EP812 - Clinical characteristics of incidental anal dysplasia

Monday, May 11, 2026

10:31 AM - 10:36 AM ET

ePoster Presenter(s)

Evan Mitchell, MD (he/him/his)

General Surgery resident
Brown Univeristy
Brown University Health
Providence, RI, United States

Disclosure information not submitted.

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Author(s)

Fumiko Egawa, MD (she/her/hers)

Colon & Rectal Surgery Fellow
Brown University/Lifespan Health
Providence, RI, United States

Disclosure information not submitted.
CM

Carina McGuire, MD

General Surgery Resident
Brown University Health
Providence, Rhode Island, United States

Disclosure information not submitted.
Paul M. Jennings, DO (he/him/his)

Colon and Rectal Surgery Fellow
Brown Health / Lifespan Health
Farmingdale, NJ, United States

Disclosure information not submitted.

Senior Author(s)

Rebecca Gologorsky, MD

Colorectal Surgeon
Brown University
Providence, Rhode Island, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

AK

Adam Klipfel, MD

Colon and Rectal Surgery
Brown University
Providence, Rhode Island, United States

Disclosure information not submitted.
Steven Schechter, MD (he/him/his)

Professor of Surgery, Warren Alpert School of Medicine of Brown University
Brown Surgical Associates
Warren Alpert School of Medicine of Brown University
providence, RI, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
MV

Matthew Vrees, MD

Clinical Associate Professor of Surgery, Director of Surgery at The Miriam Hospital
Brown University
Providence, Rhode Island, United States

Disclosure information not submitted.
LR

Leslie Roth, MD

Associate Professor of Surgery
Brown university
Providence, Rhode Island, United States

Disclosure information not submitted.
KB

Katherine Baysinger, MD

Colorectal Surgeon
Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States

Disclosure information not submitted.

Purpose/Background: Anal squamous intraepithelial neoplasia (AIN) is a known precursor to anal squamous cell carcinoma. While there is literature on the prevalence of incidentally found squamous cell carcinoma in-situ of hemorrhoidectomy specimens, there is limited literature on the prevalence of anal dysplasia incidentally found on procedures like colonoscopy or hemorrhoidectomy. One descriptive study reports a 2.2% incidence of incidental anal dysplasia in hemorrhoidectomy specimens. Statistics from other incidental sources such as colonoscopic biopsy are even more lacking. In this descriptive study we report the characteristics of patients with incidentally diagnosed anal dysplasia at a single tertiary academic institution.

Methods/Interventions: A retrospective review was performed of patients who were referred for anorectal pathology to the colorectal service at a single tertiary academic center between October 2014-September 2024. All patients were ages 18 years or older. Reason for referral, presenting symptoms, incidental pathology, high resolution anoscopy (HRA), human papillomavirus (HPV) status, and HPV vaccination status were evaluated.

Results/Outcomes: Review of 185 patients with anal dysplasia revealed that n= 124 male and n= 61 female. Average age was 51.47 years old (range 23-87 years). The most common indication for referral was HIV positive status (n=49, 34.7%) followed by condyloma (n=37, 26.2%). 65 patients were symptomatic, and rectal bleeding (n=17, 9.1%) was the most common presenting symptom. 18.9 % were diagnosed with anal dysplasia as an incidental finding after another procedure, most commonly by colonoscopy (n=21, 61.7%). Of the patients with anal dysplasia, 56.3.% were HPV positive; sub-group analysis revealed 21.2% of the incidentally diagnosed group were HPV positive. 40 % underwent HRA following anal pap with findings of abnormal cytology. There was concordance in the anal pap and HRA findings in 32% of cases. HPV vaccination status was reported as unknown in 34.6% of cases (n=64).

Conclusion/Discussion: Prior literature has highlighted the importance of sending hemorrhoidectomy specimens separately, given the baseline prevalence of 2.2% of anal dysplasia in otherwise asymptomatic patients. The findings of our preliminary analysis indicate that anal dysplasia may be identified on colonoscopy in otherwise asymptomatic patients, which should prompt referral to a colorectal surgeon for ongoing management and surveillance. The incidence in new anal squamous cell carcinoma diagnosis has been increased by nearly 3% per year in the US. The findings of this preliminary analysis underscore the importance of understanding risk factors for anal dysplasia and progression to carcinoma.
Nationally there has been low adoption of the HPV vaccine since its approval for females in 2006 and subsequent approval for males in 2009. In our patient population the reported HPV vaccination rate was low, and true HPV vaccination rate is unknown. While our understanding of the pathophysiology of the progression from dysplasia to carcinoma is limited, HPV is a known risk factor for the development of anal dysplasia and anal squamous cell carcinoma. Our preliminary analysis supports ongoing efforts to screen for high risk features and provide appropriate management options to reduce further risk in otherwise asymptomatic patients.