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Diseases of the Colon & Rectum

, Volume 50, Issue 5, pp 565–575 | Cite as

Infrared Coagulator Ablation of High-Grade Anal Squamous Intraepithelial Lesions in HIV-Negative Males Who Have Sex with Males

  • Stephen E. GoldstoneEmail author
  • Joshua S. Hundert
  • Jeff W. Huyett
Original Contributions

Purpose

The incidence of anal squamous carcinoma in males who have sex with males is rising. We reported that infrared coagulation of high-grade squamous intraepithelial lesions in HIV-positive males who have sex with males yielded a recurrence rate after the first ablation of 65 percent and 58 percent after a second ablation. The cure rate of an individual lesion was 72 percent. We endeavored to determine whether this technique demonstrates improved results in HIV-negative males who have sex with males.

Methods

We performed a retrospective review of medical records on HIV-negative males who have sex with males who had infrared coagulation ablation of anal high-grade squamous intraepithelial lesions. Patients had at least six months' follow-up with cytology, high-resolution anoscopy, and biopsy. Recurrent high-grade squamous intraepithelial lesions were retreated.

Results

Seventy-five patients were enrolled, with a median age of 36 years, and 113 lesions were treated. Forty patients (53 percent) developed a recurrence in a median time of 238 days and 35 patients (47 percent) were disease free for a median of 516 days. When patients were treated a second or third time, recurrence rates dropped to 28 and 0 percent, respectively. The probability of successfully treating an individual lesion at first infrared coagulation was 81 percent and 93 percent when retreated. HIV-positive patients were twice as likely to have lesions persist and 1.7 times more likely to develop a recurrent high-grade squamous intraepithelial lesion. No patient developed squamous-cell carcinoma, anal stenosis, or had a serious complication.

Conclusions

Infrared coagulation is a safe and effective office-based procedure for treating anal high-grade squamous intraepithelial lesions. Although recurrence was high after the first infrared coagulation, repeated treatment led to resolution of high-grade squamous intraepithelial lesions. Treatment success with infrared coagulation is significantly superior in HIV-negative patients compared with HIV-positive patients.

Keywords

High-grade dysplasia Anal cancer Neoplasia Homosexual Males who have sex with males Human papillomavirus Squamous intraepithelial lesion Squamous carcinoma Anus Dysplasia 

Notes

Acknowledgments

The authors thank Dr. Barbara Winkler for her time and guidance with the pathology and cytology and Erin Moshier for her help with the statistical analysis.

