High resolution anoscopy and targeted treatment of high-grade squamous intraepithelial lesions.
ABSTRACT The purpose of this video is to illustrate the use of high resolution anoscopy in the diagnosis and treatment of anal high-grade squamous intraepithelial lesions.
Five patients with anal dysplasia were examined in the operating room with acetic acid and the operative microscope. Lugol's solution was used selectively. Acetic acid is generously applied to aide in the recognition of high-grade squamous intraepithelial lesions. Acetowhite regions are examined under the operative microscope to further distinguish lesions as either low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions. Acetowhite lesions with specific vascular characteristics like punctuate vessels or honeycomb patterns are highly suggestive of high-grade disease. These lesions are selectively destroyed under direct visualization with an effort to maintain normal mucosa and skin to prevent stenosis. Some pigmented lesions contain high-grade squamous intraepithelial lesions; the operative microscope is used in this setting to look for the vascular characteristics of high-grade disease.
The video reports five male patients treated for high-grade squamous intraepithelial lesions with the aide of high resolution anoscopy. There were no intraoperative or postoperative complications. All lesions suspicious for high-grade squamous intraepithelial lesions based on observed vascular patterns were confirmed as such with permanent histopathology.
The use of acetic acid and the operative microscope with selective use of Lugol's solution accentuates the visual characteristics of high-grade lesions, enhancing the surgeon's ability to target treatment to high-grade squamous intraepithelial lesions. High resolution anoscopy is useful in the targeted treatment of high-grade squamous intraepithelial lesions.
Article: Anuscopie de haute résolution[Show abstract] [Hide abstract]
ABSTRACT: L’anuscopie de haute résolution (AHR) permet de déceler par la colposcopie, après l’application d’acide acétique, des lésions anales, non visibles à l’œil nu, liées aux virus du papillome humain. L’AHR recherche dans les régions acidophiles (blanchiment) les signes en faveur d’une néoplasie intra-épithéliale, tente d’en fixer le grade et dirige les indispensables biopsies. L’application de soluté de Lugol en précisant les limites des lésions permet un traitement adapté et donc moins morbide lors des exérèses chirurgicales des néoplasies intra-épithéliales de haut grade. L’AHR nécessite un véritable apprentissage. Combining acetic acid local application and colposcopy, high-resolution anoscopy is a helpful procedure for the diagnosis of HPV related microscopic lesions. High-resolution anoscopy looks at acidophilic areas (revealed by whitening) for signs of anal intraepithelial neoplasia, attempts to grade it and informs the necessary biopsies. In order to avoid extensive resection, the application of Lugol’s iodine solution helps define the limits of surgical excision when treating high-grade lesions. Proper training is needed to carry out high-resolution anoscopy.Côlon & Rectum 08/2008; 2(3):149-152. DOI:10.1007/s11725-008-0105-9