Skip to main content
SpringerLink
Log in

Colposcopic appearance of anal squamous intraepithelial lesions

Relationship to histopathology

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The incidence of anal cancer is increased in men with a history of anal receptive intercourse. Analogous to cervical cancer, whose precursor is cervical high-grade squamous intraepithelial lesion (HSIL), anal cancer may be preceded by anal HSIL. Although not yet proven, detection, follow-up, and treatment of HSIL may prevent development of anal cancer. Cervical colposcopic methodology was used to describe anal lesions and to determine if HSIL could be distinguished from low-grade squamous intraepithelial lesion (LSIL). METHODS; The colposcopic characteristics of 385 biopsied anal lesions were described and correlated with results of histopathology in a cohort of 121 human immunodeficiency virus-positive and 31 human immunodeficiency-negative homosexual/bisexual men with anal lesions followed as part of a longitudinal study of anal squamous intraepithelial lesions. Color, contour, surface, and vascular patterns of anal lesions were analyzed and correlated with histologic diagnosis. RESULTS: Sixty-seven percent of biopsies showed LSIL and 26 percent showed HSIL. The positive predictive value for anal HSIL in lesions with characteristics typical of cervical LSIL was 7.7 percent (95 percent confidence interval, 1.8–14), whereas the positive predictive value for anal HSIL in lesions with characteristics typical of cervical HSIL was 49 percent (95 percent confidence interval, 40–58). CONCLUSIONS: The colposcopic appearance of different grades of anal squamous intraepithelial lesions was similar to those described for the cervix. Incorporation of colposcopy into assessment of anal disease could aid in distinguishing anal LSIL from HSIL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Daling JR, Weiss NS, Hislop TG,et al. Sexual practices, sexually transmitted of anal cancer. N Engl J Med 1987;317:973–7.

    Article  PubMed  CAS  Google Scholar 

  2. Rabkin CS, Yellin F. Cancer incidence in a population with a high prevalence of infection with human immunodeficiency virus type 1. J Natl Cancer Inst 1994;86:1711–6.

    PubMed  CAS  Google Scholar 

  3. Melbye M, Cote TR, Kessler L, Gail M, Biggar RJ. High incidence of anal cancer among AIDS patients. Lancet 1994;343:636–9.

    Article  PubMed  CAS  Google Scholar 

  4. Scholefield JH, Sonnex C, Talbot IC,et al. Anal and cervical intraepithelial neoplasia: possible parallel. Lancet 1989;2:765–9.

    Article  PubMed  CAS  Google Scholar 

  5. Palefsky JM, Holly EA, Gonzales J, Berline J, Ahn DK, Greenspan JS. Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res 1991;51:1014–9.

    PubMed  CAS  Google Scholar 

  6. Kiviat N, Critchlow C, Holmes K,et al. Association of anal dysplasia and human papillomavirus with immunosuppression and HIV infection among homosexual men. AIDS 1993;7:43–9.

    PubMed  CAS  Google Scholar 

  7. de Ruiter A, Carter P, Katz DR,et al. A comparison between cytology and histology to detect anal intraepithelial neoplasia. Genitourin Med 1994;70:22–5.

    PubMed  Google Scholar 

  8. Palefsky J. Anal cancer in HIV-positive individuals: an emerging problem. AIDS 1994;8:283–95.

    PubMed  CAS  Google Scholar 

  9. Williams AB, Darragh TM, Vranizan K, Ochia C, Moss AR, Palefsky JM. Anal and cervical human papillomavirus infection and risk of anal and cervical epithelial abnormalities in human immunodeficiency virusinfected women. Obstet Gynecol 1994;83:205–11.

    PubMed  CAS  Google Scholar 

  10. Foust RL, Dean PJ, Stoler MH, Moinuddin SM. Intraepithelial neoplasia of the anal canal in hemorrhoidal tissue: a study of 19 cases. Hum Pathol 1991;22:528–34.

    Article  PubMed  CAS  Google Scholar 

  11. Syrjanen SM, von Krogh G, Syrjanen KJ. Anal condylomas in men. 1. Histopathological and virological assessment. Genitourin Med 1989;65:216–24.

    PubMed  CAS  Google Scholar 

  12. Nash G, Allen W, Nash S. Atypical lesions of the anal mucosa in homosexual men. JAMA 1986;256:873–6.

    Article  PubMed  CAS  Google Scholar 

  13. Puy-Montbrun T, Denis J, Ganansia R, Mathoniere F, Lemarchand N, Arnous-Dubois N. Anorectal lesions in human immunodeficiency virus-infected patients. Int J Colorectal Dis 1992;7:26–30.

    Article  PubMed  CAS  Google Scholar 

  14. Fenger C, Nielsen VT. Intraepithelial neoplasia in the anal canal. Acta Pathol Microbiol Immunol Scand [A] 1986;94:343–9.

