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High-Resolution Anoscopy

High-resolution anoscopy is a technique that allows the observation of the anal canal and the perianal region under magnification, normally by using a microscope (colposcope).

This technique aims to detect anal precancerous lesions, denominated anal high-grade squamous intraepithelial lesions (HSIL) or anal intraepithelial lesions (AIN) 2/3, that are normally not seen with the naked eye or under a routine anoscopy. These lesions are a possible complication of anal papillomavirus (HPV) infection.

Current recommendations from some International Societies favor high-resolution anoscopy in people living with HIV, especially men who have sex with men, that have an increased risk of anal cancer. It should be performed in patients with an abnormal cytology result. Transplant recipients and women with gynecological precancerous lesions or cancer caused by human papillomavirus infection are also high-risk groups for anal cancer.

It is normally done without sedation, is painless and lasts 15-20 minutes. If a suspicion lesion is seen during the examination, biopsies should be collected.

In case a diagnosis of anal precancerous lesion is confirmed by biopsies, the lesion should be treated to reduce the risk of progression to anal cancer. A recent study confirmed that the risk of anal cancer was significantly lower with treatment of anal precancerous lesions than with active monitoring. Lesions can be destroyed by using different methods, namely argon plasma coagulation, normally done under local anesthesia.

Dr. Andreia Albuquerque has been involved in early detection and anal cancer prevention in high-risk populations since 2014, performing anal cytology, HPV testing, high-resolution anoscopy and ablative treatment of anal high-grade squamous intraepithelial lesions. She is also highly active on research in this field and a frequent invited speaker in this area, both national and internationally. She serves in the Board of International Societies, Working Groups and Task Forces.