Course Instruction

The Virtual High Resolution Anoscopy Course will be open June 28 through November 30, 2021. This will be a self-paced course with pre-recorded thematic modules that can be completed at any time during the 5-month period the course is open.

In addition to the recorded modules, live Q&A sessions with faculty members will be scheduled approximately every 8 weeks, available in different time zones. Attendees are welcome to attend any live session(s). Questions can be submitted at any time during the course for discussion during these sessions. Recordings will be available for those who cannot attend them live.

Live Q&A with faculty are scheduled for:

Virtual Standard HRA Course Program

Module 1 

HPV Background (Epidemiology, Pathogenesis and Anatomy)


  • Apply knowledge of lower genital HPV infection, including natural history, to the anal canal
  • Describe anal canal and perianal anatomy
  • Define and identify histopathological and cytopathological features of anal squamous intraepithelial lesions and anal cancer

1.    Introduction to HPV: General Epidemiology - 28 mins

2.    Epidemiology of Anal Cancer and Squamous Intraepithelial Lesions (SIL) – 33 mins

3.    Anal Anatomy – 20 mins

4.    Pathology 1: Anal Squamous Intraepithelial Lesions and Cancer – 30 mins

5.    Pathology 2: Interpretation of Anal Cytology – 25 mins

Total time: approximately 2.3 hours

Module 2

Introduction to HRA and Related Procedures


  • Understand and define terminology related to HRA
  • Interpret the normal features encountered during HRA with respect to the transformation zone and anal/perianal anatomy
  • Learn the steps of performing an HRA exam and related procedures

1.    HRA Terminology – 26 mins

2.    HRA: Features of the Normal Anal Transformation Zone – 20 mins

3.    HRA Procedures/Skills – 45 mins

4.    Putting it together: HRA Video – 25 mins 

Total time: approximately 2 hours

    Module 3

    HRA Pattern Recognition


    • Identify and differentiate Low-grade (L)SIL and High-grade (H)SIL within the anal canal and perianus
    • Recognize features of invasive disease

    1.    HRA: Identification of LSIL – 20 mins

    2.    HRA: Identification of HSIL – 26 mins 

    3.    HRA: Identification of Perianal Lesions – 28 mins

    4.    HRA: Identification of Cancer – 33 mins

    5.    Tips to improving HRA skills – 10 mins 

    Total time: approximately 2 hours

      Module 4

      Screening for HPV-associated Lesions


      • Summarize the key principles of screening
      • Recognize how current screening criteria are used in anal cancer screening and anal cancer precursor screening 
      • Identify high-risk groups appropriate for screening

      1.    The WHO Screening Criteria – 31 mins

      2.    Screening for prevention of anal cancer: where do we stand today? - 31 mins

      3.    Panel: Perspectives on screening algorithms – 43 mins

      Total time: approximately 1.75 hours

        Module 5

        Treatment of ASIL


        • Summarize current treatment options for Anal SIL including topical, ablative and excisional methods
        • Describe their mode of action, benefits and complications 
        • Requirements for anesthesia associated with different treatment modalities

        1.    Principles of Treatment – 30 mins

        2.    Topical Therapies – 30 mins 

        3.    Ablative Therapies – 55 mins

        4.    Anesthesia for Procedures – 11 mins

        Total time: approximately 2.1 hours

          Module 6

          Management of Anal Cancer


          • Describe the standard of care for treatment of invasive anal cancer
          • Recognize the indications for and risks of conservative treatment for early anal cancer
          • Understand the management for recurrent anal cancer
          •  Define the role of HRA following treatment of anal cancer

          1.    Anal Cancer Treatment - 30 mins 

          2.    HRA following Cancer – 15 mins 

          Total time: approximately 45 mins

            Module 7

            Management and Counseling


            • Outline appropriate management for anal SIL including treatment in the operating room, and follow-up post-treatment
            • Understanding the impact of anal neoplasia on patients

            1.    Treatment Triage: Cases – 45 mins

            2.    HRA in the Operating Room: Two Perspectives – 34 min

            3.    Messaging: Counseling the Patient with HPV-associated Disease – 28 mins

            4.    The Patient’s Perspective – 32 min

            Total time: approximately 2.3 hours

              Module 8

              Practicalities for Establishing an HRA Practice


              • Define components of an HRA practice 
              • Recognize practice metrics, practice standards and international guidelines
              • Learn how to Incorporate research prevention into HRA clinical practice 
              • Describe the indications for HPV vaccination

              1.    Essential Equipment for HRA – 21 mins

              2.    Documentation for HRA – 22 mins

              3.    Guidelines for Creating a New HRA Practice – 20 mins

              4.    HRA Practice Metrics – 28 mins

              5.    Incorporating research into clinical practice – 11 mins

              6.    HPV Vaccination for prevention – 30 min

              Total time: approximately 2.2 hours

                Module 9

                Anal Neoplasia in Context

                To receive full CMEs please choose a minimum of 3 topics (subjects noted as optional do not count towards CMEs)


                • Expand knowledge to that of other specialty areas that overlap with management of lower anogenital tract disorders

                1.    Non-infectious Disease of the Anus and Perianus – 39 mins

                2.    Vulvar Disease – 31 mins

                3.    Sexually Transmitted Infections, Testing and Treatment – 35 mins

                4.    Diseases of the Colon and Rectum – 26 mins

                5.    Dermatologic conditions – 26 mins

                6.    Coding and Billing (US based providers) - Optional – 34 mins

                7.    HRA and Cervical Colposcopy: Differences - Optional – 23 mins


                    Download the printable program

                    The International Anal Neoplasia Society

                    P.O. Box 1543
                    Leesburg, Virginia 20177


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