2016 IANS International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors
2016 IANS International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors
复制标题
DOI：
10.1097/lgt.0000000000000256
复制
发表时间：
2016-10-01
影响因子：
3.7
通讯作者：
Jay, Naomi
中科院分区：
文献类型：
--
作者：
Hillman, Richard John;Cuming, Tamzin;Jay, Naomi
目的确定肛门癌先兆研究中提供服务和临床实践的最低标准。方法2015年9月17日至21日在里斯本举行的国际乳头瘤病毒会议上，专家们进行了首次面对面的会议，起草了第一个版本，并将其发送给主要利益攸关方。一份完整的草稿已由国际肛门新生症协会(IANS)理事会审查，并上载到IANS网站，供所有成员提供意见。IANS委员会于2016年6月22日批准了最终草案。结果明确了令人满意的高分辨率肛门镜(HRA)的基本组成部分。建立了服务提供的最低标准、临床医生的基本能力和标准化描述符。为从业者提出的质量保证指标包括每年至少50个HRA和识别20例或更多的肛门高级别鳞状上皮内病变(HSIL)。在高危人群中首次尝试进行技术上不令人满意的肛门细胞学样本应少于5%的病例。在细胞学HSIL已被发现的地方，组织学HSIL应该在90%的病例中被确定。在超过90%的病例中，HRA的持续时间应小于15分钟。有问题的疼痛或出血应由10%或以下的患者系统收集和报告。结论这些指南提出了HRA临床实践的初步最低能力，专业人员可以根据这些能力来判断自己，提供者可以评估培训的效果。一旦标准达成一致并得到验证，就有可能为个别从业人员制定认证方法，并对现场进行认证。
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.