Se. Goldstone et al., High prevalence of anal squamous intraepithelial lesions and squamous cellcarcinoma in men who have sex with men as seen in a surgical practice, DIS COL REC, 44(5), 2001, pp. 690-698
Anal high-grade squamous intraepithelial lesions are probable invasive anal
squamous-cell cancer precursors, and although unproved, treatment of high-
grade squamous intraepithelial lesions may prevent progression to anal squa
mous-cell cancer. Men who have sex with men are often treated for benign an
orectal disorders without consideration given to the possibility of concurr
ent high-grade squamous intraepithelial lesions or anal squamous-cell cance
r. We determined the prevalence of anal high-grade squamous intraepithelial
lesions and anal squamous-cell cancer in an urban surgical practice of men
who have sex with men referred for treatment of anal condyloma and other b
enign noncondylomatous anal disorders. METHODS: One hundred thirty-one HIV-
positive and 69 HIV-negative men who have sex with men referred for surgica
l treatment of presumed benign anorectal disease were evaluated by anal cyt
ology, high-resolution anoscopy, and biopsy. Anal cytology. and histology w
ere reported with a modified Bethesda classification. RESULTS: One hundred
fifty-seven patients (79 percent) were referred for condyloma, 4 (2 percent
) for anal squamous intraepithelial lesions (anal high-grade squamous intra
epithelial lesions) diagnosed by primary care providers, and 39 (19 percent
) for other benign anorectal disorders. One hundred forty-three patients (9
3 percent) had abnormal anal cytology, with 107 (54 percent) having high-gr
ade squamous intraepithelial lesions on cytology. Biopsy results revealed 1
20 patients (60.0 percent) with high-grade squamous intraepithelial lesions
and 5 patients (3 percent) with invasive squamous-cell carcinoma. Four of
five men with anal squamous-cell cancer were HIV positive. Fourteen men (36
percent) who have sex with men referred for noncondylomatous benign anal d
isorders had high-grade squamous intraepithelial lesions, and three (8 perc
ent) had anal squamous-cell cancer. High-grade squamous intraepithelial les
ions and anal squamous-cell cancer were seen most often at the squamocolumn
ar junction. CONCLUSIONS: Men who have sex with men referred for treatment
of either condyloma or noncondylomatous benign anorectal disease had a high
prevalence of anal high-grade squamous intraepithelial lesions and anal sq
uamous-cell cancer. All men who have sex with men referred for treatment of
benign anorectal disease should have high-resolution anoscopy and aggressi
ve biopsy of all abnormal areas. Treatment of external lesions alone could
miss high-grade squamous intraepithelial lesions or anal squamous-cell canc
er.