Results of a pilot management protocol for screening-detected ASIL in HIV-negative women with a history of HPV-related gynaecological neoplasia

Abstract

Background: Pending high-level evidence that ablative treatments of ASIL impact the incidence of anal cancer, it is appropriate to offer low-impost office-based treatments for biopsy-proven HSIL, in combination with close follow-up to monitor for disease persistence or progression. Methods: As part of a pilot screening program for ASIL in women with a history of HPV-mediated gynaecological neoplasia, those with abnormal baseline cytology (PLSIL or greater) were invited to undergo HRA and biopsy.Biopsy-proven HSIL cases were offered a short course of topical trichloroacetic acid (TCA) applications, and then followed up with cytology, digital anorectal examination (DARE), and HRA with biopsy as indicated. Results: Of 163 screened women, 57 (35%) with ASIL cytology underwent HRA and biopsy. In 14 (24.6%), HSIL was confirmed by biopsy. Lesions were typically small, but in 5 cases (35.7%), more than one octant of the transformation zone was involved.Median overall follow-up from baseline visit was approximately 36 months, and 12 months after TCA treatment.Of the 14 patients treated with TCA, 7 (50%) developed either persistent or recurrent lesions, necessitating either repeat TCA or electrocautery ablation. Of these, 5 (71.4%) had disease in more than one octant at baseline. Conclusions: Despite the small numbers in this pilot study, TCA would appear to be a suitable office treatment for unifocal/small HSIL lesions, but direct escalation to more aggressive ablative or excisional treatments is recommended for multifocal/extensive disease. Such a protocol needs to be validated with greater case numbers and a longer follow-up period.