References

  1. 1.
    Chin-Hong, PV, Palefsky, JM 2002Natural history and clinical management of anal human papillomavirus disease in men and women infected with human immunodeficiency virusClin Infect Dis3511271134PubMedCrossRefGoogle Scholar
  2. 2.
    Melbye, M, Cote, TR, Kessler, L 1994High incidence of anal cancer among AIDS patients. The AIDS/Cancer Working GroupLancet343636639PubMedCrossRefGoogle Scholar
  3. 3.
    Goedert, JJ, Cote, TR, Virgo, P,  et al. 1998Spectrum of AIDS-associated malignant disordersLancet35118331839PubMedCrossRefGoogle Scholar
  4. 4.
    Cress, RD, Holley, EA 2003Incidence of anal cancer in California: increases incidence among men in San Francisco, 1973–1999Prev Med36555560PubMedCrossRefGoogle Scholar
  5. 5.
    Diamond, C, Taylor, TH, Aboumrad, T,  et al. 2005Increased incidence of squamous cell anal cancer among men with AIDS in the era of highly active antiretroviral therapySex Trans Dis32314320CrossRefGoogle Scholar
  6. 6.
    Schiffman, M, Kjaer, SK 2003Chapter 2: Natural history of anogenital human papillomavirus infection and neoplasiaJ NCI Monographs311419Google Scholar
  7. 7.
    Galloway, DA 1999Biology of human papillomavirusesHolmes, KMardh, PSparling, P eds. Sexually transmitted diseasesMcGraw-HillNew York335346Google Scholar
  8. 8.
    Zbar, AP, Fenger, C, Beer-Gabel, M,  et al. 2002The pathology and molecular biology of anal intraepithelial neoplasia: comparisons with cervical and vulvar intraepithelial carcinomaInt J Colorectal Dis17203215PubMedCrossRefGoogle Scholar
  9. 9.
    Gervaz, P, Hahnloser, D, Wolff, BG,  et al. 2004Molecular biology of squamous cell carcinoma of the anus: a comparison of HIV-positive and HIV-negative patientsJ Gastrointest Surg810241031PubMedCrossRefGoogle Scholar
  10. 10.
    Welton, MI, Amerhauser, A, Litle, V,  et al. 2001Anal Bowen’s disease and high-grade squamous intraepithelial lesions are histologically and immunohistochemically indistinguishable [meeting abstract]Dis Colon Rectum44A32Google Scholar
  11. 11.
    Nelson, H, Dozios, RR 2001AnusTownsend, CM eds. Sabiston textbook of surgeryWB SaundersPhiladelphia974996Google Scholar
  12. 12.
    Palefsky, JM, Holly, EA, Ralston, ML,  et al. 1998High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual menAIDS12495503PubMedCrossRefGoogle Scholar
  13. 13.
    Ruiter, A, Carter, P, Katz, DR,  et al. 1994A comparison between cytology and histology to detect anal intraepithelial neoplasiaGenitourin Med702225PubMedGoogle Scholar
  14. 14.
    Goldstone, SE, Winkler, B, Ufford, LJ,  et al. 2001High prevalence of anal squamous intraepithelial lesions and squamous-cell carcinoma in men who have sex with men as seen in a surgical practiceDis Colon Rectum44690698PubMedCrossRefGoogle Scholar
  15. 15.
    Follen, M 2001Preinvasive squamous lesions of the female lower genital tractGershenson, DMCeCherney, AHCurry, SLBrubaker, L eds. Operative gynecologyWB SaundersPhiladelphia273279Google Scholar
  16. 16.
    Litle, VR, Leavenworth, JD, Darragh, TM,  et al. 2000Angiogenesis, proliferation, and apoptosis in anal high-grade squamous intraepithelial lesionsDis Colon Rectum43346352PubMedCrossRefGoogle Scholar
  17. 17.
    Scholefield JH, Ogunbiyi OA, Smith JH, et al. Treatment of anal intraepithelial neoplasia. Br J Surg 1994:1238–40Google Scholar
  18. 18.
    Lyons, MB, Francis, N, Path, MR, Allen-Mersh, TG 1999Treatment of grade 3 anal intraepithelial neoplasia by complete anal mucosal excision without fecal diversionDis Colon Rectum4213421344PubMedCrossRefGoogle Scholar
  19. 19.
    Brown, SR, Skinner, P, Tidy, J,  et al. 1999Outcome after surgical resection for high-grade anal intraepithelial neoplasia (Bowen’s disease)Br J Surg8610631066PubMedCrossRefGoogle Scholar
  20. 20.
    Pehoushek, J, Smith, KJ 2001Imiquimod and 5% fluorouracil therapy for anal and perianal squamous cell carcinoma in situ in an HIV-1-postive manArch Dermatol1371416PubMedGoogle Scholar
  21. 21.
    Hamdan, KA, Tait, IS, Nadeau, V,  et al. 2003Treatment of grade III anal intraepithelial neoplasia with photodynamic therapyDis Colon Rectum4615551559PubMedCrossRefGoogle Scholar
  22. 22.
    Webber, J, Fromm, D 2004Photodynamic therapy for carcinoma in situ of the anusArch Surg139259261PubMedCrossRefGoogle Scholar
  23. 23.
    Browse, DJ, Baigrie, RJ, Goldberg, PA, Nevin, J 2000Radical excision of multifocal anal intraepithelial neoplasiaDis Colon Rectum43549550CrossRefGoogle Scholar
  24. 24.
    Lacey, CJ 2005Therapy for genital human papillomavirus-related diseaseJ Clin Virol32(Suppl 1)582590Google Scholar
  25. 25.
    Chang, GJ, Berry, JM, Jay, N, Palefsky, JM, Welton, ML 2002Surgical treatment of high-grade anal squamous intraepithelial lesions: a prospective studyDis Colon Rectum45453458PubMedCrossRefGoogle Scholar
  26. 26.
    Goldstone, SE, Kawalek, AZ, Huyett, JW 2005Infrared coagulator™: a useful tool for treating anal squamous intraepithelial lesionsDis Colon Rectum4810421054PubMedCrossRefGoogle Scholar
  27. 27.
    Jay, N, Berry, JM, Hogeboom, CJ,  et al. 1997Colposcopic appearance of anal squamous intraepithelial lesions: relationship to histopathologyDis Colon Rectum40919928PubMedCrossRefGoogle Scholar
  28. 28.
    Solomon D, Nayar R, eds. The Bethesda system for reporting cervical cytology: definitions, criteria and explanatory notes. 2nd ed. New York: Springer-Verlag, 2004:169–74Google Scholar
  29. 29.
    Ries LA, Harkins D, Krapcho M, et al., eds. SEER cancer statistics review, 1975–2003. Bethesda, MD: National Cancer Institute. Available at: http://seer.cancer.gov/csr/1975_2003, Accessed 2006
  30. 30.
    Fox, PA 2006Human papillomavirus and anal intraepithelial neoplasiaCurr Opinions Infect Dis196266CrossRefGoogle Scholar
  31. 31.
    Chin-Hong, PV, Vittinghoff, E, Cranston, RD,  et al. 2005Age-related prevalence of anal cancer precursors in homosexual men: the explore studyJ Natl Cancer Inst97896905PubMedCrossRefGoogle Scholar
  32. 32.
    Goldie, SJ, Kuntz, KM, Weinstein, MC,  et al. 2000Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in HIV-negative homosexual and bisexual menAm J Med108631641CrossRefGoogle Scholar
  33. 33.
    Rome, RM, England, PG 2000Management of vaginal intraepithelial neoplasia: a series of 132 cases with long-term follow-upInt J Gynecol Cancer10382390PubMedCrossRefGoogle Scholar
  34. 34.
    Devaraj, B, Cosman, BC 2006Expectant management of anal squamous dysplasia in patients with HIVDis Colon Rectum493640PubMedCrossRefGoogle Scholar
  35. 35.
    Ortholan, C, Ramaioli, A, Peiffert, D,  et al. 2005Anal canal carcinoma: early-stage tumors ≤10 mm (T1 or TIS). Therapeutic options and original pattern of local failure after radiotherapyInt J Radiat Oncol Biol Phys62479485PubMedCrossRefGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2007

Authors and Affiliations

  • Stephen E. Goldstone
    • 1
    Email author
  • Joshua S. Hundert
    • 1
  • Jeff W. Huyett
    • 1
  1. 1.Department of SurgeryMount Sinai School of MedicineNew YorkUSA

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