Dysplasia Clinic Research Articles

PP011: Brush versus scalpel: Consensus agreement on orcellex brush cytology versus incisional biopsy

We have previously demonstrated the efficacy of brush cytology and liquid based cytology as a diagnostic adjunct in oral precancer management. The purpose of this study was to compare brush biopsy cytology with laser excision definitive histopathology. Histopathology following excision biopsy is the gold standard for diagnosis of oral dysplasia. Renewed interest in brush cytology however has demonstrated that microengineered brushes can demonstrate cellular changes before they are detected on excision biopsy, the implication being that cytology may be more than a useful adjunct to direct biopsies. It may be a useful prognostic test in itself. Following informed consent, patients with new red or white patches attending the oral dysplasia clinic were invited to participate in the study. All patients underwent brush cytology followed incision and where appropriate, laser excision biopsy. Consensus agreement was obtained by oral pathologists and cytologists working to agreed WHO criteria. 156 patients were recruited into the study. On cytology, normal ( n = 25); atypia ( n = 10); Candida ( n = 13); hyperkeratosis ( n = 53); mild dyskaryosis ( n = 15); moderate dyskaryosis ( n = 12); severe dyskaryosis ( n = 21) CIS ( n = 6); SCC ( n = 2). Excision biopsy however demonstrated hyperkeratosis with lichenoid inflammation ( n = 37), Hyperkeratosis alone ( n = 41), Candida ( n = 3); mild dysplasia ( n = 25); moderate dysplasia ( n = 14), proliferative verrucous leukoplakia ( n = 16); severe dysplasia ( n = 18); SCC ( n = 2). Mismatches in pathology versus cytology occurred in 55.6% cases. A random sample of 16 mismatches were further reviewed at a consensus meeting with 4 reporters and 11 mismatches were found here and 5 matches. In four cases, severe dyskaryosis with high Ki67 labelling indices were reported as hyperkeratosis with lichenoid by the panel of pathologists, and similarly in three cases, reported as mild dysplasia,or actinic keratosis. Cytology was unable to diagnose proliferative verrucous leukoplakia in four cases. Orcellex brush cytology particularly with or without KI67 labelling can demonstrate cellular changes that are not evident at the tissue level and upstage severity of premalignancy. It is a useful adjunct to oral precancer diagnosis.

25. Observational database of anal dysplasia in persons living with HIV/AIDS (PLWH) in an HMO

Background PLWH have increased risk for HPV-related squamous cell cancer of the anus. Screening PLWH for anal dysplasia can reduce morbidity and mortality. Routine screening for anal dysplasia is not yet universally adopted. Accumulating evidence and clinical experience support screening for and treatment of precancerous lesions. Methods: KPNW started an anal dysplasia screening program using anal cytology, HRA with biopsies and ablation of biopsy-proven HGAIN as a routine component of the primary care HIV services. The Anal Dysplasia Clinic (ADC) follows and treats members with any abnormal findings. Treatment includes the use of intra-anal imiquimod, trichloroacetic acid, efudex and infrared coagulation. When indicated, patients are referred to rectal surgery for excision and fulguration. Results: 73% of eligible members have been screened for anal dysplasia. 45% of the 1438 screenings performed were abnormal. There have been 390 referrals since 20 April 2011. To evaluate the success of early detection and treatment, stages of precancerous lesions found in each biopsy are tracked. 619 biopsies were examined from 207 patients. There has been an overall decrease in HGAIN in patients who received multiple biopsies. 52% of 122 patients with HGAIN were successfully treated with IRC. Conclusions: Over 300 patients have been identified as having anal abnormalities. Routine anal Pap screening is easily performed in an HMO setting utilising clinic support staff. High-grade lesions were present in 70% and correlated with Pap smear but not CD4 nadir. Routine anal Pap smears in PLWH followed by HRA with biopsy and treatment HGAIN should be the standard of care for PLWH.

