Anal Dysplasia – High Resolution Anoscopy

Anal Dysplasia – High Resolution Anoscopy

Francesco Grasso, M.D., F.A.C.S is a specialist in the diagnosis and treatment of anal dysplasia, and in the prevention of anal cancer. Dr. Grasso’s clinical focus includes anal cancer, sexually transmitted infections, and human papilloma virus infections. He has advanced expertise in the surgical treatment of anal HPV-related dysplasia and is actively involved in both prevention and treatment of HPV related conditions. He is a member of the International Anal Neoplasia Society

Basic Anatomy of the Anus

There are two types of cells in the anal canal: skin (squamous) cells and mucosal (columnar) cells. They meet at the squamo-columnar junction or transitional zone. This is where most anal cancers originate.

What is Anal Dysplasia?

Anal dysplasia is the presence of abnormal squamous cells in the anal canal or in the perianal area.
Anal dysplasia is a pre-cancerous condition, potentially leading to invasive squamous cell anal cancer.
Anal dysplasia, or Squamous Intraepithelial Lesion, could be Low Grade (LG-SIL or AIN-I) or
High Grade (HG-SIL or AIN-II and AIN-III)

Even though not all lesion progress into anal cancer, evaluation by a physician at regular intervals is strongly recommended.

What is HPV?

HPV, or Human Papilloma Virus, is one of the most common sexually transmitted diseases; HPV is transmitted during vaginal and anal sex, but also during oral sex, genital-to-genital contact and body fluids.
HPV causes anal dysplasia and anal warts.
HPV types 16 and 18 are associated with anal cancer, cervical cancer and throat cancer.
HPV types 6 and 11 are associated with anal warts, also called condyloma acuminata.

Who is at risk of anal cancer?

  • HIV positive men and women have higher risk, even if the HIV infection is well controlled by HAART (Highly Active Anti-Retroviral Therapy).
  • People who take drugs to suppress the immune systems, including people who have received organ transplants and people who take biologic drugs for inflammatory bowel disease or rheumatoid arthritis
  • History of anal sexual intercourse, especially if unprotected and/or with multiple partners.
  • History of sexually transmitted diseases.
  • History of anal condylomas/warts
  • History of HPV infection
  • Women with abnormal Pap Test
  • Age greater than 50 years
  • History of smoking

What are the symptoms?

Most people with anal dysplasia have NO SYMPTOMS. Therefore, it is important to have regular colorectal surgery visits so that we may complete routine screenings. Symptoms of anal cancer include:

  • Bleeding from the anus or rectum
  • Pain or pressure in the anal area
  • A mass or growth in the anal area
  • Anal itching, burning or discharge
  • Swollen groin lymph nodes

What is the anal Pap test?

The anal Pap test, or anal cytology test, is a procedure in which cells are scraped from the lining of the anus using a q-tip swab and looked at under a microscope. It is used to find cancer and changes in cells that may lead to cancer. An anal Pap test can also show conditions that are not cancer, such as infection or inflammation. Also called anal Pap smear. It is usually performed in the physician’s office and is painless.

What is High Resolution Anoscopy (HRA)?

  • High Resolution Anoscopy, or HRA, is the examination of the anal canal at high magnification, 12-16 times larger than the original size, through a small round tube called anoscope.
  • The doctor will apply a local anesthetic cream during the digital rectal examination at the beginning of the procedure, followed by acetic acid (vinegar) and iodine solution to facilitate the identification of abnormal tissue such as anal dysplasia.
  • If indicated, the physician will obtain one or more biopsies.
  • The HRA is performed in the doctor’s office and generally lasts about 15-20 minutes. It is usually very well tolerated with mild discomfort.
  • Significant risks such as bleeding or infection are extremely rare. No bowel cleansing or enemas are needed.


Acetic Acid
Iodine Solution

For patient’s safety, we use only DISPOSABLE ANOSCOPES.

Prevention of HPV Infection

The best way to prevent HPV infection is abstinence. If you are sexually active, using condoms during vaginal, oral, and anal sex may decrease the risk of sexually transmitted diseases, but it does not completely protect you or your partner. HPV vaccines are helpful when administered BEFORE the exposure to sex.

Prevention of Anal Cancer

The best way to prevent anal cancer is the early diagnosis and treatment of anal dysplasia, starting with Anal Pap test and following with HRA (High Resolution Anoscopy) at regular intervals, depending on each individual situation.

Anal Pap Test results

  • Normal test containing both squamous and columnar cells should be repeated once a year (false negative – 20%)
  • Abnormal test (ASCUS, ASC-H, L-SIL, H-SIL or other) should be further evaluated with HRA (High Resolution Anoscopy).

HRA results

  • Low Grade Anal Dysplasia (AIN-I or LG-SIL), may be monitored with HRA or Pap test in 12 months.
  • High Grade Anal Dysplasia (AIN II-III or HG-SIL), should be treated by surgical methods, either excision or ablation, then followed with surveillance HRA in 3-4 months.

Preparation for your visit

Do not take aspirin, ibuprofen, Motrin, Aleve, blood thinners (such as Coumadin, Xarelto, Eliquis, etc.), vitamin E, fish oil for 7 days prior to your office appointment.


Location Info


6569 N Charles St, Suite 502, Towson, MD 21204

Union Memorial Office

3333 North Calvert Street Suite 665B Baltimore, MD 21218

Bel Air Office

208 Plumtree Rd., Suite F, Bel Air 21015

Endoscopy Center at Bel Air

208 Plumtree Rd Suite G, Bel Air, MD 21015