HPV and proctology
The month of March began with the celebration of the International HPV Awareness Day. On this occasion, we found it important to focus on a crucial examination in proctology, directly related to this condition: High-Resolution Anoscopy (HRA). HRA represents a diagnostic technology of reference in modern medicine, recognized internationally, that enables the early diagnosis of squamous cell anal carcinoma and high-grade precancerous lesions that, if left untreated, can evolve into malignant neoplasms.
Anal canal carcinoma originates from the mucosa of the anal opening, which is the terminal portion of the intestine. Although it is a relatively rare neoplasm, its incidence has significantly increased in recent years. One of the primary causes is infection by Human Papillomavirus (HPV), which is also responsible for other cancers, including cervical carcinoma. Similarly to the Pap test used in gynecology, a version of the Pap test for the anal canal is used in proctology, aimed at detecting HPV and identifying the different viral strains present. However, due to the limited sensitivity of this instrument, which ranges from 69% to 93%, the generally preferred and most commonly accepted method is High-Resolution Anoscopy.
Who is HRA for?
High-Resolution Anoscopy is indicated for:
- Patients with suspicious or potentially dangerous lesions, such as anal warts.
- Patients with anal or genital lesions that raise suspicion of neoplasia.
- Immunocompromised individuals, such as those who have undergone organ transplants.
- HIV-positive patients.
- Men who have sex with men (MSM).
- Women with a history of cervical carcinoma.
- HPV-positive women, based on age and risk level, for whom appropriate follow-up, including High-Resolution Anoscopy, is recommended.
How High-Resolution Anoscopy is performed
High-Resolution Anoscopy is an advanced diagnostic technique that uses state-of-the-art tools to obtain ultra-high-resolution images of the anal area. This method is distinguished by its ability to provide extremely precise details of the anal mucosa, allowing the identification of even the most subtle alterations and lesions that might be missed by direct observation or other diagnostic techniques, such as traditional anoscopy. The procedure takes only a few minutes, is painless, and is performed in an outpatient setting without the need for anesthesia.
The patient, placed in the left lateral position (Sims position) on an examination table, is given a gauze soaked in 3% or 5% acetic acid applied in the anal canal for a few minutes to highlight any alterations. Subsequently, an anoscope is inserted to perform a detailed inspection of the transitional area of the anal canal. At the end of the analysis, Lugol’s solution is applied.
Acetic acid highlights areas indicating dysplasia, turning them white (Acetowhite positivity), while Lugol’s solution will stain abnormal areas differently, which do not stain like normal epithelium. The highlighted areas are then biopsied to confirm the presence of neoplasms or precancerous lesions. If the biopsies are positive for high-grade intraepithelial anal neoplasia (AIN II and III/H-SIL), the lesions are removed by ablation or excision. In the case of low-grade dysplasia (AIN I and L-SIL), the patient will be monitored with periodic check-ups to ensure proper follow-up.
The contents of this page are for informational purposes only and should in no way replace the advice, diagnosis, or treatment prescribed by your physician. Responses to the same treatment may vary from patient to patient. Always consult your doctor regarding any information related to diagnoses and treatments, and meticulously follow their instructions.
