The aims of the study of April's Paper of the Month were to determine the rate of remission of high-grade intraepithelial lesions (HSIL) and to identify factors associated with remission.
High-grade intraepithelial lesions of the anus - patience: A road to wisdom
Gouriou C, Landemaine A, Carlo A, Boisteau E, Henno S, Thibault V, et al.
Colorectal Dis. 2025; 27:e70053.
What is known about the subject?
High-grade intraepithelial lesions (HSIL) of the anus are a cause for concern due to their potential to progress to cancerous lesions. In response to this, screening programmes are being developed and adapted worldwide with the objective of detecting and treating these lesions. There exists a number of factors capable of influencing the progression to cancer, or even remission, of HSIL. The identification of these factors is an ongoing process, with the aim of refining the screening programmes.
What the study adds?
The study presents a single-centre experience of patients with HSIL and its progression over the years. The study was conducted at a tertiary centre in France and the high-resolution anoscopies were performed by two experienced gastroenterologists. The population under study was characterised by heterogeneity, with approximately half of the patients being male and identifying as homosexual, and one third of the population being female. The final analysis encompassed 144 patients, with a median follow-up period of 4.1 years. The probability of HSIL remission was determined to be 21.5%, while 4.9% of patients exhibited cancer development.
The study identified three primary factors associated with HSIL remission: the absence of human papillomavirus 16 at referral, the absence of endoanal lesions, and the excision of HSILs.
Implications for colorectal practice
The remission of HSILs was not a frequent event in this long-term cohort study. It proposes the implementation of active screening procedures for anal precancerous and cancerous lesions within high-risk demographics. The management of HSIL lesions is a pivotal element in achieving remission. The authors propose that excision of the HSIL, when possible, could be a preferred treatment to allow better remission.
References
- Gouriou C, Landemaine A, Carlo A, Boisteau E, Henno S, Thibault V, et al. High-grade intraepithelial lesions of the anus - patience: A road to wisdom. Colorectal Dis. 2025; 27:e70053.
- Lee JY, Lensing SY, Berry-Lawhorn JM, Jay N, Darragh TM, Goldstone SE, et al; ANCHOR Investigators. Design of the ANal Cancer/HSIL Outcomes Research study (ANCHOR study): A randomized study to prevent anal cancer among persons living with HIV. Contemp Clin Trials. 2022; Feb;113:106679.
- Spindler L, Etienney I, Abramowitz L, de Paras V, Pigot F, Siproudhis L, et al. Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice. Tech Coloproctol. 2024; 28(1): 23.