33 - 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.