Anal intraepithelial neoplasia: diagnosis, screening, and treatment
Open Access
- 1 January 2019
- journal article
- review article
- Published by Hellenic Society of Gastroenterology in Annals of Gastroenterology
- Vol. 32 (3), 257-263
- https://doi.org/10.20524/aog.2019.0364
Abstract
Anal intraepithelial neoplasia (AIN) is a premalignant lesion for anal cancer. It is more commonly found in high-risk patients (e.g., human papilloma virus (HPV)/human immunodeficiency virus infections, post-organ transplantation patients, and men who have sex with men) and development is driven by HPV infection. The incidence of AIN is difficult to estimate, but is heavily skewed by preexisting conditions, particularly in high-risk populations. The diagnosis is made from cytology or biopsy during routine examinations, and can be performed at a primary care provider's office. A pathologist can then review and classify cells, based on nucleus-to-cytoplasm ratios. The classification of low or high grade can better predict progression from AIN to anal cancer. There is little debate that AIN can develop into anal cancer, and the main rationale for treatment is to delay the progression. Significant controversy remains regarding screening, surveillance, and treatment for AIN. Management options are separated into surveillance (watchful waiting) and interventional strategies. Emerging data suggest that close patient follow up with a combination of ablative and topical treatments may offer the greatest benefit. HPV vaccination offers a unique treatment prior to HPV infection and the subsequent development of AIN, but its use after the development of AIN is limited. Ablative treatment includes excision, fulguration, and laser therapy.Keywords
This publication has 56 references indexed in Scilit:
- Progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions in HIV-infected and uninfected menAIDS, 2013
- Current treatment options for management of anal intraepithelial neoplasiaOncoTargets and Therapy, 2013
- Human papillomavirus and cervical cancerThe Lancet, 2013
- HIV Infection Alters the Spectrum of HPV Subtypes Found in Cervical Smears and Carcinomas from Kenyan WomenThe Open Virology Journal, 2013
- HPV infection, anal intra-epithelial neoplasia (AIN) and anal cancer: current issuesBMC Cancer, 2012
- Practising high-resolution anoscopySexual Health, 2012
- HPV Vaccine against Anal HPV Infection and Anal Intraepithelial NeoplasiaNew England Journal of Medicine, 2011
- A double-blind, randomized controlled trial of the use of imiquimod cream for the treatment of anal canal high-grade anal intraepithelial neoplasia in HIV-positive MSM on HAART, with long-term follow-up data including the use of open-label imiquimodAIDS, 2010
- Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with MenCurrent Infectious Disease Reports, 2010
- Incidence of Non-AIDS-Defining Malignancies in HIV-Infected Versus Noninfected Patients in the HAART Era: Impact of ImmunosuppressionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2009