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Infrared Coagulator™: A Useful Tool for Treating Anal Squamous Intraepithelial Lesions

  • Original Contribution
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Diseases of the Colon & Rectum

PURPOSE

The incidence of invasive anal squamous carcinoma in men who have sex with men is rising, particularly in those with human immunodeficiency virus. As in the cervix the high-grade squamous intraepithelial lesion is thought to be an invasive squamous cell carcinoma precursor. Cervical high-grade squamous intraepithelial lesions are treated by removing the squamocolumnar transition zone. This is not possible in the anus, where treatment is often surgical and is accompanied by significant pain and morbidity. Better office-based techniques to treat anal high-grade squamous intraepithelial lesions are needed. We employed the infrared coagulator™ in an office setting to ablate high-grade squamous intraepithelial lesions.

METHODS

A retrospective review of medical records was performed on 68 human immunodeficiency virus-positive men who have sex with men who underwent infrared coagulator™ ablation of biopsy-proven high-grade dysplasia from the time we began using the procedure in 1999. All patients have had at least six months of follow-up. Procedures were performed with local anesthesia on patients with discrete high-grade squamous intraepithelial lesions. Follow-up consisted of anal cytology with high-resolution anoscopy and biopsy of suspicious areas every three to six months. New or recurrent high-grade dysplasia was retreated. Patients with circumferential or bulky disease were treated in the operating room and were excluded from the study.

RESULTS

Altogether, 68 patients met the enrollment criteria. The median patient age was 41 years (range 29–62 years). A total of 165 lesions were treated (mean 1.6 lesions, range 1–5) and only 46 (28 percent) persisted. However, 44 patients (65 percent) developed a new or persistent high-grade squamous intraepithelial lesion within a median time of 217 days (range 27–566 days) after infrared coagulation. The remaining 24 patients (35 percent) were free of high-grade dysplasia for a median of 413 days (range 162–1313 days) after infrared coagulation. When patients were treated a second or third time, the incidence of new or persistent high-grade dysplasia dropped to 58 percent and 40 percent, respectively. The probability of curing a retreated lesion was 72 percent. Using generalized estimating equations, the incidence of high-grade dysplasia decreased with repeated infrared coagulator™ treatments. No patient developed squamous-cell carcinoma, had a serious adverse event, or developed anal stenosis.

CONCLUSIONS

The infrared coagulator™ is a safe, office-based modality for treating anal high-grade squamous intraepithelial lesion in human immunodeficiency virus-positive men who have sex with men. Successive treatments led to decreased recurrence rates.

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REFERENCES

  1. Ries LA, Eisner MP, Kosary CL, et al (eds). SEER cancer statistics review, 1975-2000, National Cancer Institute. Bethesda, MD: http://seer.cancer.gov/csr/1975_2000, 2003

  2. M Melbye TR Cote L Kessler et al. (1994) ArticleTitleHigh incidence of anal cancer among AIDS patients Lancet 343 636–9 Occurrence Handle10.1016/S0140-6736(94)92636-0 Occurrence Handle1:STN:280:DyaK2c7lvVGhsw%3D%3D Occurrence Handle7906812

    Article  CAS  PubMed  Google Scholar 

  3. JJ Goedert TR Cote P Virgo et al. (1998) ArticleTitleSpectrum of AIDS-associated malignant disorders Lancet 351 1833–9 Occurrence Handle1:STN:280:DyaK1czhsVOktg%3D%3D Occurrence Handle9652666

    CAS  PubMed  Google Scholar 

  4. GJ Chang JM Berry N Jay JM Palefsky ML Welton (2002) ArticleTitleSurgical treatment of high-grade anal squamous intraepithelial lesions: a prospective study Dis Colon Rectum 45 453–8 Occurrence Handle12006924

    PubMed  Google Scholar 

  5. RD Cress EA Holley (2003) ArticleTitleIncidence of anal cancer in California: increases incidence among men in San Francisco, 1973-1999 Prev Med 36 555–60 Occurrence Handle12689800

    PubMed  Google Scholar 

  6. JM Palefsky EA Holly ML Ralston N Jay JM Berry TM Darragh (1998) ArticleTitleHigh incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men AIDS 12 495–503 Occurrence Handle10.1097/00002030-199805000-00011 Occurrence Handle1:STN:280:DyaK1c3gt1Cmsg%3D%3D Occurrence Handle9543448

    Article  CAS  PubMed  Google Scholar 

  7. JM Palefsky (1999) ArticleTitleAnal squamous intraepithelial lesions: relation to HIV and human papillomavirus infection J Acquir Immune Defic Syndr 21 S42–8 Occurrence Handle10430218

    PubMed  Google Scholar 

  8. CW Critchlow CM Surawicz KK Holmes et al. (1995) ArticleTitleProspective study of high grade anal squamous intraepithelial neoplasia in a cohort of homosexual men: influence of HIV infection, immunosuppression and human papillomavirus infection AIDS 9 1255–62 Occurrence Handle1:STN:280:DyaK287is1Wrsg%3D%3D Occurrence Handle8561979

