Anal chromoendoscopy using gastroenterological video-endoscopes: A new method to perform high resolution anoscopy for diagnosing intraepithelial neoplasia and anal carcinoma in HIV-infected patients

Abstract

Introduction Anal carcinoma represents an increasing problem in HIV-infected patients. Anal intraepithelial neoplasia (AIN), the precursor lesion, is currently diagnosed by high-resolution anoscopy (HRA) using optical magnification derived from gynecological colposcopy. This prospective study evaluates anal chromoendoscopy (ACE) using standard gastroenterological video-endoscopes in diagnosing AIN.

Methods After clinical examination, proctoscopy and surface staining with acetic acid followed by Lugol’s solution, ACE was performed with a mucosectomy cap on the tip of the endoscope. Biopsy specimens were collected from areas with a pathological staining pattern and from areas with normal appearance; combined results were considered as reference.

Results Two hundred eleven HIV-positive patients seen between 2007 and 2013 were evaluated. Of these, 95.7 % were males, and the median age was 45 years. In 86.7 %, the mode of HIV transmission was sex among males. Combination antiretroviral treatment was applied in 75.8 %. The sensitivity of ACE in diagnosing AIN was 0.85, the specificity was 0.55, the positive predictive value was 0.50, and the negative predictive value (NPV) was 0.87. Diagnostic performance increased in individuals with high-grade lesions (NPV: 0.99) and in the second study period from 2011 to 2013. Side effects were rare and of minor clinical relevance.

Conclusions Anal chromoendoscopy is safe and effective in diagnosing AIN in a population of HIV-infected patients. It is particularly useful for the exclusion of high-grade lesions that have the strongest risk of progression to anal carcinoma. Therefore, ACE may become a valuable new tool to manage AIN and to prevent anal malignancy in HIV-positive patients.

Zusammenfassung

Einleitung Das Analkarzinom stellt ein zunehmendes Problem bei HIV-infizierten Patienten dar. Seine Vorläuferläsion, die anale intraepitheliale Neoplasie (AIN), wird gegenwärtig durch die hochauflösende Anoskopie (HRA) diagnostiziert, bei der eine gynäkologische Vergrößerungsoptik eingesetzt wird (Kolposkopie). Die vorliegende prospektive Studie untersucht die anale Chromoendoskopie (ACE) mit gastroenterologischen Video-Endoskopen in der Diagnostik der AIN.

Methoden Nach rektal-digitaler Austastung, einer Proktoskopie sowie der Oberflächenfärbung mit Essigsäure und Lugol’scher Lösung wurde die ACE mithilfe einer auf die Endoskopspitze aufgesetzten Mukosektomiekappe durchgeführt. Biopsien wurden von Arealen mit pathologischem Färbeverhalten und von unauffälligen Bezirken entnommen, als Referenz diente die kombinierte Analyse der Biopsiebefunde.

Ergebnisse Von 2007 bis 2013 wurden 211 Patienten eingeschlossen. 95,7 % waren männlich, das mediane Alter betrug 45 Jahre, bei 86,7 % war die HIV-Infektion durch Sex unter Männern erworben, eine kombinierte antiretrovirale Therapie wurde bei 75,8 % angewandt. Die Sensitivität der ACE für die Diagnose der AIN betrug 0,85, die Spezifität 0,55, der positive prädiktive Wert lag bei 0,50 und der negative prädiktive Wert (NPV) bei 0,87. Die diagnostische Ausbeute nahm für Patienten mit hochgradiger Neoplasie (NPV: 0,99) und in der zweiten Studienperiode von 2011 bis 2013 zu. Nebenwirkungen waren selten und von geringer klinischer Relevanz.

Schlussfolgerung Die ACE ist sicher und nützlich in der Diagnostik der AIN bei HIV-Infizierten. Sie ist insbesondere geeignet, um hochgradige anale Läsionen auszuschließen, die mit dem höchsten Risiko eines Progresses zum Karzinom einhergehen. Die ACE hat das Potenzial, zu einer wertvollen Methode des Managements der AIN und der Prävention des Analkarzinoms bei HIV-Positiven zu werden.

Schlüsselwörter

Anale Dysplasien - AIN - AIDS - Proktoskopie

Key words

anal dysplasia - AIN - AIDS - proctoscopy

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