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    RANZCOG Fellows’ adherence to guidelines following cytological prediction of cervical adenocarcinoma-in-situ: Cause for concern?

    Access Status
    Fulltext not available
    Authors
    Powell, A.
    Cohen, P.
    Spilsbury, Katrina
    Steel, N.
    Blomfield, P.
    Date
    2018
    Type
    Journal Article
    
    Metadata
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    Citation
    Powell, A. and Cohen, P. and Spilsbury, K. and Steel, N. and Blomfield, P. 2018. RANZCOG Fellows’ adherence to guidelines following cytological prediction of cervical adenocarcinoma-in-situ: Cause for concern? The Australian and New Zealand Journal of Obstetrics and Gynaecology. 59 (2): pp. 294-300.
    Source Title
    The Australian and New Zealand Journal of Obstetrics and Gynaecology
    DOI
    10.1111/ajo.12886
    ISSN
    0004-8666
    URI
    http://hdl.handle.net/20.500.11937/73446
    Collection
    • Curtin Research Publications
    Abstract

    Background: For Australian women with screen-detected adenocarcinoma-in-situ (AIS), an excisional biopsy is mandatory for further assessment, treatment, and to exclude the presence of cervical adenocarcinoma. The only exclusion to this rule is if the woman has a clinically evident invasive cervical malignancy. Excisional treatments should be tailored according to a patient's age and future obstetric needs. To date, practitioner compliance with this recommendation has not been investigated. Aims: To investigate clinical management for patients with a cytological test result predicting AIS. Secondary aims were to report the most severe histological findings of excisional biopsy specimens following cytological prediction of AIS and investigate treatment outcomes for conservatively managed patients with biopsy-confirmed AIS. Materials and Methods: A retrospective, population-based cohort study was conducted. Cases were ascertained from the Tasmanian and Western Australia Cervical Screening Registries. Cytology and histology results for women with an index cervical smear reporting AIS from 2001 to 2012 were reviewed. Results: Three hundred and twenty-one women (age range 18–69 years) had an index smear reporting AIS. Cervical cancer was diagnosed in 62 (19.3%) patients within the study cohort. Twenty-one of 321 patients (6.7%) were not initially managed according to the 2005 NHMRC Guidelines for the management of asymptomatic women with screen-detected abnormalities, including two women diagnosed with an occult cancer following a total hysterectomy. Conclusions: A minority of women were not managed in accordance with guidelines. This is of concern given that nearly one in five women with a smear predicting AIS had a final diagnosis of cervical cancer.

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