BACKGROUND: Anal squamous intraepithelial lesions (SIL) and cancers are increased in immunocompromised populations. Based upon anatomic and histologic similarities, the cervix is used as the model for anal screening. During cervical colposcopy, acetic acid (AA) and Lugol׳s staining (LS) result in characteristic changes that help distinguish low-grade (L)SIL from high-grade (H)SIL. Lesion characteristics were evaluated for their ability to distinguish anal (a)LSIL from anal (a)HSIL during high-resolution anoscopy after application of AA and LS. METHODS: AA-stained lesions were described using standard cervical colposcopic criteria. LS was then applied and lesions were characterized as Lugol׳s-negative (L−), Lugol׳s-partial (L+/−), or Lugol׳s positive (L+) and then biopsied. Biopsies were characterized as benign, squamous atypia, LSIL or HSIL. RESULTS: 835 anal lesions were analyzed. Sensitivity and positive predictive value (PPV) for aHSIL were highest for characteristics associated with cervical (c)HSIL. L− was independently associated with aHSIL (OR=4.7, 95% CI=3.4–6.7). In multiple logistic regression analysis, significant predictors of aHSIL were flat contour (OR=2.24, 95% CI=1.3–3.8), mosaic pattern (OR=2.0, 95% CI=1.4–2.9), vascular punctation (OR=1.5, 95% CI=1.1–2.1) and L− (OR=2.3, 95% CI=1.5–3.4). L− staining improved the PPV of aHSIL almost twofold in lesions that otherwise had a colposcopic impression of LSIL. CONCLUSIONS: Evaluating acetowhite lesions for contour, surface, vascularity, and LS may maximize the likelihood of identifying aHSIL.

BACKGROUND: Many cancer patients seek traditional Chinese medicine (TCM), the prevalence varying with diagnosis, comorbidities, and demographics. Interventions sought include acupuncture, massage, herbs, diet, and exercise, usually combined with conventional therapies. It is not known what proportion of TCM practitioners care for cancer patients, their cancer specific training or caseload, what interventions they employ, their outcomes, and their communication patterns with conventional oncologists. METHODS: A survey was mailed to all 2213 licensed acupuncturists in the 9-county San Francisco Bay Area gathering descriptive statistics. RESULTS: A total of 472 (21%) responded by mail or web-based Research Electronic Data Capture (REDCap) tool. Most respondents (77%) reported caring for patients with cancer, with 29% reporting having 6 to 10 years of practice experience, and 44.2% having 0 to 20 hours of training specific to the needs of patients with cancer. Improving quality of life was reported by 94% as what their treatment offered cancer patients as well as the area where treatment was felt to have the greatest impact. The most useful TCM modalities were acupuncture (98%), herbs (79%), diet (72%), moxibustion (46%), and meditation instruction (44%). Absence of adverse reactions was noted by 95%. Ninety-one percent reported never or hardly ever having been contacted by patients oncologists to discuss treatment. CONCLUSIONS: Many acupuncturists seeing cancer patients have significant clinical experience and have sought specialized training. Improved communication is needed between TCM practitioners and oncologists sharing care of cancer patients.

BACKGROUND: Anal squamous intraepithelial lesions (SIL) and cancers are increased in immunocompromised populations. Based upon anatomic and histologic similarities, the cervix is used as the model for anal screening. During cervical colposcopy, acetic acid (AA) and Lugol׳s staining (LS) result in characteristic changes that help distinguish low-grade (L)SIL from high-grade (H)SIL. Lesion characteristics were evaluated for their ability to distinguish anal (a)LSIL from anal (a)HSIL during high-resolution anoscopy after application of AA and LS. METHODS: AA-stained lesions were described using standard cervical colposcopic criteria. LS was then applied and lesions were characterized as Lugol׳s-negative (L−), Lugol׳s-partial (L+/−), or Lugol׳s positive (L+) and then biopsied. Biopsies were characterized as benign, squamous atypia, LSIL or HSIL. RESULTS: 835 anal lesions were analyzed. Sensitivity and positive predictive value (PPV) for aHSIL were highest for characteristics associated with cervical (c)HSIL. L− was independently associated with aHSIL (OR=4.7, 95% CI=3.4–6.7). In multiple logistic regression analysis, significant predictors of aHSIL were flat contour (OR=2.24, 95% CI=1.3–3.8), mosaic pattern (OR=2.0, 95% CI=1.4–2.9), vascular punctation (OR=1.5, 95% CI=1.1–2.1) and L− (OR=2.3, 95% CI=1.5–3.4). L− staining improved the PPV of aHSIL almost twofold in lesions that otherwise had a colposcopic impression of LSIL. CONCLUSIONS: Evaluating acetowhite lesions for contour, surface, vascularity, and LS may maximize the likelihood of identifying aHSIL.