22. Integration of anal Pap screening into a colposcopy clinic for HIV-infected women

Background Persistent human papillomavirus (HPV) infection is a precursor to cervical and anal dysplasia and cancer. Among HIV+ women, HPV is more difficult to treat. While no national standards exist for anal dysplasia screening, it may be an important tool in reducing anal cancer risk. At an urban university hospital in South Florida, HIV+ women lacked access to screening; thus, a pilot project was initiated. Methods: With support from the university, the hospital and the Florida/AIDS Education and Training Center (AETC), we implemented an anal dysplasia clinic within our existing HIV colposcopy clinic. A video developed by the Pennsylvania/Mid-Atlantic AETC provided anal Pap technique training to Advanced Registered Nurse Practitioners. The protocols for specimen collection included Dacron swabs and Thin Prep® fixative, and cytology samples were read using the Bethesda criteria. AETC funded two gynaecologists to attend ASCCP’s high-resolution anoscopy (HRA) training; Health Resources and Services Administration funded a dedicated colposcope for HRA. Women attending the clinic were offered anal Pap screening with referral to HRA for abnormal results. Results: Anal Pap smears were collected for 124 women between May 2012 and June 2013; 114 (92%) had ASCUS, ASC-H, LSIL or HSIL. Overall, women are receptive to anal Pap screening; however, the no-show rate for follow-up HRA is 64%. Conclusions: Anal pap screening in an existing colposcopy clinic is a feasible model for detecting anal dysplasia and could be replicated for HIV+ women in other locales. Further study should assess the effect of staff engagement and patient education on screening to improve follow-up HRA rates.

Abstract CN02-02: Malignant risk prediction for patients with oral premalignant lesions

Abstract Oral cancers remain both a challenge and an opportunity for clinicians and scientists working with this disease. Worldwide, it represents a significant global challenge, with close to 300,000 new cases diagnosed each year. The disease is potentially preventable: we have knowledge of its risk factors; it is also at an easily accessible site and is often preceded by oral premalignant lesions (OPLs). The challenge has been to develop a framework that would let us both detect and better manage such lesions. Unfortunately, only a small proportion of OPLs will progress to a cancer and histology alone has not allowed clinicians to differentiate high- from low-risk lesions. This uncertainty has also meant that, even when OPLs are detected, there is no consensus on who to treat and how. In 1999, we established the Oral Cancer Prevention Program in British Columbia to develop an integrated knowledge translation approach to facilitate systematic change for prevention, detection and management of this disease across the continuum of care throughout the province. This effort has involved optimization of screening in community dental practices, creation of a triage pathway from a centralized oral biopsy service to oral dysplasia clinics where patients are assessed, and formation of linkages to the cancer agency and local hospitals to facilitate both treatment and follow-up. A new Canadian Partnership Against Cancer-funded Oral Dysplasia Surveillance System has been developed in BC to monitor natural history of the disease. This province-wide structure has facilitated the formation of the Oral Cancer Prediction Longitudinal (OCPL) study, a unique resource for development and validation of biomarkers of risk of malignant progression. To date, ∼ 450 low-grade (mild and moderate) dysplasia cases have been accrued to this study and are in follow-up. In September of this year, we published results from the first 296 patients accrued to the OCPL study (Zhang et al., Cancer Prevention Research). We focused on the validation of a LOH risk model proposed by our group in 2000 that utilized a set of microsatellite markers at key chromosomal loci to predict progression of low-grade dysplasia in a retrospective cohort (Rosin et al., Clin Cancer Res 2000; 6:357–62). In the new study, cases were classified into high- or low-risk profiles to validate the 2000 model. Risk models were further refined using recursive partitioning and Cox regression analyses. The study showed that the high-risk lesions (3p &/or 9p LOH) had a 22•6 -fold increase in risk (P = 0•002) compared to low-risk lesions (3p & 9p retention). Addition of another two markers (loci on 4q/17p) further improved the risk prediction, with five-year progression rates of 3•1%, 16•3%, and 63•1% for the low-, intermediate-, and high-risk lesions, respectively. Compared to the low-risk group, intermediate- and high-risk groups had 11•6-fold and 52•1-fold increase in risk (P < 0•001). The new LOH profiles in the refined model were validated as risk predictors by using the initial retrospective cohort from 2000. Multi-covariate analysis with clinical features showed LOH models to be the most significant predictors of progression. The importance of this study is that it has direct implication for standard of care in the community setting, providing a tool by which patients could be triaged to different levels of intervention. Patients with elevated risk would be guided towards increased surveillance with this risk providing a rationale for the targeting of intervention regimes, even if these were associated with some morbidity. Two of three patients with such high-risk profiles progressed to cancer in 5 years. In contrast, patients with low-risk profiles could be spared in from aggressive monitoring and intervention. In our study, low-risk patients represented close to half of those individuals that were accrued to the study. Future research should be aimed towards exploring such possibilities, as an initial step towards personalizing oral cancer prevention strategies. LOH is currently being used in two chemoprevention trials of patients with OPLs to guide patient accrual: the phase III Erlotinib Prevention of Oral Cancer study and the Phase II Cetuximab for Treatment of High-Risk Pre- Malignant Upper Aerodigestive Lesions trial. The results of these studies should provide even greater knowledge upon which to build new strategies for patient triage that could better focus risk reduction programs for this disease. (Supported by grants from the NIH and the National Institute of Dental and Craniofacial Research (R01DE13124 and R01DE17013). Citation Format: Miriam P. Rosin, Lewei Zhang, Catherine Poh, Michele Williams, Denise M. Laronde, Ken Berean, Pamela J. Gardner, Huijun Jiang, Lang Wu, J. Jack Lee. Malignant risk prediction for patients with oral premalignant lesions. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr CN02-02.

