Appendix C. Clinical question list

From Cancer Guidelines Wiki


Clinical question list

Questions 1

Relevant guidelines content page: Oncogenic HPV types not 16/18

Question 1a

Primary PICO

For women who are positive for hr-HPV types other than 16 or 18 and have pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./dLSIL reflex liquid based cytology (intermediate risk), what is the safety and effectiveness of immediate colposcopy compared to colposcopy delayed by 12 months based on later HPV test results (assuming referral to colposcopy if any HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. at 12 months)?

Population Study design Intervention Control Outcome
Women who are positive for hr-HPV types other than 16 or 18 and have pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./dLSIL (ASC-USAtypical squamous cells, undetermined significance/LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.) liquid based cytology (intermediate risk) Randomised or pseudo randomized controlled trial Immediate

ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities.

Repeat HPV test in 12 months;

ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. if positive

Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

Secondary PICO (In the event that no randomised or pseudo-randomised controlled trials were identified that directly addressed the primary PICO)

For women undergoing routine cervical screening what is the risk of CIN3+ for women who are positive for HPV oncogenic types other than 16 and 18 and have p/dLSIL cytology compared with women who have p/d LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. cytology regardless of HPV status, p/dHSIL cytology regardless of HPV status, or are HPV 16/18Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory.+ regardless of cytology?

Population Study design Exposure Comparator Outcome
Women undergoing routine cervical screening Longitudinal or cross-sectional prognostic Positive for HPV oncogenic types other than 16 and 18 and have p/dLSIL cytology p/dLSIL or

p/dHSIL or

HPV 16/18Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory.+

CIN3+

CIN2+

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Question 1b

Primary PICO

For women who are positive for hr-HPV types other than 16 or 18 and have negative or pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./dLSIL reflex liquid based cytology (intermediate risk), what is the safety and effectiveness of repeating HPV testing in 12 and 24 months compared to repeating HPV test at 12 months only before returning to 5 yearly screening?

Population Study design Intervention Control Outcomes
Women who are positive for hr-HPV types other than 16 or 18 and have negative or pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./dLSIL (ASC-USAtypical squamous cells, undetermined significance/LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.) liquid based cytology (intermediate risk) Randomized or pseudo randomized controlled trial Repeat HPV test in 12 and 24 months;

ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. if positive or if both negative discharge back to screening

Repeat HPV test in 12 months; ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. if positive and if negative discharge to screening Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

Secondary PICO (In the event that no randomised or pseudo-randomised controlled trials were identified that directly addressed the primary PICO)

For women undergoing routine cervical screening what is the risk of subsequent CIN3+ for women who are positive for HPV oncogenic types other than 16 and 18 and have negative cytology compared with women who have p/d LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. regardless of HPV status or who have p/d LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. and are positive for HPV oncogenic types other that 16 and 18?

Population Study design Exposure Comparator Outcomes
Women undergoing routine cervical screening Longitudinal prognostic Positive for HPV oncogenic types other than 16 and 18 and have NILM cytology p/dLSIL

or

positive for HPV oncogenic types other than 16 /18 and have p/dLSIL cytology

CIN3+

CIN2+

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Questions 2

Relevant guidelines content page: Normal colposcopic findings following LBC prediction of LSIL or HSIL

Question 2a

Primacy PICO

For HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women who are not in treatment follow-up and who have negative or LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. cytology and who have undergone colposcopy and the colposcopy was negative, what is the safety and effectiveness of testing with repeat HPV test at 12 months when compared with repeat cytology and HPV testing in 12 months?

Population Study design Intervention Control Outcomes
HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women who have undergone colposcopy and the colposcopy was negative and cytology was:

i. negative,

ii. p/d LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.

