| Institution: | 1. Academic Unit of Colorectal Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 10 – 16 Alexandra Parade, Glasgow G31 2ER, Scotland, UK;2. Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK;3. Undergraduate School of Medicine, Wolfson Medical School Building, University Avenue, Glasgow, G12 8QQ, Scotland, UK;4. Department of Gynaecological Oncology, Glasgow Royal Infirmary, PRMH Building, 16 Alexandra Parade, Glasgow, G31 2ER, Scotland, UK;1. Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland;2. UCD Centre for Precision Surgery, Section of Surgery and Surgical Specialties, School of Medicine, University College Dublin, Dublin, Ireland;1. Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy;2. Breast Unit Humanitas Cancer Centre, Catania, Italy;3. Breast Unit - ASUGI DSMCS, Trieste University, Italy;4. Department of Pathology-Breast Unit ASL TO 5, Moncalieri (TO), Italy;5. Breast Unit Policlinico di Sant’Orsola, Bologna University, Italy;6. Breast Unit Humanitas Cancer Centre, Rozzano, Italy;7. Senonetwork Italia Onlus, Florence, Italy;8. Breast Unit Perrino Hospital, Brindisi, Italy;1. Department of Surgery, University of Modena and Reggio Emilia – Policlinico of Modena, Modena Italy Via Del Pozzo, 71 41100, Modena, Italy;2. Department of General Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be’er Ya’akov, Israel, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Dept. of Surgery, University of Modena and Reggio Emilia –Via Del Pozzo, 71 41124 Modena, Italy;1. Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea;1. Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia;2. College of Medicine and Public Health, Flinders University, South Australia, Australia;3. Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany |
| Abstract: | PurposeTo describe the regional burden of AIN and rate of progression to cancer in patients managed in specialist and non-specialist clinic settings.MethodsPatients with a histopathological diagnosis of AIN between 1994 and 2018 were retrospectively identified. Clinicopathological characteristics including high-risk status (chronic immunosuppressant use or HIV positive), number and type of biopsy (punch/excision) and histopathological findings were recorded. The relationship between clinicopathological characteristics and progression to cancer was assessed using logistic regression.ResultsOf 250 patients identified, 207 were eligible for inclusion: 144 from the specialist and 63 from the non-specialist clinic. Patients in the specialist clinic were younger (<40 years 31% vs 19%, p = 0.007), more likely to be male (34% vs 16%, p = 0.008) and HIV positive (15% vs 2%, p = 0.012). Patients in the non-specialist clinic were less likely to have AIN3 on initial pathology (68% vs 79%, p = 0.074) and were more often followed up for less than 36 months (46% vs 28%, p = 0.134). The rate of progression to cancer was 17% in the whole cohort (20% vs 10%, p = 0.061). On multivariate analysis, increasing age (OR 3.02, 95%CI 1.58–5.78, p < 0.001), high risk status (OR 3.53, 95% CI 1.43–8.74, p = 0.006) and increasing number of excisions (OR 4.88, 95%CI 2.15–11.07, p < 0.001) were related to progression to cancer.ConclusionThe specialist clinic provides a structured approach to the follow up of high-risk status patients with AIN. Frequent monitoring with specialist assessments including high resolution anoscopy in a higher volume clinic are required due to the increased risk of progression to anal cancer. |