Interrater agreement of anal cytology

The majority of anal cancers are caused by persistent infections with carcinogenic human papillomaviruses (HPV). Similar to cervical carcinogenesis, the progression from HPV infection to anal cancer occurs through precancerous lesions that can be treated to prevent invasion. In analogy to cervical cytology, anal cytology has been proposed as a screening tool for anal cancer precursors in high-risk populations. The authors analyzed the interobserver reproducibility of anal cytology in a population of 363 human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). Liquid-based cytology (LBC) specimens were collected in the anal dysplasia clinic before the performance of high-resolution anoscopy on all patients. Papanicolaou-stained LBC slides were evaluated by 2 cytopathologists, each of whom was blinded to the clinical outcome and the other pathologist's results, using the revised Bethesda terminology. Overall agreement between the 2 observers was 66% (kappa, 0.54; linear-weighted kappa, 0.69). Using dichotomizing cytology results (atypical squamous cells of undetermined significance [ASC-US] or worse vs less than ASC-US), the agreement increased to 86% (kappa, 0.69). An increasing likelihood of testing positive for markers associated with HPV-related transformation, p16/Ki-67, and HPV oncogene messenger RNA was observed, with increasing severity of cytology results noted both for individual cytologists and for consensus cytology interpretation (P value for trend [p(trend)] < .0001 for all). Moderate to good agreement was observed between 2 cytopathologists evaluating anal cytology samples collected from HIV-positive MSM. A higher severity of anal cytology was associated with biomarkers of anal precancerous lesions. Anal cytology may be used for anal cancer screening in high-risk populations, and biomarkers of HPV-related transformation can serve as quality control for anal cytology.

New topics in the skeletal dysplasias

A first glance at the Table of contents of this issue might give the impression that we have chosen a disparate group of conditions to explore. However, we feel that this selection represents several key principles of the field and genetics, as well as medicine in general: these rare disorders need careful delineation and study so as not to be mistakenly lumped and inappropriately treated, molecular origins turn out to be more intricate and beautiful than previously imagined, and only through accurate recording can we move forward. Drs. Terhal and Mortier from the Netherlands and Belgium, together with clinical partners from several countries, have studied a large series of patients with mutations in theCOL2A1 gene and elaborated new growth curves for spondylo-epiphyseal dysplasia congenital (SEDC) and related collagen 2 disorders. Development of these molecularly based growth curves is a major step forward in the nosography of collagen 2-related dysplasias, one of the largest and most important group of patients in a skeletal dysplasia clinic. Although variability remains significant and points to the multifactorial determination of height even in the presence of a single gene with a major influence, the possibility of comparing the growth chart of a single patient with that of a cohort of patients with similar mutations is a significant improvement over the past and projects us towards the future. It is hoped that similar studies will begin as soon as possible for all other major chondrodysplasia genes allowing the creation of a comprehensive database. In the best of worlds, such a database would include also data on morbidity and complications. The data presented by Drs. Terhal, Mortier and coworkers will undoubtedly constitute an important reference for years to come. The so-called enchondromatoses have been difficult to deal with in many a revision of the Nosology. Are they really ‘‘anarchic’’ development of bone or are they a special type of dysplasia? Andwhat about their inheritance, so many cases being sporadic? Drs. SupertiFurga, Nishimura and Spranger have tried to tackle these questions with the help of recent results that have revealed unexpected molecular mechanisms. They suggest that enchondromas are useful but nonspecific findings and that the molecular bases include both homeostatic defects of bone resorption as well as true dysregulation of cell proliferation. In the latter group, the role of somatic mutations gives a novel twist to the story. The newly proposed classification and the presentation of reference images from molecularly proven individuals will prove to be a helpful companion for the clinician and radiologist. The Paris group led by Dr. Valerie Cormier-Daire contributes two articles illustrating the contribution of the study of genetic disorders to our understanding of skeletal biology and of human growth. In the article on ‘‘ciliary’’ disorders, Drs. Huber and Cormier take us into the world of monocilia, fascinating structures that stand like tall poles on the surface ofmost cells, including chondrocytes, receiving and transmitting signals—much like the antennas of cellular phones that today line the highways of modern countries—or, like in photoreceptors, carry large stacks of sensory molecules. The high morphologic and functional specialization of cilia is based on a complex transport and assembly apparatus (the intraflagellary transport system, IFT) and mutations in components of this apparatus affect proliferation and differentiation of cells. Based on the current state of knowledge in the skeletal dysplasias and in other ciliary disorders such as the Bardet–Biedl syndrome and the genetic nephropathies, Le Goff and Cormier predict that mutations in many more ciliary genes will be uncovered, and that genotype– DEDICATION To the memory of

The clinical determinants of malignant transformation in oral epithelial dysplasia

While the size and clinical appearance are known risk factors for malignant transformation of potentially malignant oral the importance of site, grade of dysplasia and exposure to environmental carcinogens remains controversial. We aim to report the clinical determinants of malignant progression in a series of patients with histopathologically graded oral epithelial dysplasia (OED). We recruited patients with a histopathological diagnosis of OED to a longitudinal observational study in a tertiary oral dysplasia clinic. Clinical, histopathological and risk factor data were recorded at baseline. One of three clinical endpoints were determined: malignant transformation, progression of dysplasia grade, remission/stable dysplasia grade. Ninety-one patients meeting the criteria gave consent for inclusion to the cohort, with outcomes reported after a median follow up of 48 months. An estimated 22% (SE 6%) of patients underwent malignant transformation within 5 years, with significant predictors being: non-smoking status (χ(2)=15.1, p=0.001), site (χ(2)=15.3, p=0.002), non-homogeneous appearance (χ(2)=8.2, p=0.004), size of lesion >200 mm(2) (χ(2)=4.7, p=0.03) and, of borderline significance, high grade (χ(2)=5.8, p=0.06). Gender, age, number of lesions and alcohol history did not predict for malignant transformation. Although a number of these clinical determinants have previously been associated with higher malignant transformation in OED, the high-risk nature of lesions in non-smokers is of particular note and requires a greater emphasis and recognition amongst clinicians dealing with OED. It suggests that those non-smokers with OED, have an inherited or acquired predisposition and should be treated more aggressively; these should form the focus for further investigation.

Síndrome de coalición tarso-carpiana: un caso familiar

Tarsal-carpal coalition syndrome (TCC, OMIM #186570) is an autosomal dominant disorder characterised by fusion of the carpals, tarsals, and phalanges, with the short first metacarpals causing brachydactyly and humeroradial fusion. Mutations in the NOG gene have been reported in many families. We describe a family with carpal tarsal fusion seen at a Skeletal Dysplasia Clinic and look at the differential diagnoses.

Infusing Swanson's Theory of Caring into an Advanced Practice Nursing Model for an Infectious Diseases Anal Dysplasia Clinic

The incidence of anal cancer is increasing among HIV-infected men and women. The process of screening for anal dysplasia and the management of abnormal findings are currently and most often based on a medical model. The needs of these patients, however, go well beyond medical care. A more comprehensive and holistic approach to health care is, therefore, required. Given the scope of practice of advanced practice nurses who are involved in the diagnosis and treatment of patients with anal dysplasia, it is appropriate for them to assume leadership roles in addressing the needs of these patients. This article describes the application of a theory of caring to create an advanced practice nursing model of care for HIV-infected men and women in infectious diseases anal dysplasia clinics.

P3-S4.04 Topical 80% Trichloroacetic Acid (TCA) shows efficacy in the treatment of internal High-Grade Anal Intraepithelial Neoplasia (HGAIN)

BackgroundHIV positive men who have sex with men (MSM) are at 60–70 times increased risk of developing anal squamous cell carcinoma than the general population. HGAIN, the putative precursor to...

Economic burden of vulvar and vaginal intraepithelial neoplasia: retrospective cost study at a German dysplasia centre.

BackgroundHuman papillomavirus is responsible for a variety of diseases including grade 2 and 3 vulvar and vaginal intraepithelial neoplasia. The aim of this study was to assess parts of the burden of the last diseases including treatment costs. The direct medical resource use and cost of surgery associated with neoplasia and related diagnostic procedures (statutory health insurance perspective) were estimated, as were the indirect costs (productivity losses) associated with surgical treatment and related gynaecology visits for diagnostic purposes.MethodsData from 1991-2008 were retrospectively collected from patient records of the outpatient unit of the Gynaecological Dysplasia Clinic, Heinrich Heine University, Dusseldorf, Germany. Two subgroups of patients were analysed descriptively: women undergoing one surgical procedure related to a diagnosis of vulvar and/or vaginal intraepithelial neoplasia, and women undergoing two or more surgical procedures. Target measures were per-capita medical resource consumption, direct medical cost and indirect cost.ResultsOf the 94 women analysed, 52 underwent one surgical intervention and 42 two or more interventions (mean of 3.0 interventions during the total period of analysis). Patients undergoing one surgical intervention accrued €881 in direct costs and €682 in indirect costs; patients undergoing more than one intervention accrued €2,605 in direct costs and €2,432 in indirect costs.ConclusionsThe economic burden on German statutory health insurance funds and society induced by surgical interventions and related diagnostic procedures for grade 2/3 vulvar and vaginal neoplasia should not be underrated. The cost burden is one part of the overall burden attributable to human papillomavirus infections.

Initial Experience with Topical Fluorouracil for Treatment of HIV-Associated Anal Intraepithelial Neoplasia

Exposure to high-risk strains of human papillomavirus (HPV) promotes cellular dysplasia of the anal canal epithelium, potentially leading to anal intraepithelial neoplasia (AIN), which is in turn a precursor to invasive squamous cell carcinoma of the anus (SCCA). People with HIV infection who engage in anoreceptive intercourse are at heightened risk for acquiring HPV, AIN, and SCCA. Although intravenous 5-fluorouracil (5-FU) is commonly used for treatment of invasive SCCA, there has been little experience with the use of topical 5-FU as therapy for AIN. We retrospectively reviewed records of the first 11 HIV-positive patients treated with topical 5-FU in our anal dysplasia clinic. Six (55%) patients had clinical improvement with reduction in area of dysplasia seen on high-resolution anoscopy (HRA). Three (27%) patients had improvement in AIN pathologic grade. Eight (73%) patients reported mild-to-moderate perianal irritation, which led six to reduce the frequency of 5-FU application. Further study of topical 5-FU for treatment of HIV-associated AIN is warranted.

Clearance of Human Papillomavirus in Women Treated for Cervical Dysplasia

To estimate human papillomavirus (HPV) clearance of women with cervical abnormalities after treatment. Women attending dysplasia clinics between 2001 and 2007 with a new diagnosis of high-grade dysplasia or persistent low-grade dysplasia requiring treatment by excision or laser ablation were invited to participate. Cervical cytology, histology of biopsies collected at colposcopy, and HPV DNA detection and genotyping of 37 HPV genotypes on specimens collected at treatment and subsequent routine visits were examined. A log-rank test was used to compare the survival distribution between groups. Of the 1,649 women eligible at treatment (baseline), 1,207 (73%) were included in the analysis; 96% (n=1,159) had three or more posttreatment visits. At baseline and the subsequent three follow-up visits, the prevalence of women with HPV DNA detected was 84%, 53% (on average, 6.3 months after baseline), 44% (on average, 15.7 months after baseline), and 45% (on average, 24.3 months after baseline). The median time to HPV clearance was approximately 6 months for either HPV 16 (n=387) or HPV 18 (n=96), irrespective of concurrent detection of other types. On average, HPV 16 or HPV 18 types cleared faster than other types (P<.001). This association remained significant after adjustment for age, preoperative histology, number of preoperative histology results, and treatment type. Clearance times of HPV 16 and HPV 18 infections were similar to each another but shorter than other HPV types. III.

