : TheBodyPro

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