Randomized or pseudo randomized controlled trial Repeat HPV test at 12 months;

ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. (and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test) if positive

If negative HPV test in 12 months

Repeat cytology and HPV testing at 12 months: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. if HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. test or if cytology pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. or worse, and another 12 months follow-up if HPV negativeWomen in whom oncogenic HPV types are not detected by the HPV testing platform. p/dLSIL; repeat HPV and cytology test in 12 months if HPV negativeWomen in whom oncogenic HPV types are not detected by the HPV testing platform. and cytology p/dLSIL or negative Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

Secondary PICO (In the event that no randomised or pseudo-randomised controlled trials were identified that directly addressed the primary PICO)

For HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women who are not in treatment follow-up and who have negative or p/dLSIL cytology on referral and who had colposcopy and the colposcopy was negative what are the predictors of subsequent detection of high-grade disease?

Population Study design Exposure Comparator Outcomes
Women who have p/dLSIL or negative cytology who have undergone colposcopy and no abnormalities were seen on colposcopy Cohort Referral cytology

Referral HPV status

Age

Other

Referral cytology

Referral HPV status

Age

Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 2b

For women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with p/dHSIL referral cytology and p/dLSIL or less after cytologic review and colposcopy is negative, what is the safety and effectiveness of conservative management compared with excision of the transformation zone?

Population Study design Intervention Control Outcome
HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women who have undergone colposcopy and the colposcopy was negative and referral cytology was p/d HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). and review cytology was p/d LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. or less Randomized or pseudo randomized controlled trial Conservative management Excision of the transformation zone Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

dHSIL = definite HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).; dLSIL = definite LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.; HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). = high-grade squamous intraepithelial lesion; LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. = low-grade squamous intraepithelial lesion pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. = possible HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).; pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system. = possible LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.

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Question 2c

For women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with p/dHSIL referral cytology and p/dHSIL after cytologic review and colposcopy is negative, what is the safety and effectiveness of cytologic and colposcopic follow-up at 3-6 months compared with excision of the transformation zone?

Population Study design Intervention Control Outcome
HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women who have undergone colposcopy and the colposcopy was negative and referral and review cytology was p/d HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). Randomized or pseudo randomized controlled trial Conservative management; cytologic and colposcopic follow-up at 3-6 months Excision of the transformation zone Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

dHSIL = definite HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).; HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). = high-grade squamous intraepithelial lesion; pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. = possible HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).

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Questions 3

Relevant guidelines content page: Type 3 TZ (previously termed ‘unsatisfactory’) colposcopy following LBC prediction of LSIL or HSIL


Question 3a

For HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women currently not in treatment follow-up and have negative or LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. cytology who have undergone colposcopy and the colposcopy was unsatisfactory what is the safety and effectiveness of repeat HPV test at 12 months compared with repeat cytology and HPV testing in 12 months?

Population Study design Intervention Control Outcomes
HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women who have undergone colposcopy and the colposcopy was unsatisfactory

and cytology was:

i. negative,

ii. p/d LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.

Randomized or pseudo randomized controlled trial Repeat HPV test at 12 months; ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. (and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test) if positive and if negative HPV test in 12 months Repeat cytology and HPV testing at 12 month; ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. if HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. test or if cytology pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. or worse, and another 12 months follow-up if HPV negativeWomen in whom oncogenic HPV types are not detected by the HPV testing platform. p/dLSIL; repeat HPV and cytology test in 12 months if HPV negativeWomen in whom oncogenic HPV types are not detected by the HPV testing platform. and cytology p/dLSIL or negative Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 3b

For HPV-positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women with a referral cytology finding of p/dHSIL and who have an unsatisfactory colposcopy, what is the safety and effectiveness of conservative management compared with diagnostic excision of the transformation zone?

Population Study design Intervention Control Outcomes
HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women who have undergone colposcopy and the colposcopy was unsatisfactory

and cytology was:

p/d HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).