    CAS  Google Scholar 

  15. Tsunoda A, Talbot IC, Nicholls RJ. Incidence of dysplasia in the anorectal mucosa in patients having restorative proctocolectomy. Br J Surg 1990;77:506–8.

    PubMed  CAS  Google Scholar 

  16. Miles AJ, Mellor CH, Gazzard B, Allen-Mersh TG, Wastell C. Surgical management of anorectal disease in HIV-positive homosexuals. Br J Surg 1990;77:869–71.

    PubMed  CAS  Google Scholar 

  17. Richart RM, Barron BA. A follow-up study of patients with cervical dysplasia. Am J Obstet Gynecol 1969;105:386–93.

    PubMed  CAS  Google Scholar 

  18. McIndoe WA, McLean MR, Jones RW, Mullins PR. The invasive potential of carcinomain situ of the cervix. Obstet Gynecol 1984;64:451–8.

    PubMed  CAS  Google Scholar 

  19. Campion MJ, McCance DJ, Cuzick J, Singer A. Progressive potential of mild cervical atypia: prospective cytological, colposcopic and virological study. Lancet 1986;2:236–40.

    Google Scholar 

  20. Petersen O. Spontaneous course of cervical precancerous conditions. Am J Obstet Gynecol 1956;72:1063–71.

    PubMed  CAS  Google Scholar 

  21. Coppleson M, Pixley E, Reid B. Colposcopy: a scientific and practical approach to the cervix, vagina, vulva in health and disease. 4th ed. Springfield: Charles C Thomas, 1986.

    Google Scholar 

  22. Reid R, Campion MJ. HPV-associated lesions of the cervix: biology and colposcopic features. Clin Obstet Gynecol 1989;32:157–79.

    PubMed  CAS  Google Scholar 

  23. Palefsky JM, Gonzales J, Greenblatt RM, Ahn DK, Hollander H. Anal intraepithelial neoplasia and anal papillomavirus infection among homosexual males with group IV HIV disease. JAMA 1990;263:2911–6.

    Article  PubMed  CAS  Google Scholar 

  24. Kurman RJ, Solomon D. The Bethesda system for reporting cervical/vaginal cytologic diagnoses: definitions, criteria, and explanatory notes for terminology and specimen adequacy. New York: Springer-Verlag, 1994.

    Google Scholar 

  25. Wright TC, Kurman RJ, Ferenczy A. Precancerous lesions of the cervix. In: Kurman RJ, ed. Blaustein's pathology of the female genital tract. 4th ed. New York: Springer-Verlag, 1994:229–77.

    Google Scholar 

  26. Sonnex C, Scholefield JH, Kocjan G,et al. Anal human papillomavirus infection: a comparative study of cytology, colposcopy and DNA hybridisation as methods of detection. Genitourin Med 1991;67:21–5.

    PubMed  CAS  Google Scholar 

  27. Surawicz CM, Kirby P, Critchlow C, Sayer J, Dunphy C, Kiviat N. Anal dysplasia in homosexual men: role of anoscopy and biopsy. Gastroenterology 1993;105:658–66.

    PubMed  CAS  Google Scholar 

  28. Scholefield JH, Ogunbiyi OA, Smith JH, Rogers K, Sharp F. Anal colposcopy and the diagnosis of anal intraepithelial neoplasia in high-risk gynecologic patients. Int J Gynecol Cancer 1994;4:119–26.

    Article  PubMed  Google Scholar 

  29. Surawicz CM, Crithclow C, Sayer J,et al. High grade anal dysplasia in visually normal mucosa in homosexual men: seven cases. Am J Gastroenterol 1995;90:1776–8.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Laboratory Medicine, University of California, San Francisco, Box 0100, 94143-0100, San Francisco, California

    Naomi Jay R.N.P., M.S. &  Joel M. Palefsky M.D.

  2. Departments of Stomatology, University of California, San Francisco, San Francisco, California

    J. Michael Berry M.D.

  3. Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California

    Charissa J. Hogeboom M.A. & Elizabeth A. Holly Ph.D., M.P.H.

  4. Departments of Pathology, University of California, San Francisco, San Francisco, California

    Teresa M. Darragh M.D.

Authors
  1. Naomi Jay R.N.P., M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Michael Berry M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charissa J. Hogeboom M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth A. Holly Ph.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teresa M. Darragh M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joel M. Palefsky M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by Grants NCI R01CA54053 and by funds provided by the Cigarette and Tobacco Surtax Fund of the State of California through the Tobacco Related Diseases Research Program of the University of California (Grant RT484). These studies were performed in the General Clinical Research Center, University of California, San Francisco, with funds provided by the Division of Research Resources 5 M01-RR-00079, United States Public Health Service.

About this article

Cite this article

Jay, N., Berry, J.M., Hogeboom, C.J. et al. Colposcopic appearance of anal squamous intraepithelial lesions. Dis Colon Rectum 40, 919–928 (1997). https://doi.org/10.1007/BF02051199

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02051199

Key words

Search

Navigation