Anal neoplasm in colonoscopy: What endoscopists need to know

Table 1 Risk groups and incidence rates, as cases per 100000 person-years

Risk groups	IRs
HIV-positive MSM > 60 years	107.5
HIV-positive MSM < 30 years	16.8
HIV-positive MSM	85
Non-MSM male PLHIV	32
Female PLHIV	22
HIV-negative MSM	19
Solid organ transplant recipients	13
SOTRs in males > 10 years after transplant	24.5
SOTRs in females > 10 years after transplant	49.6
Vulvar cancer	48
Vaginal cancer	10
Cervical cancer	9
Systemic lupus erythematous	10
Ulcerative colitis	6
Crohn’s disease	3

IR: Incidence rate; HIV: Human immunodeficiency virus; MSM: Men who have sex with men; PLHIV: Persons living with human immunodeficiency virus; SOTR: Solid organ transplant recipient.

Table 2 Findings of video anoscopies of the females and males classified by 10-year age groups, n (%)

Variable	Video anoscopies (n = 16836)
	Male (n = 6922)									Female (n = 9914)									Total patients
Age group	0-10	10-20	20-30	30-40	40-50	50-60	60-70	> 70	Total	0-10	10-20	20-30	30-40	40-50	50-60	60-70	> 70	Total
Age - mean (SD)									49.61 (14.55)									48.11 (14.5)	48.73 (14.54)
Age - median (minimum-maximum)									50 (4-93)									48 (5-94)	49 (4-94)
Anal examination	6 (0.09)	117 (1.69)	598 (8.64)	1210 (17.48)	1625 (23.48)	1706 (24.65)	1108 (16.01)	552 (7.97)	6922 (41.11)	7 (0.07)	168 (1.69)	1071 (10.8)	1930 (19.47)	2336 (23.56)	2328 (23.48)	1447 (14.6)	627 (6.32)	9914 (58.89)	16836 (100)
Normal	6 (100)	77 (65.81)	300 (50.17)	392 (32.4)	340 (20.92)	260 (15.24)	145 (13.09)	121 (21.92)	1641 (23.71)	5 (71.43)	121 (72.02)	603 (56.3)	781 (40.47)	661 (28.3)	434 (18.64)	247 (17.07)	136 (21.69)	2988 (30.14)	4629 (27.49)
Neoplasms	0 (0)	0 (0)	0 (0)	0 (0)	3 (0.18)	2 (0.12)	4 (0.36)	0 (0)	9 (0.13)	0 (0)	0 (0)	1 (0.09)	0 (0)	3 (0.13)	1 (0.04)	2 (0.14)	1 (0.16)	8 (0.08)	17 (0.1)
SCC	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.06)	1 (0.06)	2 (0.18)	0 (0)	4 (0.06)	0 (0)	0 (0)	0 (0)	0 (0)	2 (0.09)	1 (0.04)	2 (0.14)	0 (0)	5 (0.05)	9 (0.05)
Adenocarcinoma	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.06)	1 (0.06)	1 (0.09)	0 (0)	3 (0.04)	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.04)	0 (0)	0 (0)	1 (0.16)	2 (0.02)	5 (0.03)
Rare neoplasms	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.06)	0 (0)	1 (0.09)	0 (0)	2 (0.03)	0 (0)	0 (0)	1 (0.09)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.01)	3 (0.02)
Polyps	0 (0)	0 (0)	3 (0.5)	9 (0.74)	10 (0.62)	10 (0.59)	14 (1.26)	4 (0.72)	50 (0.72)	0 (0)	0 (0)	4 (0.37)	7 (0.36)	14 (0.6)	9 (0.39)	8 (0.55)	1 (0.16)	43 (0.43)	93 (0.55)
Fibroepithelial	0 (0)	0 (0)	3 (0.5)	6 (0.5)	10 (0.62)	9 (0.53)	11 (0.99)	3 (0.54)	42 (0.61)	0 (0)	0 (0)	4 (0.37)	7 (0.36)	12 (0.51)	6 (0.26)	8 (0.55)	1 (0.16)	38 (0.38)	80 (0.48)
Hyperplastic	0 (0)	0 (0)	0 (0)	2 (0.17)	0 (0)	0 (0)	2 (0.18)	0 (0)	4 (0.06)	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.04)	2 (0.09)	0 (0)	0 (0)	3 (0.03)	7 (0.04)
