Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice

In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.

French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease

PURPOSE

The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year's follow-up.

METHOD

This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II-III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave.

RESULTS

A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1-14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4. Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications. Reported complications were haemorrhage (3), dysuria (3), abscess (2), anal fissure (1), external haemorrhoidal thrombosis (10), pain requiring morphine (11). Degree of satisfaction was high (+ 5 at 3 months on a - 5/+ 5 scale).

CONCLUSION

RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave.

CLINICAL TRIAL REGISTRATION AND DATE

Clinical trial NCT04229784 (18/01/2020).

Multiwatt-power highly-coherent compact single-frequency tunable vertical-external-cavity-surface-emitting-semiconductor-laser

We demonstrate high power (2.1W) low noise single frequency operation of a tunable compact verical-external-cavity surface-emitting- laser exhibiting a high beam quality. We took advantage of thermal lens-based stability to develop a short (3-10 mm) plano-plano external cavity without any intracavity filter. The semiconductor structure emitting at 1microm is optically pumped by a 8W commercial 808 nm multimode diode laser at large incidence angle. For heat management purpose the GaAs-based VECSEL membrane was bonded on a SiC substrate. We measured a low divergence quasi-circular TEM00 beam (M2 = 1.2) close to diffraction limit, with a linear light polarization (>30 dB).We simulated the steady state laser beam of this unstable cavity using Fresnel diffraction. The side mode suppression ratio is > 45 dB. The free running laser linewidth is 37 kHz limited by pump induced thermal fluctuations. Thanks to this high-Q external cavity approach, the frequency noise is low and the dynamics is in the relaxation-oscillation-free regime, exhibiting low intensity noise (< 0.1%), with a cutoff frequency approximately 41MHz above which the shot noise level is reached. The key parameters limiting the laser power and coherence are studied. This design/properties can be extended to other wavelengths.

High power single-frequency continuously-tunable compact extended-cavity semiconductor laser

We demonstrate high power high efficiency (0:3 W) low noise single frequency operation of a compact extended-cavity surface-emitting-semiconductor-laser exhibiting a continuous tunability over 0:84 THz with high beam quality. We took advantage of thermal lens-based stability to develop a short (< 3 mm) plano-plano external cavity without any intracavity filter. The structure is optically pumped by a 1 W commercial 830 nm multimode diode laser. No heat management was required. We measured a low divergence circular TEM(00) beam at the diffraction limit (M(2) < 1:05) with a linear light polarization (> 37 dB). The side mode suppression ratio is 60 dB. The free running laser linewidth is 850 kHz limited by pump induced thermal fluctuations. Thanks to this high-Q external cavity approach, the frequency noise is low and the dynamics is in the relaxation-oscillation-free regime, exhibiting a low intensity noise, with a cutoff frequency approximately 250 MHz above which the shot noise level is reached. We show that pump properties define the cavity design and laser coherence.