Randomized or pseudo- randomized controlled trial Conservative management:

Co-testingHPV test and LBC both requested and performed on a cervical sample. at 3-6 months or repeat HPV test at 12 months

Diagnostic excision of the transformation zone Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

dHSIL = definite HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).; HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). = high-grade squamous intraepithelial lesion; pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. = possible HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).

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Question 4

Relevant guidelines content page Chapter 9. Management of histologically confirmed low-grade squamous abnormalities


For HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women currently not in treatment follow-up who have undergone colposcopy (without treatment) with colposcopy LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. and CIN 1 or less on biopsy what is the safety and effectiveness of excisional treatment or testing with repeat HPV test at 12 months when compared with repeat cytology and HPV testing in 12 months?

Population Study design Intervention Control Outcomes
HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women, who have undergone colposcopy and colposcopy LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category., confirmed by biopsy CIN1mild dysplasia or less,

and referral cytology was:

i. negative or p/d LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.

or

ii. p/dHSIL

Randomized or pseudo randomized controlled trial Excisional treatment

or

Repeat HPV test at 12 months

i. Negative cytology or p/dLSIL: Repeat cytology and HPV testing at 12 months: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. if HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. test or if cytology pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. or worse, and another 12 months follow-up if HPV negativeWomen in whom oncogenic HPV types are not detected by the HPV testing platform. p/dLSIL; repeat HPV and cytology test in 12 months if HPV negativeWomen in whom oncogenic HPV types are not detected by the HPV testing platform. and cytology p/dLSIL or negative

ii. p/dHSIL: repeat cytology and colposcopy in 6 months

Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Questions 5

Relevant guidelines content page: Investigation of cytological glandular abnormalities

Question 5a

For women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with atypical endocervical cells of undetermined significance (confirmed on review) and negative colposcopy what is the safety and effectiveness of repeating HPV and cytology testing when compared with treatment with excisional cone biopsy?

Population Study design Intervention Control Outcomes
Women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with atypical endocervical cells of undetermined significance (confirmed on review) and colposcopy negative Randomized or pseudo randomized controlled trial Repeat HPV and liquid based cytology testing at 6 months Excisional cone biopsy cervix Cervical cancer mortality

Other gynaecologic cancer diagnosis (endometrial, ovarian)

Cervical cancer diagnosis

Precancerous high grade lesion (including AISAdenocarcinoma in situ) detection

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Question 5b

For women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with atypical glandular cells of undetermined significance (AGUSAtypical glandular cells of undetermined significance) or possible high grade glandular lesion (confirmed on review) and negative colposcopy what is the safety and effectiveness of repeating HPV and cytology testing when compared with treatment with excisional cone biopsy?

Population Study design Intervention Control Outcomes
Women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with AGUSAtypical glandular cells of undetermined significance or possible HGGAHigh-grade glandular atypia (confirmed on review) and colposcopy negative Randomized or pseudo randomized controlled trial Repeat HPV and liquid based cytology testing at 6 months Excisional cone biopsy cervix Cervical cancer mortality

Cervical cancer diagnosis

Endometrial cancer diagnosis

Ovarian cancer diagnosis

Precancerous high grade lesion (including AISAdenocarcinoma in situ) detection

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Question 6

Relevant guidelines content page: Treatment of HSIL CIN2

For women with biopsy confirmed CIN2 what is the safety and effectiveness of p16 immunohistochemistry and treating only p16 positive CIN2 while conservatively managing p16 negative CIN2 when compared with treating all CIN2 cases?