Adenoma	0 (0)	0 (0)	0 (0)	1 (0.08)	0 (0)	1 (0.06)	1 (0.09)	1 (0.18)	4 (0.06)	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.04)	1 (0.04)	0 (0)	0 (0)	2 (0.02)	6 (0.04)
HPV	0 (0)	1 (0.85)	10 (1.67)	4 (0.33)	4 (0.25)	1 (0.06)	1 (0.09)	0 (0)	21 (0.3)	0 (0)	1 (0.6)	4 (0.37)	1 (0.05)	4 (0.17)	2 (0.09)	1 (0.07)	0 (0)	13 (0.13)	34 (0.2)
Perianal Crohn’s disease	0 (0)	3 (2.56)	5 (0.84)	10 (0.83)	7 (0.43)	1 (0.06)	6 (0.54)	0 (0)	32 (0.46)	0 (0)	0 (0)	4 (0.37)	3 (0.16)	5 (0.21)	1 (0.04)	2 (0.14)	3 (0.48)	18 (0.18)	50 (0.3)
Perianal fistula	0 (0)	1 (0.85)	9 (1.51)	16 (1.32)	12 (0.74)	10 (0.59)	3 (0.27)	0 (0)	51 (0.74)	0 (0)	0 (0)	2 (0.19)	3 (0.16)	5 (0.21)	3 (0.13)	0 (0)	1 (0.16)	14 (0.14)	65 (0.39)
Thrombosis hemorrhoids	0 (0)	6 (5.13)	10 (1.67)	23 (1.9)	21 (1.29)	16 (0.94)	3 (0.27)	2 (0.36)	81 (1.17)	0 (0)	0 (0)	10 (0.93)	22 (1.14)	17 (0.73)	12 (0.52)	5 (0.35)	1 (0.16)	67 (0.68)	148 (0.88)
Anal stenosis	0 (0)	0 (0)	0 (0)	1 (0.08)	3 (0.18)	3 (0.18)	9 (0.81)	4 (0.72)	20 (0.29)	0 (0)	0 (0)	1 (0.09)	2 (0.1)	1 (0.04)	6 (0.26)	4 (0.28)	7 (1.12)	21 (0.21)	41 (0.24)
Bleeding	0 (0)	2 (1.71)	8 (1.34)	28 (2.31)	38 (2.34)	25 (1.47)	13 (1.17)	7 (1.27)	121 (1.75)	0 (0)	1 (0.6)	6 (0.56)	11 (0.57)	10 (0.43)	16 (0.69)	9 (0.62)	3 (0.48)	56 (0.56)	177 (1.05)
Anal fissure	0 (0)	9 (7.69)	47 (7.86)	65 (5.37)	50 (3.08)	39 (2.29)	15 (1.35)	7 (1.27)	232 (3.35)	2 (28.57)	12 (7.14)	80 (7.47)	80 (4.15)	57 (2.44)	41 (1.76)	14 (0.97)	4 (0.64)	290 (2.93)	522 (3.1)
Hemorrhoids total	0 (0)	17 (14.53)	189 (31.61)	642 (53.06)	1098 (67.57)	1295 (75.91)	866 (78.16)	390 (70.65)	4497 (64.97)	0 (0)	25 (14.88)	327 (30.53)	947 (49.07)	1492 (63.87)	1728 (74.23)	1116 (77.13)	453 (72.25)	6088 (61.41)	10585 (62.87)
Hemorrhoids grade I	0 (0)	16 (13.68)	161 (26.92)	518 (42.81)	793 (48.8)	822 (48.18)	507 (45.76)	219 (39.67)	3036 (43.86)	0 (0)	24 (14.29)	295 (27.54)	842 (43.63)	1242 (53.17)	1324 (56.87)	828 (57.22)	311 (49.6)	4866 (49.08)	7902 (46.94)
Hemorrhoids grade II	0 (0)	1 (0.85)	27 (4.52)	119 (9.83)	297 (18.28)	463 (27.14)	350 (31.59)	165 (29.89)	1422 (20.54)	0 (0)	1 (0.6)	31 (2.89)	103 (5.34)	236 (10.1)	386 (16.58)	278 (19.21)	133 (21.21)	1168 (11.78)	2590 (15.38)
Hemorrhoids grade III	0 (0)	0 (0)	1 (0.17)	5 (0.41)	7 (0.43)	10 (0.59)	9 (0.81)	6 (1.09)	38 (0.55)	0 (0)	0 (0)	1 (0.09)	2 (0.1)	13 (0.56)	18 (0.77)	10 (0.69)	6 (0.96)	50 (0.5)	88 (0.52)
Hemorrhoids grade IV	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.06)	0 (0)	0 (0)	0 (0)	1 (0.01)	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.04)	0 (0)	0 (0)	3 (0.48)	4 (0.04)	5 (0.03)
Others	0 (0)	1 (0.85)	16 (2.68)	22 (1.82)	34 (2.09)	38 (2.23)	29 (2.62)	15 (2.72)	155 (2.24)	0 (0)	7 (4.17)	32 (2.99)	71 (3.68)	61 (2.61)	73 (3.14)	45 (3.11)	18 (2.87)	307 (3.1)	462 (2.74)

SCC: Squamous cell carcinoma; HPV: Human papilloma virus.