title: Electrocautery ablation of high-grade anal squamous intraepithelial lesions in HIV-negative and HIV-positive men who have sex with men.
abstract: BACKGROUND
  Anal squamous cell carcinoma (ASCC) incidence has been rising over the past decade, most dramatically in HIV-positive men who have sex with men (MSM). We aimed to identify a novel in-office approach for ablating high-grade anal intraepithelial neoplasia (HGAIN), the believed precursor lesion to ASCC.
  
  
  METHODS
  We performed a retrospective analysis of medical records from a New York City surgical practice, identifying patients with HGAIN treated with electrocautery ablation (ECA) and followed for at least 5 months with high-resolution anoscopy, biopsies, and/or cytology. We sought to determine HGAIN recurrence and progression to ASCC after ECA.
  
  
  RESULTS
  Two hundred thirty-two MSM, 132 HIV positive and 100 HIV negative, with median follow-up of 19.0 and 17.5 months, respectively, met inclusion criterion. In HIV-negative and HIV-positive MSM, the probability of curing a lesion after first ECA was 85% and 75%, respectively. Over follow-up, 53% of HIV-negative and 61% of HIV-positive patients recurred. After first and second ECA, HIV-positive MSM were 1.28 times (P = 0.16) and 2.34 times (P = 0.009) more likely to recur than HIV-negative MSM. The majority of recurrence was due to development of additional lesions at untreated sites (metachronous recurrence). One patient (0.4%) developed ASCC. At last visit, 83% of HIV-negative and 69% of HIV-positive patients were HGAIN free.
  
  
  CONCLUSIONS
  ECA is an effective treatment for HGAIN, with fewer patients progressing to ASCC than predicted with expectant management. HIV-positive patients are significantly more likely to recur than HIV-negative patients.
authors: Department of Surgery, Mount Sinai School of Medicine, New York, NY 10011, USA.
authors: Douglas K
authors: DK
authors: Marks
authors: Stephen E
authors: SE
authors: Goldstone
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016009:Chi-Square Distribution; D004564:Electrocoagulation / Q000379:methods; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000473:pathology / Q000821:virology; D006651:Histocytochemistry; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery* / Q000821:virology; D012189:Retrospective Studies; D055815:Young Adult