Abstract
High-resolution anoscopy (HRA) is a form of low-resolution anal microscopy currently
utilized in the screening and management of anal squamous dysplasia. No randomized
controlled trials, national or international guidelines exist on the use of HRA for
this purpose. Much of our understanding of this entity has been adapted from the literature
on cervical squamous dysplasia, including the technique of HRA itself. Epidemiologic
evidence has shown that the prevalence and incidence of anal dysplasia is highest
in HIV-positive populations. The history of this technique parallels the evolution
of our understanding of anal dysplasia. To understand the history of the use of HRA
and its place in the screening and management of anal squamous dysplasia, we discuss
key advances in the understanding of human papillomavirus–related squamous dysplasia.
We begin with early reports in the field establishing the link between this virus
and squamous dysplasia, through the marked increase in anal cancer seen with the onset
of the HIV epidemic, the identification of relevant populations at risk, the performance
of the test itself, to its use today.
Keywords
high-resolution anoscopy - anal dysplasia - anal cancer - anal intraepithelial lesions
