Discussion: Management of histologically confirmed high-grade glandular abnormalities

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Unresolved issues

Whilst at this time indefinite co-testingHPV test and LBC both requested and performed on a cervical sample. is recommended, the ongoing monitoring of the renewed NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. may provide data in the future to support the safety of discharging women who have been negative for both HPV and cytology on multiple occasions at an earlier point.

Future research priorities

Well-designed prospective research studies are needed to compare the use of cold knife cone biopsy with diathermy loop excision (LEEPLoop electrical excision procedureLoop electrical excision procedure or LLETZLarge loop excision of the transformation zone) in the diagnosis and treatment of AISAdenocarcinoma in situ. If such a study were to show that loop excision was non-inferior to cold-knife cone biopsy for the outcomes of post-treatment recurrent and adenocarcinoma, loop excision could be recommended as an appropriate treatment option for AISAdenocarcinoma in situ. This would benefit women because, unlike cold-knife cone procedures, loop excision does not require hospital admission and general anaesthesia.

Studies evaluating endocervical curettage would provide useful evidence to determine its role in clinical practice.

Long-term data from the National Cancer Screening RegisterA database of identifiable persons containing defined demographic and health information, established for a specific purpose. In the case of cervical screening or other cancer screening registers, the purpose includes inviting eligible persons for screening, sending reminders when they are overdue for screening, follow up of abnormalities, statistical reporting and research. should be analysed to determine the minimal effective surveillance period for women undergoing annual Test of Cure for post-treatment AISAdenocarcinoma in situ before returning to routine 5-yearly screening.

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