    CAS  PubMed  Google Scholar 

  9. JM Palefsky EA Holly ML Ralston et al. (1998) ArticleTitleHigh incidence of high grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men AIDS 12 495–503 Occurrence Handle10.1097/00002030-199805000-00011 Occurrence Handle1:STN:280:DyaK1c3gt1Cmsg%3D%3D Occurrence Handle9543448

    Article  CAS  PubMed  Google Scholar 

  10. Galloway DA. Biology of human papillomaviruses. In: Holmes K, Mardh P, Sparling P, eds. Sexually transmitted diseases. New York: McGraw-Hill, 1999:335–46

  11. AP Zbar C Fenger M Beer-Gabel et al. (2002) ArticleTitleThe pathology and molecular biology of anal intraepithelial neoplasia: comparisons with cervical and vulvar intraepithelial carcinoma Int J Colorectal Dis 17 203–15 Occurrence Handle1:STN:280:DC%2BD38zivFKgsA%3D%3D Occurrence Handle12073068

    CAS  PubMed  Google Scholar 

  12. AB Williams TM Darragh K Vranizan et al. (1994) ArticleTitleAnal and cervical human papillomavirus infection and risk of anal and cervical epithelial abnormalities in human immunodeficiency virus-infected women Obstet Gynecol 3 205–11

    Google Scholar 

  13. VR Litle JD Leavenworth TM Darragh et al. (2000) ArticleTitleAngiogenesis, proliferation, and apoptosis in anal high-grade squamous intraepithelial lesions Dis Colon Rectum 43 346–52 Occurrence Handle1:STN:280:DC%2BD3c7psFamtg%3D%3D Occurrence Handle10733116

    CAS  PubMed  Google Scholar 

  14. JM Palefsky EA Holly ML Ralston et al. (2001) ArticleTitleEffect of highly active antiretroviral therapy on the natural history of anal squamous intraepithelial lesions and anal human papillomavirus infection J Acquir Immune Defic Syndr 28 422–8 Occurrence Handle1:CAS:528:DC%2BD38XltVKktA%3D%3D Occurrence Handle11744829

    CAS  PubMed  Google Scholar 

  15. E Holley M Ralston T Darrah et al. (2001) ArticleTitlePrevalence and risk factors for anal squamous intraepithelial lesions in women J Natl Cancer Inst 93 843–9 Occurrence Handle11390533

    PubMed  Google Scholar 

  16. DR Tate RJ Anderson (2002) ArticleTitleRecrudescence of cervical dysplasia among women who are infected with human immunodeficiency virus: a case-control analysis Am J Obstet Gynecol 186 880–2 Occurrence Handle12015501

    PubMed  Google Scholar 

  17. SE Goldstone B Winkler LJ Ufford E Alt JM Palefsky (2001) ArticleTitleHigh prevalence of anal squamous intraepithelial lesions and squamous-cell carcinoma in men who have sex with men as seen in a surgical practice Dis Colon Rectum 44 690–8 Occurrence Handle1:STN:280:DC%2BD3M3ptFKlug%3D%3D Occurrence Handle11357031

    CAS  PubMed  Google Scholar 

  18. GJ Chang JM Berry N Jay JM Palefsky ML Welton (2002) ArticleTitleSurgical treatment of high-grade anal squamous intraepithelial lesions: a prospective study Dis Colon Rectum 45 453–8 Occurrence Handle12006924

    PubMed  Google Scholar 

  19. G Nath (1981) ArticleTitleThe new principle of infrared coagulation in medicine and its physical fundamentals Coloproctology 3 379–81

    Google Scholar 

  20. Z Bekassy L Westrom (1987) ArticleTitleInfrared coagulation in the treatment of condyloma accuminata in the female genital tract Sex Transm Dis 14 209–12 Occurrence Handle1:STN:280:DyaL1c7ksFyjsg%3D%3D Occurrence Handle3438785 Occurrence Handle10.1097/00007435-198710000-00006

    Article  CAS  PubMed  Google Scholar 

  21. JF Johanson A Rimm (1992) ArticleTitleOptimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation and injection sclerotherapy Am J Gastroenterol 87 1601–6

    Google Scholar 

  22. NS Ambrose D Morris J Alexander-Williams et al. (1985) ArticleTitleA randomized trial of photocoagulation or injection sclerotherapy for the treatment of first- and second-degree hemorrhoids Dis Colon Rectum 28 238–40 Occurrence Handle1:STN:280:DyaL2M7ltlKgtw%3D%3D Occurrence Handle3884297

    CAS  PubMed  Google Scholar 

  23. W Grunberger E Kubista R Ulm (1983) ArticleTitleClinical experience with infrared coagulation in treating benign alterations of the cervix Gynakol Prax 7 115–21

