QS140 - Defining Quality Standards for High-Resolution Anoscopy - Dysplasia Detection Rate

Sunday, June 2, 2024

4:13 PM – 4:16 PM ET, USA

Location: Room 327

Quick Shot Presenter(s)

JC Chen, MD (they/them/theirs)

Resident
Ohio State University
Ohio State University
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.

Author(s)

MA

Madiha Aziz, MD

Colorectal Surgery Fellow
OSU
The Ohio State University
Columbus, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Laura DeCesare, MD

Colorectal Surgery Fellow
The Ohio State University
The Ohio State University
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.
YouJin Cho, PhD (she/her/hers)

Medical Student
The Ohio State University College of Medicine
The Ohio State University
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.
Samantha Toscano, BS

Medical Student
Ohio State University College of Medicine
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.
AH

Alan Harzman, MD

Professor
The Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
Emily Huang, MD, MEd

Assistant Professor of Surgery
Ohio State University
Columbus, Ohio, United States

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This individual has no financial relationships with ineligible companies.
Matthew F. Kalady, MD, FACS, FASCRS

Professor of Surgery
The Ohio State University Wexner Medical Center
Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
Amber Traugott, MD (she/her/hers)

Associate Professor - Clinical
The Ohio State University Wexner Medical Center
The Ohio State University Wexner Medical Center
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.
MA

Mark Arnold, yes

Professor
The Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
LC

Lisa Cunningham, MD

Assistant Professor of Surgery
Ohio State University
Ohio State University

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This individual has no financial relationships with ineligible companies.
aG

alessandra Gasior, DO

Assistant professor
The ohio state wexner medical center
Dublin, Ohio, United States

Disclosure information not submitted.
NJ

Nimalan A. Jeganathan, MD

Associate Professor of Surgery
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure information not submitted.

Senior Author(s)

Syed Husain, MB.,BS.

Associate Professor of Surgery-Clinical
Ohio State University
Ohio State University
Columbus, OH, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Purpose/Background: The Anal Cancer-HSIL Outcomes Research (ANCHOR) trial has underscored the significance of high-resolution anoscopy (HRA) as a highly effective screening method to detect anal dysplasia early and prevent progression to anal cancer. As the adoption of HRA grows, the need to establish objective and effective quality metrics is imperative. Currently, most criteria for credentialing and maintaining clinical privileges are based on the volume rather than the quality of examinations conducted. However, the quality of HRA hinges on the examiner's ability to accurately identify abnormal tissue. To address the need for an objective quality metric that maximizes the prevention of anal cancer, we propose the implementation of a metric similar to adenoma detection rates for colonoscopy: high-grade dysplasia (HGD) detection rate.

Methods/Interventions: Patients age 18+ who underwent HRA at the Ohio State University’s Comprehensive Cancer Center between 2017-2023 for abnormal anal cytology were included. Dysplasia was defined as biopsy pathology returning as anal intraepithelial neoplasia-1 (AIN-1), AIN-2, or AIN-3 with HGD defined as AIN-2 and AIN-3. HGD detection was calculated as the proportion of HGD among the total biopsies obtained per provider. Provider detection rates were weighted by number of biopsies to calculate an unbiased estimate of the average overall detection rate. Pearson’s correlation coefficients and linear regression examined the association between case volume and HGD detection rates using likelihood ratio tests. Regression models controlled for patient age, race, ethnicity, sexuality, marital status, insurance type, smoking status, HIV status, high-risk HPV status, history of HPV vaccination, use of immunosuppression, and history of genital dysplasia. P-values were adjusted for multiple testing using Bonferroni corrections.

Results/Outcomes: A total of 1645 biopsies were performed on 580 patients between 7 providers, of which 1160 returned with dysplasia (70.99%), 583 with HGD (35.66%), and 578 with low-grade dysplasia (35.14%). The weighted mean detection rate for dysplasia was 63.89% (range 57.71%-96.16%) and for HGD was 34.17% (range 21.66%-46.99%) (see Table). Pearson’s correlation coefficient between HGD detection rates and number of biopsies was r= +0.27 (p < 0.001), number of HRAs was r= +0.30 (p < 0.001), and biopsies/month was r= +0.08 (p=0.005). In multivariate analysis, there was no association between HGD detection rates and number of biopsies (adjusted p-value=0.106) nor with number of HRAs performed (adjusted p-value=0.083).

Conclusion/Discussion: Our findings suggest that case volume is poorly correlated with HGD detection rate. As such, provider credentialing and maintenance of privileges should not hinge solely on provider’s case volumes. Rather, individual providers’ HGD detection rates may serve as a more tangible measure of proficiency in preventing anal cancer. Further studies are needed to determine the optimal target HGD detection rate that reflects competency.