Population Study design Intervention Control Outcomes
Women with biopsy confirmed CIN2 Randomized or pseudo randomized controlled trial Using p16 immunohistochemistry to stratify management:

p16 positive cases treated with excision and p16 negative cases conservatively managed

Treat all CIN2 with excision of transformation zone. Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 7

Relevant guidelines content page: Follow-up after excisional treatment for AIS

For women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with adenocarcinoma in situ (AISAdenocarcinoma in situ) or possible high-grade glandular lesion cytology or biopsy confirmed AISAdenocarcinoma in situ, what is the safety and effectiveness of large loop excision of the transformation zone (LLETZLarge loop excision of the transformation zone), Fischer coneThe Fischer cone is a conisation specimen obtained by using a Fischer cone biopsy excisor, and uses similar electrosurgical technology as used in loop excision procedures., laser cone or straight wire/needle excision of the transformation zone (SWETZStraight wire excision of the transformation zone/NETZNeedle Excision of the Transformation Zone) compared with cold knife cone biopsy?

Population Study design Intervention Control Outcomes
Women who are HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with AISAdenocarcinoma in situ or possible high-grade glandular lesion cytology or biopsy confirmed AISAdenocarcinoma in situ Randomized or pseudo randomized controlled trial LLETZLarge loop excision of the transformation zone or

Fischer coneThe Fischer cone is a conisation specimen obtained by using a Fischer cone biopsy excisor, and uses similar electrosurgical technology as used in loop excision procedures. or

laser cone or

SWETZStraight wire excision of the transformation zone or

NETZNeedle Excision of the Transformation Zone or

Any electro-surgery of the transformation zone

Cold knife cone biopsy Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion (including recurrent AISAdenocarcinoma in situ) detection

Completeness of excision.

Depth of excision

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Question 8

Relevant guidelines content page: Investigation of abnormal vaginal bleeding

For women with postcoital, intermenstrual bleeding or heavier periods (menorrhagia), what is the safety and effectiveness of direct colposcopy compared with HPV test and cytology?

Population Study design Intervention Control Outcomes
Women with postcoital (PCBPostcoital bleedingVaginal bleeding after intercourse) or intermenstrual bleeding (IMBIntermenstrual bleedingVaginal bleeding at any time other than during normal menstruation or following sexual intercourse.) or menorrhagia Randomized or pseudo randomized controlled trial Direct referral to colposcopy Cytology and HPVHuman papillomavirus Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 9

Relevant guidelines content page: Screening in immune-deficient women

For women who are at higher risk of cervical cancer due to immunosuppression what is the safety and effectiveness of screening using strategies other than those recommended for the general population compared to those recommended for the general population?

Population Study design Intervention Control Outcome
Chronically immuno-suppressed or immuno-compromised asymptomatic women

or

Potentially immune suppressed or immune compromised women

Screening randomized controlled or pseudo- randomized trial Modified recommended screening strategy:

starting at an age <25 years and/or screening intervals less than 5 years and/or referring all HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. women to colposcopy irrespective of reflex cytology result

Recommended screening strategy

Primary HPV screening every 5 years from ages 25 – 69 years using partial genotyping with women positive for HPV16/18 referred to colposcopy and women positive for other oncogenic types undergoing cytology triage

Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 10

Relevant guidelines content page: Women who have experienced early sexual activity or have been victims of sexual abuse

For women with a history of sexual abuse or early sexual debut what is the safety and effectiveness of screening using strategies other than those recommended for the general population compared to those recommended for the general population?

Population Study design Intervention Control Outcome
History of sexual abuse or early sexual debut Screening randomized or pseudo- randomized controlled trial Modified recommended screening strategy:

Starting at an age <25 years

Recommended screening strategy

Primary HPV screening every 5 years from ages 25 – 69 years using partial genotyping with women positive for HPV16/18 referred to colposcopy and women positive for other oncogenic types undergoing cytology triage

Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 11

Relevant guidelines content page: Screening in DES-exposed women

For women who were exposed to diethylstilboestrol (DESDiethylstilbestrol) in utero and their daughters what is the safety and effectiveness of screening using strategies other than those recommended for the general population compared to those recommended for the general population?

