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The results of the latest studies<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> have helped to set down clinical guidelines on the management of these patients<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> but there is still controversy concerning which lesions detected at Pap smear screening are worthy of having their study completed with an HRA (high-resolution anuscopy); what effect HPV genotyping has on this; which lesions are treated; and what the most effective treatment would be.</p><p id="par0010" class="elsevierStylePara elsevierViewall">At our centre we have modified the previous action protocol. Currently, we include HIV patients monitored by the Infectious Diseases Unit through an annual anal smear at our anal dysplasia screening. The ASCUS/atypia Pap smear findings of undetermined significance, LSIL with high-risk genotypes (HPV 16 or 18) and HSIL are subjected to HRA.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In our study, 64/66 patients with ASCUS results on anal Pap smear presented dysplasia in posterior anal biopsy, and half of these patients (32/64) had high-grade dysplasia. Pap smear is an effective initial diagnostic method because it is a non-invasive and easily reproduced test, although it may underdiagnose cases of dysplasia when compared to anal biopsy.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a> For this reason, we consider that a patient with ASCUS in Pap smear deserves an HRA examination and biopsy of lesions suspected of dysplasia.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Currently, the follow-up on patients with ASCUS in Pap smear screening is still not defined and the action taken depends on each centre: a) follow-up, b) HRA depending on the genotyping of the virus or c) HRA in all patients.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,7,10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Currently, we systematically perform HPV genotyping on all Pap smear and histology samples from screening patients and this is an additional tool that helps us detect which patients are at higher risk of developing high-grade dysplasia and who would benefit from HRA.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,8,11,12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Unlike the previous protocol, the results of LSIL in the biopsy will be monitored by a further Pap smear at 6–12 months. Patients with a histological result of HSIL will be treated with 80% TCA (trichloroacetic acid) in two sessions. In agreement with the authors, there is no current evidence regarding the treatment of low-grade dysplasia for the prevention of the development of anal squamous cell carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> There are few centres that currently treat these lesions, and periodical follow-up by HRA is more common.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The integration of HRA into routine clinical practice has improved the detection of lesions in the anal canal with better visualisation and resolution than previously used methods, such as the rigid manual anuscope. In our centre, we apply TCA treatment specifically by quadrants to those lesions suspected of dysplasia. During our follow-up, we did not report any serious side effects in patients undergoing this treatment, and it was generally well tolerated.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, and despite the fact that Pap smear tests can lead to false negatives, it is still our method of choice to evaluate the efficacy of treatment, due to the characteristics mentioned above. In addition, these patients will continue the set screening and many of them will present re-infection with other HPV strains or persistence requiring, in most cases, another HRA over their follow-up.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Our goal is to carry out short to long term follow-up on the diagnosis and treatment of this pathology in future studies after the change in screening protocol. Prospective studies with longer follow-ups are needed to reach a consensus on the most appropriate management in the screening of patients with anal dysplasia.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Our experience in the short-term diagnostic-therapeutic management of the patient with anal dysplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Galán Martínez" 1 => "M.P. Hernández Casanovas" 2 => "L. Sala Vilaplana" 3 => "A. Sánchez López" 4 => "M.C. Martínez Sánchez" 5 => "J. 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Journal Information
Vol. 102. Issue 6.
Pages 351-352 (June 2024)
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Vol. 102. Issue 6.
Pages 351-352 (June 2024)
Letter to the Editor
Update of our anal dysplasia screening protocol
Actualización de nuestro protocolo de cribado de la displasia anal
Visits
5
Clara Galán Martínez
, M Pilar Hernández Casanovas, Anna Sánchez López, Eduardo M Targarona Soler
Corresponding author
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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