title: Detection of anal dysplasia is enhanced by narrow band imaging and acetic acid.
abstract: OBJECTIVE
  Anal intraepithelial neoplasia precedes the development of anal squamous cell carcinoma. Detection of the lesion is essential to management. This paper describes a prospective study to detect and ablate anal squamous intraepithelial lesions (SILs) using white light narrow band imaging (NBI) and NBI with acetic acid (NBIA).
  
  
  METHODS
  Sixty patients with abnormal anal cytology and risk factors for anal dysplasia underwent examination of the anoderm with a high definition gastroscope and NBIA. Targeted biopsies were taken and the lesions were ablated and characterized histopathologically. Visualization of the anal transitional zone was facilitated by retroflexion and examination through a disposable anoscope.
  
  
  RESULTS
  Targeted biopsies were taken from lesions in 58 patients. No lesion was seen in two patients. Histopathology showed SIL in 48 (80.0%) of 60 biopsies. One biopsy showed lymphoid aggregates. Biopsies in nine (15%) of the 60 patients showed normal mucosa. Lesions were seen in white light in 27 (45%) of the 60 cases, NBI in 39 (65%) and NBIA in 57 (95%). There was no major morbidity. Sensitivity analysis showed that all methods were significantly different from each other.
  
  
  CONCLUSIONS
  Anal SIL in the anal transitional zone and anal canal can be identified by NBIA. Patient selection influences findings. Limitations include small sample size and non-randomization.
authors.affiliation: Departments of Gastroenterology/Hepatology and Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Inkster
authors.affiliation: Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: H O
authors.initials: HO
authors.lastname: Wiland
authors.affiliation: Departments of Gastroenterology/Hepatology and Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Wu
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology*; D001005:Anus Neoplasms / Q000150:complications / Q000175:diagnosis*; D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology*; D001706:Biopsy; D002278:Carcinoma in Situ / Q000150:complications / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007202:Indicators and Reagents; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D030361:Papillomavirus Infections / Q000150:complications; D011230:Precancerous Conditions; D011446:Prospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid
keywords: Anal dysplasia; anal transitional zone; human immunodeficiency virus; human papillomavirus; narrow band imaging; squamous intraepithelial lesion