High resolution anoscopy for anal intraepithelial neoplasia surveillance: new service delivery in Wales

Abstract Introduction Anal intraepithelial neoplasia (AIN) is a pre-malignant precursor to anal squamous cell carcinoma (SCC). High Resolution Anoscopy (HRA) is utilised in the surveillance of these lesions allowing significant magnification and inspection of the perianal, vulval and anal squamous epithelium to obtain targeted biopsies from areas of suspicion. We present the experience of Wales's first HRA surveillance program. Methods A retrospective review of AIN patients enrolled into HRA screening was performed. The ease of establishing HRA, of running the service, histological outcomes, risk factors and complications were obtained. Results A business case for HRA equipment was authorised – capital cost £23850, warranty £19080 for 4 years, disposable proctoscope £25 per patient. Two surgeons trained in the use of the equipment with industry support. Twenty-six patients underwent HRA and biopsy (male: female 11:15). Patients included those with one or more of the following recognised risk factors including: transplant/immunocompromised (30.8%), HPV (50%), smoking currently or previous (61.5%), MSM (9.1% of males), VIN (86.7% of females). A total of 122 biopsies were taken (median 4 per patient (1-17)). Eight patients (30.8%) attended two or more sessions. There were no complications perioperatively. Ten patients (38.5%) found to have AIN3. Three females (20%) had VIN3. Three patients (11.5%) found to have SCC and referred to local oncology services. Conclusion HRA is a safe and effective surveillance programme for patients with AIN. Magnification enhances the ability to target biopsies to areas of suspicion at an early stage. Recording of images is useful in planning subsequent assessments.