An Update on the Current Role of High Resolution Anoscopy in Patients With Anal Dysplasia

Anticancer Res. 2019 Jan;39(1):17-23. doi: 10.21873/anticanres.13075.


The incidence of anal squamous cell carcinoma (ASCC) in the U.S. is increasing, particularly in immunocompromised patients. Preventative screening is used to monitor precancerous dysplasia known as anal intraepithelial neoplasia (AIN), which can progress to ASCC. High Resolution Anoscopy (HRA) is one screening procedure that uses a colposcope with acetic acid and Lugol's iodine solution to visualize the anal epithelium for AIN. HRA has offered potential in managing AIN, but as more evidence emerges it is unclear whether HRA provides definitive benefit. This narrative review updates readers on the efficacy of HRA in screening AIN, compares HRA to other techniques, compares the use of HRA in various high-risk populations, and offers practical information on the use of HRA. Keyword searches were conducted using MEDLINE, Web of Science, and Cochrane Library. Current literature is mixed regarding the utility of HRA. Further randomized controlled trials are needed to definitively assess the role of HRA.

Keywords: Anal squamous cell carcinoma; anal dysplasia; anal intraepithelial neoplasia; high resolution anoscopy; review.

Publication types

  • Review

MeSH terms

  • Acetic Acid / therapeutic use
  • Anal Canal / diagnostic imaging
  • Anal Canal / pathology
  • Anus Neoplasms / diagnosis*
  • Anus Neoplasms / diagnostic imaging
  • Anus Neoplasms / pathology
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Colposcopes / trends*
  • Humans
  • Iodides / therapeutic use
  • Precancerous Conditions / diagnosis*
  • Precancerous Conditions / diagnostic imaging
  • Precancerous Conditions / pathology


  • Iodides
  • Acetic Acid
  • Lugol's solution