Anal dysplasia among patients with multiple HPV anal lesions: mosaic or homogeneity?

Aim Anal dysplasia is caused by chronic infection with the human papillomavirus and exposes to the risk of anal cancer. Usually during a surgery for anal condylomas only one or two biopsies on visible lesions are performed to classify the level of dysplasia. The aim of this study was to evaluate the distribution of dysplasia anal grade among patients operated on for multiple anal condylomas with no macroscopic differences. Method Cross-sectional study of patients operated on for multiple anal condylomas including a mapping of dysplasia by performing systematically for each patient one biopsy on visible lesion from each of the 4 quadrants on anal margin and in anal canal. All biopsies were read independently by 2 different pathologists. Results Among 72 patients, 60 were men, 48 were HIV-infected with a median age of 37.5 years. The proportion of high-grade squamous intraepithelial lesion (HSIL) was higher in the anal canal (41.7%) compared to the margin (20.8%) (p= 0.004). HSIL frequency did not differ according to the quadrant (anterior, posterior, right or left) of the two areas. HSIL on anal canal was not associated with HSIL on anal margin and vice versa (p=0.39). Neither age nor sex was associated to HSIL but HIV positivity increased the risk of HSIL on the anal margin (p=0.01). Conclusion Anal dysplasia is heterogeneously distributed in the anal canal as well as between anal canal and anal margin. The diagnostic of the grade of dysplasia for a person should require multiple biopsies on the canal and anal margin.