Systematic Review of guidelines for the assessment and management of High Grade XXXX (AIN II/III).

@entity1 @entity5 @entity3354 @entity645 @entity911 @entity1893 @entity5436
AIM: There is ambiguity with regard to the optimal management of @entity3354 . The aim of this review was to assess and compare international/national society guidelines currently available in the literature on the management, treatment and surveillance of @entity3354 . We also aimed to assess the quality of the studies used to compile the guidelines and to clarify the terminology used in histological assessment. METHOD: An electronic search of PubMed and Embase was performed using the search terms ' @entity5436 ', 'AIN', ' @entity5 ', 'guidelines', 'surveillance' and 'management'. Literature reviews and guidelines or practice guidelines in peer reviewed journals from 1(st) January 2000 to 31(st) December 2014, assessing the treatment, surveillance or management of @entity1 with AIN related to HPV were included. The guidelines identified by the search were assessed for the quality of evidence behind them using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. RESULTS: The database search identified 5159 articles and two further guidelines were sourced from official body guidelines. After inclusion criteria were applied, 28 full text papers were reviewed. Twenty-five of these were excluded, leaving three guidelines for inclusion in the systematic review including those published by the Association of Coloproctology of Great Britain and Ireland (ACPGBI), the American Society of Colon and Rectal Surgeons (ASCRS) and the Italian Society of Colorectal Surgery (SICCR). There were no guidelines identified on the management of @entity3354 from @entity645 associations and societies. All three guidelines agree that a high index of clinical suspicion is essential for diagnosing AIN with a disease-specific history, physical examination, digital rectal examination and anal cytology. There is interchange of terminology from @entity1893 ( @entity1893 ) (which incorporates AIN II/III) and @entity3354 between the literature leading to @entity911 in therapy use. Treatment varies from immunomodulation and photodynamic therapy to targeted destruction of areas of @entity1893 /AIN II/III using infrared coagulation, electrocautery, cryotherapy or surgical excision but with little consensus between the guidelines. Recommendations on surveillance strategies were similarly discordant, ranging from six-monthly physical examination to annual anoscopy +/- biopsy. Over 50% of the recommendations are based on Level 3 or Level 4 evidence and many were compiled using studies that were greater than 10 years old. CONCLUSION: Despite concordance regarding diagnosis, there is significant variation amongst the guidelines over recommendations on the treatment and surveillance of @entity1 with @entity1893 /AIN II/III. All three sets of guidelines are based on low level, out-dated evidence originating from the 1980s and 1990s. This article is protected by copyright. All rights reserved.