    Google Scholar 

  24. N Jay JM Berry CJ Hogeboom et al. (1997) ArticleTitleColposcopic appearance of anal squamous intraepithelial lesions: relationship to histopathology Dis Colon Rectum 40 919–28 Occurrence Handle1:STN:280:DyaK2svhtleqsQ%3D%3D Occurrence Handle9269808

    CAS  PubMed  Google Scholar 

  25. Solomon D, Nayar R, eds. The Bethesda system for reporting cervical cytology: definitions, criteria and explanatory notes. 2nd ed. New York: Springer-Verlag, 2004:169–74

  26. MI Welton A Amerhaauser V Litle et al. (2001) ArticleTitleAnal Bowen’s disease and high-grade squamous intraepithelial lesions are histologically and immunohistochemically indistinguishable [meeting abstract] Dis Colon Rectum 44 A32

    Google Scholar 

  27. DE Beck VW Fazio DG Jaelman IC Lavery (1988) ArticleTitlePerianal Bowen’s disease Dis Colon Rectum 31 419–22 Occurrence Handle1:STN:280:DyaL1c3kt1elsg%3D%3D Occurrence Handle3288448

    CAS  PubMed  Google Scholar 

  28. RG Fruchter M Maman A Sedlis et al. (1996) ArticleTitleMultiple recurrences of cervical intraepithelial neoplasia in women with the human immunodeficiency virus Obstet Gynecol 87 338–44 Occurrence Handle1:STN:280:DyaK287ns1Crug%3D%3D Occurrence Handle8598951

    CAS  PubMed  Google Scholar 

  29. K Holcomb RP Matthews JE Chapman et al. (1999) ArticleTitleThe efficacy of cervical conization in the treatment of cervical intraepithelial neoplasia in HIV-positive women Gynecol Oncol 74 428–31 Occurrence Handle1:STN:280:DyaK1MvhtVeltA%3D%3D Occurrence Handle10479504

    CAS  PubMed  Google Scholar 

  30. Nelson H, Dozois RR. Anus. In: Townsend CM, ed. Sabiston textbook of surgery. Philadelphia: Saunders, 2001:988

  31. MJ Godley CS Bradbeer M Gellan et al. (1987) ArticleTitleCryotherapy compared with trichloroacetic acid in treating genital warts Genitourin Med 63 390–2 Occurrence Handle1:STN:280:DyaL1c7htlKqsg%3D%3D Occurrence Handle3323028

    CAS  PubMed  Google Scholar 

  32. SK Tyring I Arany M Stanley et al. (1998) ArticleTitleA randomized, controlled, molecular study of condylomata accuminata clearance during treatment with imiquimod J Infect Dis 178 551–5 Occurrence Handle1:CAS:528:DyaK1cXlsV2hsLc%3D Occurrence Handle9697742

    CAS  PubMed  Google Scholar 

  33. SE Goldstone JM Palefsky MT Winnett JR Neefe (2002) ArticleTitleActivity of HspE7, a novel immunotherapy, in patients with anogenital warts Dis Colon Rectum 45 502–7 Occurrence Handle12006932

    PubMed  Google Scholar 

  34. F Sharp S Duffy (1990) ArticleTitleSquamous cervical intraepithelial neoplasia: the role of laser treatment Ann Chir Gynaecol 79 225–30 Occurrence Handle1:STN:280:DyaK3MzksFaqtg%3D%3D Occurrence Handle2102640

    CAS  PubMed  Google Scholar 

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ACKNOWLEDGMENTS

The authors thank Dr. Barbara Winkler for her time and guidance with the pathology and cytology and Erin Moshier, M.A. for her help with the statistical analysis in this study.

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Authors and Affiliations

  1. Department of Surgery, Mount Sinai School of Medicine, New York, New York

    Stephen E. Goldstone M.D., Adam Z. Kawalek M.D. & Jeff W. Huyett M.S., A.P.R.N. B.C.

Authors
  1. Stephen E. Goldstone M.D.
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  2. Adam Z. Kawalek M.D.
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  3. Jeff W. Huyett M.S., A.P.R.N. B.C.
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Corresponding author

Correspondence to Stephen E. Goldstone M.D..

Additional information

This retrospective chart review was performed on patients treated at the first author’s surgical practice in New York City. It was supported in part by supply of the infrared coagulator™ furnished by Redfield Corporation, Rochelle Park, New Jersey. Adam Kawalek’s participation was partially funded through the Mount Sinai School of Medicine Alumni Summer Research Fellowship.

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Goldstone, S., Kawalek, A. & Huyett, J. Infrared Coagulator™: A Useful Tool for Treating Anal Squamous Intraepithelial Lesions. Dis Colon Rectum 48, 1042–1054 (2005). https://doi.org/10.1007/s10350-004-0889-0

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