1 Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania2 Division of Colorectal Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania3 Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania
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BACKGROUND:The gold standard for surveillance of patients with anal lesions is unclear.OBJECTIVE:The aim of this study was to stratify patients for risk of progression of disease and to determine appropriate intervals for surveillance of patients with anal disease.DESIGN:This was a retrospective chart review for patients treated for anal lesions between 2007 and 2014. Only patients with ≥1 year of follow-up from index evaluation, pathology, documented physical examination, and anoscopy findings were included for analysis.SETTINGS:The study was conducted at an urban university hospital.PATIENTS:HIV-positive patients with anal lesions treated with excision and fulguration were included.MAIN OUTCOME MEASURES:Recurrence of anal lesions, progression of disease, and progression to cancer were measured.RESULTS:Ninety-one patients met inclusion criteria. The mean age was 41.6 years, and mean follow-up was 38.6 months (range, 11.0–106.0 mo). On initial pathology, 8 patients (8.8%) had a diagnosis of condyloma acuminatum without dysplasia, 20 patients (22%) had anal intraepithelial neoplasia I, 32 (35.2%) had anal intraepithelial neoplasia II, and 31 (34.1%) had anal intraepithelial neoplasia III. Sixty-nine patients (75.8%) had repeat procedures. Seven (87.5%) of 8 patients with condyloma and 6 (30%) of 20 patients with anal intraepithelial neoplasia I progressed to high-grade lesions. Five (15.6%) of 32 patients progressed from anal intraepithelial neoplasia II to III, and 2 patients with anal intraepithelial neoplasia III (6.5%) developed squamous cell carcinoma (2.3% for the entire cohort).LIMITATIONS:This was a single institution study. High-resolution anoscopy was not used.CONCLUSIONS:All of the HIV-positive patients with condyloma or anal intraepithelial neoplasia, regardless of the presence of dysplasia, should be surveyed at equivalent 3-month time intervals, because their risk of progression of disease is high. Video Abstract at http://links.lww.com/DCR/A389.