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Using high\u2010resolution anoscopy (HRA), surgical excision, ablative and topical therapies are widely used to treat HSIL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>With ASCC incidence increasing and new guidelines on screening high\u2010risk patients, we sought to evaluate the efficacy and safety of HSIL treatment modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>EMBASE, MEDLINE, and Cochrane databases were searched for English\u2010language, original studies specifically on HSIL or anal intraepithelial neoplasia (AIN) treatment from inception until December 31, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>Two reviewers independently reviewed abstracts and full\u2010text articles with a third reviewer for discrepancies. Studies were evaluated for efficacy, recurrence and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty\u2010four original papers were evaluated, of which five were randomised controlled trials (two directly comparing different modalities). Numbers in each study and overall quality were low, and extensive heterogeneity existed in methodology. Side effects were common, but significant complications only occurred with surgical excision and photodynamic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is insufficient evidence to clearly identify any gold standard HSIL treatment modality. Regardless of the modality, treatment overall is safe, but recurrence is high. Studies directly comparing modalities with standardisation of methodologies and outcome measures are required, especially in light of increasing incidence of ASCC and up\u2010take of HRA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70738","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:29:52Z","timestamp":1778650192000},"page":"2339-2352","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and Safety of Anal High\u2010Grade Squamous Intraepithelial Lesion Treatment Modalities: A Systematic Review"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2307-3088","authenticated-orcid":false,"given":"Matthew Joseph","family":"Marino","sequence":"first","affiliation":[{"name":"Austin Hospital  Melbourne Australia"},{"name":"University of Tasmania School of Medicine  Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Jones","sequence":"additional","affiliation":[{"name":"Royal Hobart Hospital  Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas Reid","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Melbourne Health &amp; Eastern Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Cartwright","sequence":"additional","affiliation":[{"name":"Royal Hobart Hospital  Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4966-5839","authenticated-orcid":false,"given":"Benedict","family":"Blacket","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals Trusts  Oxford United\u00a0Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2276-8999","authenticated-orcid":false,"given":"Richard Clive","family":"Turner","sequence":"additional","affiliation":[{"name":"University of Tasmania School of Medicine  Hobart Australia"},{"name":"Royal Hobart Hospital  Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33185"},{"key":"e_1_2_9_3_1","unstructured":"Australia Government \u201cBowel Cancer (Colorectal Cancer) in Australia Statistics: Cancer Australia \u201d(2024) https:\/\/www.canceraustralia.gov.au\/cancer-types\/bowel-cancer\/bowel-cancer-colorectal-cancer-australia-statistics."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0000000000000842"},{"key":"e_1_2_9_5_1","unstructured":"Health AIo Welfare \u201cCancer Data in Australia: AIHW \u201d(2024) https:\/\/www.aihw.gov.au\/reports\/cancer\/cancer-data-in-australia."},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30653-9"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001384"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28431"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djad176"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2201048"},{"key":"e_1_2_9_11_1","unstructured":"Australasian Society for HIV VH Medicine SH \u201cAnal Cancer Screening Guidelines: ASHM \u201d(2025) https:\/\/analcancerscreening.guidelines.org.au\/."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34850"},{"key":"e_1_2_9_13_1","first-page":"2273","article-title":"High\u2010Resolution Anoscopy Referral Rates Adopting Different Anal Cancer Screening Strategies for Men Who Have Sex With Men","volume":"386","author":"Benevolo M.","year":"2025","journal-title":"Cancer Prevention Research (Philadelphia, Pa.)"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.scrs.2017.04.005"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-020-03740-6"},{"key":"e_1_2_9_16_1","unstructured":"J.Howick I.Chalmers P.Glasziou et\u00a0al. \u201cThe Oxford Levels of Evidence 2: Oxford Centre for Evidence\u2010Based Medicine \u201d(2011) https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/ocebm-levels-of-evidence."},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_9_19_1","unstructured":"J. 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