title: Which lesions should be biopsied during high-resolution anoscopy? Prospective descriptive study of simple morphological criteria.
abstract: OBJECTIVE
  High-resolution anoscopy (HRA) is a useful screening tool for anal intraepithelial neoplasia (AIN), although reputedly challenging for interpretation of suspected lesions.
  
  
  METHODS
  All consecutive patients who underwent biopsies for at least 1 lesion suspicious for AIN during HRA from November 2010 to March 2012 were prospectively included. The characteristics (borders, staining with acetic acid and Lugol iodine solution, and patterns of epithelium and vascularization) of the lesions detected during HRA were compared with histology.
  
  
  RESULTS
  A total of 168 suspicious anal lesions were biopsied and analyzed in 103 patients (68% men, mean age ± standard deviation = 49.8 ± 9 y, 57% positive status on human immunodeficiency virus infection). According to histology, 41.7% of the lesions were high grade, 34.5% were low grade, and 23.8% were nondysplastic. Lesions with irregular epithelial pattern (or irregular vascularization) were twice as likely to be high grade compared with lesions with regular epithelial pattern (or regular vascularization). The incidences of acetic acid-induced whitening were 91.4%, 94.8%, and 70% among the high-grade AIN, low-grade AIN, and nondysplastic samples, respectively. Among the high-grade AIN, 62.9% were not stained by Lugol solution (vs 31% of the low-grade AIN). The positive predictive value of a combination of these simple morphological criteria was 68.6%.
  
  
  CONCLUSIONS
  Several simple morphological criteria are significantly associated with high-grade AIN and are found less often in low-grade AIN. A combination of these morphological criteria provides sufficient positive predictive value to guide biopsy placement during HRA.
authors.affiliation: 1Department of Proctology, Diaconesses Hospital, and 2Department of Anatomopathology, University Paris VI, Saint-Antoine Hospital, APHP, Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Camus
authors.forename: Anne-Carole
authors.initials: AC
authors.lastname: Lesage
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Fléjou
authors.forename: Nadia
authors.initials: N
authors.lastname: Hoyeau
authors.forename: Patrick
authors.initials: P
authors.lastname: Atienza
authors.forename: Isabelle
authors.initials: I
authors.lastname: Etienney
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D001706:Biopsy / Q000379:methods*; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies