New Insights into Endoscopic Description of Anal Intraepithelial Neoplasia

Aims Anal intraepithelial neoplasia (AIN or ASIL) is the precursor of anal carcinoma. Particularly inhigh-risk populations, there is a significantly elevated risk of anal carcinoma. In recent years, endoscopy has increasingly emerged as a widely available and straightforward tool forvisualizing anal mucosa. The aim is to improve the endoscopic description of anal dysplasias compared to conventional high-resolution anoscopy and, due to the enhanced resolution, to describe those features that are only visible endoscopically.

Methods New high-resolution endoscopes allow microscopicvisualization of capillary structures. The consistent use of water insufflation in theinverse-mounted distance cap without drainageopening leads to a relevant additional magnifyingeffect [1].

Results Dysplasia-suspect lesions are typically described with punctate, mosaic, or wart-like patterns using high-resolution anoscopy (HRA). In contrast, high-resolution endoscopy reveals that these punctate and mosaic structures correspond to atypical vascular patterns. Unlike the linear and sometimes mesh-like vessels observed in normal anal mucosa, dysplastic lesions may exhibit vascular spirals and vascular clusters. Additionally, the lesions can be delineated from the normal mucosa with greater precision endoscopically.

Conclusions This previously unreported vascular patterns described in the AIN/ASIL screening literature could help to better identify these lesions in the future and to better define the margins in minimally invasive local ablation procedures.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Stier EA, Clarke MA, Deshmukh AA, Wentzensen N, Liu Y, Poynten IM, Cavallari EN, Fink V, Barroso LF, Clifford GM, Cuming T, Goldstone SE, Hillman RJ, Rosa-Cunha I, La Rosa L, Palefsky JM, Plotzker R, Roberts JM, Jay N.. International Anal Neoplasia Society's consensus guidelines for anal cancer screening. Int J Cancer 2024; 154 (10): 1694-1702 Epub 2024 Jan 3138297406