To continue on the trail of events that marked the month of November, we want to delve into one of the most important topics in proctology concerning Sexually Transmitted Infections, and specifically, HPV: High-Resolution Anoscopy. The High Resolution Anoscopy (HRA) procedure represents a milestone in modern medicine for the diagnosis and management of anal lesions. It is the only globally recognized diagnostic technique for the early diagnosis of squamous cell carcinoma of the anus and benign forms that can transform into carcinoma over time.
HPV and anal carcinoma
Anus canal neoplasia originates from the orifice, the terminal part of the intestine. It is a relatively rare tumor but has seen a significant increase in recent years. In Italy, just over 1,000 cases are reported each year, with 450 in men and 650 in women (data available in ‘The Numbers of Cancer in Italy 2016’). One of the main risk factors for anal cancer is infection with Human Papillomavirus (HPV), also responsible for other tumors, particularly cervical cancer. Similar to the Pap test conducted in gynecology, proctology also employs an anal Pap test to detect the presence of HPV in the anal canal and identify its various viral strains. However, due to the low sensitivity of this tool (ranging from 69% to 93%), the most commonly accepted method is High-Resolution Anoscopy.
Technology and procedure behind HRA
High-Resolution Anoscopy (HRA) utilizes state-of-the-art tools to obtain extremely high-resolution images of the anal area. It stands out for its ability to provide an exceptionally detailed visual of the anal mucosa, revealing even the subtlest alterations and lesions that might escape direct observation or other diagnostic techniques, such as traditional anoscopy. This high level of precision makes HRA a fundamental ally for proctologists involved in the diagnosis and management of anal pathologies. The procedure lasts a few minutes, is painless, and is performed on an outpatient basis without the use of anesthesia. By employing substances such as acetic acid and Lugol’s solution (iodine dissolved in water), the proctologist can identify anal lesions in a pre-cancerous stage and perform a biopsy to precisely identify the nature and stage of the lesions.
Who is High-Resolution Anoscopy for?
High-Resolution Anoscopy is recommended for:
1. Patients with potentially dangerous lesions, such as condylomas.
2. Patients with suspicious lesions for neoplasia.
3. Patients falling into the risk category for Human Papillomavirus (HPV), including:
- Individuals with HIV infection, who have a two to six times higher likelihood of contracting a co-infection with HPV, thereby increasing the risk of developing cancerous forms of the anal canal.
- Homosexual men.
- Immunocompromised individuals, for example, those who have undergone organ transplantation.
- Women with a history of cervical carcinoma. Depending on age and risk level, High-Resolution Anoscopy is recommended for all HPV-positive women, with appropriate follow-up thereafter.
The early diagnosis and benefits for patients
One of the distinctive advantages of HRA is its ability to detect lesions in the early stages of development. This is crucial in the context of anal pathologies, where an early diagnosis can make a difference in the treatment and improvement of the patient’s health outlook. The introduction of HRA has significantly enhanced the patient experience, reducing the need for invasive procedures and enabling a quicker and more effective diagnosis.