Abstract PL05-04: From basic science to public health: The Canadian approach to oral leukoplakia

Abstract PL05-04: From basic science to public health: The Canadian approach to oral leukoplakia

Initial experience with topical fluorouracil (5-FU) for treatment of anal intraepithelial neoplasia (AIN) in HIV-positive patients

Background Exposure to certain strains of human papilloma virus (HPV) promotes dysplasia in cells of the anal canal epithelium, leading to AIN, which is in turn a precursor to squamous cell carcinoma of the anus (SCCA). Patients with HIV infection who have anoreceptive intercourse are at heightened risk for acquiring HPV, AIN, and SCCA. The use of topical 5-FU to prevent the progression of lower genital tract neoplasia to invasive cervical carcinoma has been studied in both HIV+ and HIV- women. Although intravenous 5-FU is also commonly used for treatment of invasive SCCA, there has been little experience with the use of topical 5-FU as therapy for AIN. Materials and methods We retrospectively reviewed medical records from our anal dysplasia clinic. Our study population comprised 11 HIV+ men with biopsy-proven AIN who were treated with topical 5-FU. All patients were initially instructed to apply a pea-sized amount of topical 5-FU to the anus each night, to wash their hands afterwards, and to wipe away excess 5-FU in the morning. Patients reduced the frequency of application if they experienced undue local irritation. Results

Management of oral carcinoma: benefits of early precancerous intervention

Management of oral precancerous lesions remains polarised between interventional surgery and conservative treatment. We have previously shown the efficacy of carbon dioxide laser excision for both diagnosis and treatment of oral precancerous lesions. The aim of this study was to review the clinicopathological details of a group of patients in whom pre-existing but occult invasive carcinoma was diagnosed histopathologically in specimens excised by laser. We retrospectively reviewed 169 patients who attended the Maxillofacial Dysplasia Clinic at Newcastle General Hospital with single, new oral premalignant lesions over a 5-year period (2004–2008). They were all treated by laser excision of lesions that were confirmed to be dysplastic from examination of preoperative incisional biopsy specimens. There was a significant correlation between the results of diagnostic incisional, and laser excision, biopsy specimens ( p < 0.01), but 15 patients had signs of occult invasive carcinoma in the excision specimens (9%). In all cases the carcinomas were completely excised by the laser. Carbon dioxide laser excision is not only an effective treatment of precancerous lesions, but also facilitates early diagnosis and management of oral carcinoma at a stage when it is otherwise clinically undetectable.

Zytologische Befunde bei Patientinnen bis zum 20. Lebensjahr in einer Dysplasiesprechstunde

PURPOSE: The German screening program for cervical cancer starts at age 20. The goal of this study was to examine whether this is sufficient or whether screening should already be performed earlier, based on other criteria. MATERIALS AND METHODS: From 7/2004-2/2009 we evaluated the reason for referral, the age and cohabitarche of all patients younger than 20 years referred to our Dysplasia Clinic. RESULTS: 117 patients between 12-20 years (mean 18.3 years) were included. The mean age of cohabitarche was 14.9 years, 41 months prior to initial referral to our department. Twenty-four percent (28/117) were referred for vulvar condylomata. Most women (81/117; 69 %) were referred because of suspicious cervical findings. In the latter group histological examination showed LSIL (low grade squamous intraepithelial lesion) in 56 patients and HSIL (high grade squamous intraepithelial lesion) in 6 patients. Five patients received laser therapy for ectocervical CIN II, one patient had conization due to CIN III. The remaining patients (n = 19) showed no pathologic findings. CONCLUSION: These data illustrate that the first cytological pathologies appear at around three years after cohabitarche, mostly in association with LSIL. Only few patients required therapy for HSIL. The results suggest that the start of the cervical cancer screening program should depend rather on cohabitarche (for example, starting 3 years later) than solely on the patient's age. Practically, this could be accomplished by linking screening to the prescription of contraceptives. Additional monitoring in a dysplasia clinic might reduce the number of unnecessary surgical interventions.

