Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men

The incidence of human papillomavirus (HPV)–associated anal cancer in men who have sex with men (MSM) is striking and has not been mitigated by the use of highly active antiretroviral therapy. Detection and treatment of high-grade anal intraepithelial neoplasia (HGAIN) may reduce the incidence of anal cancer. Anal cytology is a useful tool to detect HGAIN; annual screening of HIV-positive MSM and biennial screening of HIV-negative MSM appears to be cost-effective. MSM with abnormal cytology should be referred for high-resolution anoscopy and biopsy. Individuals with HGAIN should receive treatment; treatment modalities for HGAIN demonstrate moderate efficacy and are usually well tolerated, but greater study is required to determine which treatment is optimal. Large prospective studies are needed to document the efficacy of screening and treatment of HGAIN on anal cancer incidence. The HPV vaccine holds promise for primary prevention of anal cancer in MSM, but significant implementation challenges remain

Analysis of TaqMan Array Cards Data by an Assumption-Free Improvement of the maxRatio Algorithm Is More Accurate than the Cycle-Threshold Method

<div><p>Quantitative PCR diagnostic platforms are moving towards increased sample throughput, with instruments capable of carrying out thousands of reactions at once already in use. The need for a computational tool to reliably assist in the validation of the results is therefore compelling. In the present study, 328 residual clinical samples provided by the Public Health England at Addenbrooke's Hospital (Cambridge, UK) were processed by TaqMan Array Card assay, generating 15 744 reactions from 54 targets. The amplification data were analysed by the conventional cycle-threshold (CT) method and an improvement of the <i>maxRatio</i> (MR) algorithm developed to filter out the reactions with irregular amplification profiles. The reactions were also independently validated by three raters and a consensus was generated from their classification. The inter-rater agreement by Fleiss' kappa was 0.885; the agreement between either CT or MR with the raters gave Fleiss' kappa 0.884 and 0.902, respectively. Based on the consensus classification, the CT and MR methods achieved an assay accuracy of 0.979 and 0.987, respectively. These results suggested that the assumption-free MR algorithm was more reliable than the CT method, with clear advantages for the diagnostic settings.</p></div

The LAST Project and the diagnostic bottom line.

The LAST Project's consensus recommendations for terminology and biomarker use to improve the accuracy and reproducibility of histopathological diagnoses for HPV-associated squamous intraepithelial lesions of the lower anogenital tract are reviewed

The LAST Project and the diagnostic bottom line.

The LAST Project's consensus recommendations for terminology and biomarker use to improve the accuracy and reproducibility of histopathological diagnoses for HPV-associated squamous intraepithelial lesions of the lower anogenital tract are reviewed

Classification of anal squamous intraepithelial lesions: 2-tiered terminology and the quest to reduce the incidence of anal cancer among at-risk individuals

The incidence of anal cancer is increasing in the general population among both men and women. Its incidence is particularly high among certain risk groups such as men who have sex with men and individuals immunosuppressed because of HIV infection. In recognition of the similarity in the biology of anal cancer and human papillomavirus-associated cancer elsewhere in the genital tract, the Lower Anogenital Squamous Terminology project recommended that terminology for lesions be standardized across the anogenital tract, including the anus. Thus, a 2-tier system is recommended, with anal low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesion (HSIL) replacing older terminology. Anal cytology and histopathology use the same 2-tier terminology. Anal LSIL is not believed to be precancerous, whereas HSIL is likely the anal cancer precursor. As at other genital sites, p16 staining is recommended for lesions that are morphologically difficult to distinguish between LSIL and HSIL, and between HSIL and squamous metaplasia when necessary. Performance of anal cytology and high-resolution anoscopy-guided biopsy is performed similarly to procedures in the cervix. Identification and treatment of anal HSIL may reduce the risk of anal cancer, as at other genital tract sites, although this has not yet been formally demonstrated. Likewise, superficially invasive squamous cell carcinoma of the anus is defined similarly to superficially invasive squamous cell carcinoma elsewhere in the genital tract, but the utility of this diagnosis to guide treatment options has not yet been demonstrated. Copyright © 2013 by Lippincott Williams &amp; Wilkins