Anal neoplasm: Streamline follow-up of low-grade dysplasia

Screening strategies for anal cancer are based on repeated assessments in targeted populations. Low-grade lesions are frequently diagnosed, but the progression to invasive cancer is not the rule. The aim of the present study was to identify risk levels in these patients to refine screening strategies.

The data of consecutive patients referred for screening of anal intraepithelial lesions were collected prospectively. Patients with low-grade intraepithelial lesions (LSILs) at referral and at least two clinical evaluations, including cytology and virology, were included. HPV DNA screening, high-grade lesion (HSIL) and invasive cancer incidence data were extracted.

From April 2010 to December 2020, 194 patients with LSILs were included, with a median follow-up of 48 months. The cumulative probabilities of HSILs were 13.7% [9.5-19.4] at 1 year and 44.4% [35.9-53.3] at 5 years. Past history of HIV, HPV lesions, HPV subtypes (except HPV16), tobacco consumption and body mass index were not significantly related to HSILs. HPV16 status and age older than 44 years at baseline were associated with a greater risk of HSIL.

Patients with LSIL have a low risk of HSILs, except those with HPV16 subtype at baseline. After a first-year a reasonable recommendation may be a 4-year interval between two screening visits.