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Practice parameters for the diagnosis and treatment of anal intraepithelial neoplasia (AIN) on behalf of the Italian Society of Colorectal Surgery (SICCR)

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Abstract

Squamous cell carcinoma (SCC) of the anus is a human papilloma virus (HPV) related malignancy that is preceded by anal intraepithelial neoplasia (AIN) making this cancer, at least theoretically, a preventable disease. In the past 10 years the diagnosis, management and nomenclature of AIN has dramatically changed. Increased life expectancy in human immunodeficiency virus (HIV) positive patients due to highly active antiretroviral therapy (HAART) has caused an increase in the incidence of SCC of the anus. While many experts recommend screening and treatment of anal high-grade squamous intraepithelial lesion (HSIL), there is no consensus on the optimal management these lesions. Therefore, there is a need to review the current evidence on diagnosis and treatment of AIN and formulate recommendations to guide management. Surgeons who are members of the Italian Society of Colorectal Surgery (SICCR) with a recognized interest in AIN were invited to contribute on various topics after a comprehensive literature search. Levels of evidence were classified using the Oxford Centre for Evidence-based Medicine of 2009 and the strength of recommendation was graded according to the United States (US) preventive services task force. These recommendations are among the few entirely dedicated only to the precursors of SCC of the anus and provide an evidence-based summary of the current knowledge about the management of AIN that will serve as a reference for clinicians involved in the treatment of patients at risk for anal cancer.

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Authors and Affiliations

  1. Coloproctological Surgery, Biomedical Institute, Via Prà 1/b, 16157, Genoa, Italy

    G. A. Binda

  2. Department of Surgery, University of Illinois at Chicago, Chicago, USA

    G. Gagliardi

  3. Sexually Transmitted Infection Clinic, ASL Città di Torino, Turin, Italy

    I. Dal Conte

  4. Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy

    M. Verra & M. Mistrangelo

  5. Department of Medical Sciences, University of Turin, Turin, Italy

    P. Cassoni

  6. Department of Surgery, University of Perugia School of Medicine, Perugia, Italy

    E. Cavazzoni

  7. Department of Surgery, ASS-5 Friuli Venezia Giulia, 33078, San Vito al Tagliamento, Italy

    E. Stocco

  8. Medical Science Department, Dermatologic Clinic, University of Turin, Turin, Italy

    S. Delmonte

  9. Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy

    P. De Nardi

  10. Hygiene Unit, Department of Health Sciences (DISSAL), IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy

    L. Sticchi

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Binda, G.A., Gagliardi, G., Dal Conte, I. et al. Practice parameters for the diagnosis and treatment of anal intraepithelial neoplasia (AIN) on behalf of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 23, 513–528 (2019). https://doi.org/10.1007/s10151-019-02019-5

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