Population Study design Intervention Control Outcome
Asymptomatic women exposed in utero to DESDiethylstilbestrol and their daughters Screening randomized or pseudo- randomized controlled trial Current practice: Annual vaginal examination, cervical and vaginal cytology test, HPV test and colposcopy of the lower genital tract Recommended screening strategy for general population:

Primary HPV screening every 5 years from ages 25 – 69 years using partial genotyping with women positive for HPV16/18 referred to colposcopy and women positive for other oncogenic types undergoing cytology triage

Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 12

Relevant guidelines content page: Screening in Aboriginal and Torres Strait Islander women

For women who are of Aboriginal or Torres Strait Islander descent what is the safety and effectiveness of screening using strategies other than those recommended for the general population compared to those recommended for the general population?

Population Study design Intervention Control Outcomes
Women of Aboriginal or Torres Strait Islander descent Screening randomized or pseudo-randomized controlled trial Modified recommended screening strategy:

- starting at an age <25 years

- other

Recommended screening strategy for general population:

Primary HPV screening every 5 years from ages 25 – 69 years using partial genotyping with women positive for HPV16/18 referred to colposcopy and women positive for other oncogenic types undergoing cytology triage

Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 13

Relevant guidelines content page: Screening in pregnancy

For women who are pregnant update the literature of management of abnormal cytology in pregnancy p.74 from the old guidelines. Describe guidance for excluding presence of invasive cancer. How can we support the exclusion of the presence of the invasive cervical cancer? Are there any circumstances that you would manage or treat pregnant women differently to the general population?

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Questions 14

Relevant guidelines content page: After total hysterectomy

For groups of women (literature review or PICO) who have had a hysterectomy. What should the recommendation be in regard to further ‘screening’?

  1. Women with total hysterectomy for benign conditions who have never had an abnormal HPV or cytology. Do they need any further screening?
  2. Women who have had in the past been HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. with high grade abnormality (squamous or glandular) who have been treated satisfactorily and are on surveillance or have returned to normal screening, who then have a total hysterectomy with no evidence of abnormality on the hysterectomy specimen.
  3. Women who have had a high grade abnormality treated by total hysterectomy, with complete excision of the lesion in the hysterectomy specimen. What follow up would be reasonable.
  4. Women who have had a high grade lesion (CIN2+) who have been treated and have completed test of cure and returned to routine screening, subsequently have hysterectomy with no abnormality in the hysterectomy specimen. Is there any need for further screening?

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Question 16

Relevant guidelines content page: Test of Cure after treatment for HSIL (CIN2/3)

For women have been treated for a high grade precancerous squamous lesion what is the safety and effectiveness of testing with HPV test and cytology at 12 months after treatment and discharging if double-negative compared with testing at 12 and 24 months and discharging if double-negative at both 12 and 24 months?

Population Study design Intervention Control Outcome
Women who have been treated for high grade precancerous squamous lesions Randomized or pseudo randomized controlled trial Cytology and HPV testing 12 months after treatment with discharge if double negative Cytology and HPV testing 12 and 24 months after treatment with discharge if double negative on both occasions Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion detection

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Question 17

Relevant guidelines content page: Follow-up after excisional treatment for AIS

For women have been treated for adenocarcinoma in situ (AISAdenocarcinoma in situ) with cone excision or LEEPLoop electrical excision procedureLoop electrical excision procedure and with clear histologic margins what is the safety and effectiveness of cytology and HPV testing at 12 and 24 months and discharging if double-negative at both 12 and 24 months or completion hysterectomy compared to cytology?

Population Study design Intervention Control Outcome
Women treated for AISAdenocarcinoma in situ with cone excision or LEEPLoop electrical excision procedureLoop electrical excision procedure with complete excision and clear histological margins Randomized or pseudo randomized controlled trial Cytology and HPV testing 12 and 24 months after treatment with discharge if double negative on both occasions

Or

Completion hysterectomy

Annual cytology Cervical cancer mortality

Cervical cancer diagnosis

Precancerous high grade lesion (including recurrent AISAdenocarcinoma in situ) detection

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