Published online Sep 25, 2015. doi: 10.4253/wjge.v7.i13.1083
Peer-review started: May 28, 2015
First decision: July 3, 2015
Revised: July 14, 2015
Accepted: September 1, 2015
Article in press: September 2, 2015
Published online: September 25, 2015
Processing time: 122 Days and 1.6 Hours
High-resolution anoscopy (HRA) is a procedure where patients with an increased risk of anal cancer, like men who have sex with men, human immunodeficiency virus infected individuals, transplant patients and women with a history of lower genital tract neoplasia, with abnormal anal cytology results, are submitted to anal and perianal visualization under magnification. This will allow for a better detection of anal high-grade lesions that can be treated, in an effort to prevent anal cancer. Anal cancer screening follows the same principles that cervical cancer screening. During this procedure, an anoscope is inserted and a colposcope is used to examine systematically the squamocolumnar junction, the transformation zone and the perianal skin. Initially the observation is done with no staining and then with the application of acetic acid and Lugol’s iodine solution, allowing for better lesion identification and characterization. Any suspicious lesion seen should be carefully evaluated and biopsied. Without HRA only a small percentage of suspicious lesions are identified. High-grade lesions that are detected can be ablated under HRA. This is a challenging exam to perform, with a long learning curve and the number of clinicians performing it is limited, although the growing number of patients that need to been screened. Specific equipment is required, with these patients ideally been followed by a multidisciplinary team, in a reference centre. HRA remains unfamiliar for many gastroenterologists.
Core tip: High-resolution anoscopy is a procedure where high-risk patients are submitted to anal and perianal visualization under magnification, allowing detection of anal high-grade lesions that can be treated. Anal cancer is histologically and biologically very similar to cervical cancer and the screening follows the same principles. The importance, difficulties and the description of the technique will be discussed. This is a difficult exam to perform, with a long learning curve that requires specific equipment and the need for a multidisciplinary team, ideally in a reference centre. It remains unfamiliar for many gastroenterologists.