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2016 IANS International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors

Hillman, Richard John MD, PhD; Cuming, Tamzin MD; Darragh, Teresa MD; Nathan, Mayura MBBS, FRCP; Berry-Lawthorn, Michael MD; Goldstone, Stephen MD; Law, Carmella MB, BS, FAChSHM, MBA; Palefsky, Joel MD; Barroso, Luis F. MD; Stier, Elizabeth A. MD; Bouchard, Céline MD; Almada, Justine BA; Jay, Naomi PhD, RN

Journal of Lower Genital Tract Disease: October 2016 - Volume 20 - Issue 4 - p 283–291
doi: 10.1097/LGT.0000000000000256

Objectives: To define minimum standards for provision of services and clinical practice in the investigation of anal cancer precursors.

Methods: After initial face to face meetings of experts at the International Papillomavirus meeting in Lisbon, September 17 to 21, 2015, a first version was drafted and sent to key stakeholders. A complete draft was reviewed by the Board of the International Anal Neoplasia Society (IANS) and uploaded to the IANS Web site for all members to provide comments. The final draft was ratified by the IANS Board on June 22, 2016.

Results: The essential components of a satisfactory high-resolution anoscopy (HRA) were defined. Minimum standards of service provision, basic competencies for clinicians, and standardized descriptors were established. Quality assurance metrics proposed for practitioners included a minimum of 50 HRAs per year and identifying 20 cases or more of anal high-grade squamous intraepithelial lesions (HSILs). Technically unsatisfactory anal cytological samples at first attempt in high-risk populations should occur in less than 5% of cases. Where cytological HSIL has been found, histological HSIL should be identified in ≥ 90% of cases. Duration of HRA should be less than 15 minutes in greater than 90% of cases. Problematic pain or bleeding should be systematically collected and reported by 10% or lesser of patients.

Conclusions: These guidelines propose initial minimum competencies for the clinical practice of HRA, against which professionals can judge themselves and providers can evaluate the effectiveness of training. Once standards have been agreed upon and validated, it may be possible to develop certification methods for individual practitioners and accreditation of sites.

These guidelines define the minimum standards for provision of services and clinical practice in the investigation of anal cancer precursors.

1Dysplasia and Anal Cancer Services, St Vincent’s Hospital, Darlinghurst; 2Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia; 3Homerton University Hospital NHS Foundation Trust, Homerton, London, UK; 4Department of Pathology Mt. Zion Medical Center; 5Homerton Anal Neoplasia Service (HANS), London, UK; 6Anal Neoplasia Clinic, Research, and Education Center, San Francisco, CA; 7Laser Surgery Care, New York, NY; 8St Vincent's Centre for Applied Medical Research, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia; 9University of California–San Francisco, San Francisco, CA; 10Wake Forest Baptist Health Infectious Diseases/Internal Medicine, Winston-Salem, NC; 11Obstetrics and Gynecology, Dysplasia Services, Boston University Medical Center, Boston, MD; 12Centre Médical Berger Centre, Chemin Sainte-Foy, Québec, Canada; 13Anal Cancer Foundation, Dumbo, Brooklyn, NY; and 14UCSF ANCRE Center, Mount Zion Hospital, San Francisco, CA

Reprint requests to: Richard John Hillman, MD, PhD, The University of Sydney, Western Sydney Sexual Health Centre, 62 Marsden St, Parramatta, Australia. E-mail:

The authors have no financial support to declare.

The authors have declared they have no conflicts of interest.

Review board status: This paper does not contain any research involving people or animals nor human images, so does not include a statement of review board status, consents for research or a statement of patient consent.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology