To determine the required learning time for high-resolution anoscopy (HRA)-guided biopsy to detect
histological high-risk squamous intraepithelial lesions (hHSIL) and to identify factors that impact on the training
process.
Methods: All HIV-infected, screening-naïve men-who-have-sex-with-men who underwent HRA conducted by one
single observer from 2010 to 2017 in a Spanish HIV-outpatient clinic were analysed.
Results: Eighty-five (14.7%) of the 581 patients included presented hHSIL. The factors associated with the capacity
to detect hHSIL [adjusted odds ratio (aOR), 95% confidence interval (95%CI)] were the presence of
cytological HSIL (3.04, 1.78–5.21; p < 0.001), infection with high-risk human papilloma virus (HR-HPV) (2.89,
1.38–6.05; p=0.005), the number of biopsies taken/HRA (aOR: 1.28, 1.07–1.52; p=0.006) and tobacco
smoking (1.75; 1.12–2.73; p=0.014). Two events independently augmented the detection rate of hHSIL: one
single experienced pathologist interpreted biopsies after 409 HRA (2.80, 1.74–4.48; p=0.035) and the anoscopist
underwent an additional training after 536 HRA (2.57, 1.07–6.16; p=0.035). A learning process could be
observed throughout the whole study with stable HR-HPV prevalence.
Conclusion: The data support the growing evidence that the proposed training volume of 50–200 performances is
underestimated. Extensive training of both anoscopist and pathologist is warranted and the development of tools to support the diagnostic performance may be considered.Plan Nacional R+D+I y Red de Investigación en SIDA RD16/0025/0020-ISCIII-FEDMiguel Servet research grant, Instituto de Salud Carlos III CPII18/0003
