Which Women with Vulval High Grade Squamous Intrapethelial Neoplasia (HSIL) should be Considered for Anoscopic Assessments?

Abstract

Objective: Review the results of anal assessments in women with vulval HSIL with a potential increased risk of anal HSIL, due to HIV status, macroscopic perianal lesions or vaginal/cervical intrepithelial neoplasia. Methods: Ten year retrospective review of 402 anoscopy encounters from 130 patient, who were at higher risk of anal HSIL and underwent anoscopy. Of those, only 13 women had vulval HSIL and were included. Results: Cohort mean age 51 years, 54% smoked, 15% were living with HIV, 31% had additional vaginal or cervical HPV related pathology and 77% were referred with macroscopic perianal lesions. Over half (54%) had anal biopsies demonstrating HSIL, all of whom had visible pathology.Anal cytology was available for 12 cases, varying from HPV infection (42%), HG dyskaryosis (25%) to low grade dyskaryosis (17%). The entire cohort had either anal HSIL or HPV changes and received treatment: Imiquimod (69%), laser ablation (54%), surgical excision (38%), cryotherapy (31%), electrocautery (15%) or Trichloroacetic acid (15%). Conclusion: HSIL of the vulva with visible perianal lesions must prompt anoscopy, as anal cytology specificity and sensitivity is inadequate. Vulval services should secure multi-specialty links for screening and treating HPV pathology and neoplasia, which may arise in different anatomical sites.