Abstract PR-05: Alterations in tissue autofluorescence using spectroscopy in high-risk oral lesions

Abstract High-risk oral lesions can be sometimes difficult to discriminate from reactive oral lesions, which are commonly seen within community settings. New tools need to be developed to aid in screening and early detection of high-risk lesions. The assessment of alteration in tissue autofluorescence using spectroscopy has demonstrated promising results in distinguishing cancerous from normal tissue at many organs and sites; however, there is limited information on its usage to distinguish reactive lesions (as seen by both white-light and autofluoescence imaging) from cancerous/precancerous lesions. Objectives of this study are: 1) to collect autofluorescence spectra from normal mucosa, mucosa with high-risk histological change and those with chronic inflammation under different excitation wavelengths of light, and 2) to compare the change in tissue autofluorescence in different exciting wavelengths among these oral mucosal lesions. Methods: Patients with high-risk oral lesions and inflammatory conditions were recruited from the Dysplasia Clinics of the BC Oral Cancer Prevention Program. Spectroscopic measurements were taken using a fiber optic probe of a Remiscope (Remicalm, LLC; Houston, TX). Three excitation wavelengths were used: 436 nm, 405 nm, and 355 nm. Percent loss of peak emission intensity (%PEI) was measured by comparing the PEI of the lesional and contralateral normal areas. Differences in %PEI between groups were compared using unpaired t-test. Results: From June to September 2009, 102 spectroscopic measurements were recorded from 17 patients (cancer, 5; dysplasia, 6; inflammation, 6). Among these, loss of tissue autofluorescence under 436 nm, 405 nm, and 355 nm was observed in all cases. When comparing the %PEI between cancer and dysplasia groups, increased loss was seen in the cancer group at all three excitation wavelengths, especially under 355 nm and 405 nm excitations (P = 0.023 and 0.045 respectively). When comparing to the inflammation group, there is almost the same degree of loss observed between cancer and inflammation groups in all 3 excitation wavelengths. Interestingly, there is a significant difference in %PEI observed between dysplasia and inflammation group under 436 nm and 355 nm excitations (P = 0.005 and 0.022 respectively) but no statistical difference under 405 nm excitation. Conclusions: This is the first study to use 3 different excitation wavelengths of light to examine the spectra of oral cancerous, precancerous, and specifically inflammatory oral lesions (as seen by both white-light and autofluoescence imaging). This device has shown its potential to provide an objective, sensitive approach to distinguish precancers from those commonly seen within community settings caused by chronic inflammation. (Supported by grant R01 DE17013 from the National Institute of Dental and Craniofacial Research and grant CCSRI-20336 from Canadian Cancer Society Research Institute. CFP is supported by a Clinician Scientist Award from the Canadian Institutes of Health Research and a Scholar Award from the Michael Smith Foundation for Health Research). Citation Information: Cancer Prev Res 2010;3(1 Suppl):PR-05.

HPV Vaccine Acceptance among Latina Mothers by HPV Status

We investigated whether Latina mothers who were and were not human papillomavirus (HPV) positive differed in their knowledge and acceptance of the HPV vaccine for their children. We conducted a cross-sectional survey among women aged 18-64 years between April 2007 and April 2008. Data collectors conducted in-person interviews in community clinics with 215 HPV-negative women and 190 HPV-positive women (with respective response rates of 64% and 84%). Most (83%) HPV-positive women were recruited at dysplasia clinics. Although no HPV-negative women were recruited at dysplasia clinics, they were recruited at other low-income public and private clinics. After adjustment for age, marital status, and health insurance, women who were HPV positive were more likely than HPV-negative women to have heard about the HPV vaccine, to indicate they would have their daughters and sons vaccinated against cervical cancer even if they had to pay themselves, and to be in favor of the proposed Texas law requiring girls to receive the HPV vaccine before entry into sixth grade but less likely to be in favor of girls receiving the vaccine at age > or =13. Our findings indicate that >90% of Latinas living on the Texas-Mexico border find the HPV vaccine acceptable for their own daughters and sons.

Initial experience of an anal dysplasia clinic for HIV-infected men in Seattle, WA

Initial experience of an anal dysplasia clinic for HIV-infected men in Seattle, WA