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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 <jats:styled-content style=\"fixed-case\">AIN III<\/jats:styled-content>. We also aimed to assess the quality of the studies used to compile the guidelines and to clarify the terminology used in histological assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>An electronic search of PubMed and Embase was performed using the search terms \u2018anal intraepithelial neoplasia\u2019, \u2018<jats:styled-content style=\"fixed-case\">AIN<\/jats:styled-content>\u2019, \u2018anal cancer\u2019, \u2018guidelines\u2019, \u2018surveillance\u2019 and \u2018management\u2019. Literature reviews and guidelines or practice guidelines in peer reviewed journals from 1 January 2000 to 31 December 2014 assessing the treatment, surveillance or management of patients with <jats:styled-content style=\"fixed-case\">AIN<\/jats:styled-content> related to human papilloma virus were included. The guidelines identified by the search were assessed for the quality of evidence behind them using the Oxford Centre for Evidence\u2010based Medicine 2011 Levels of Evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The database search identified 5159 articles and two further guidelines were sourced from official body guidelines. After inclusion criteria were applied, 28 full\u2010text papers were reviewed. Twenty\u2010five of these were excluded, leaving three guidelines for inclusion in the systematic review: those published by the Association of Coloproctology of Great Britain and Ireland, the American Society of Colon and Rectal Surgeons and the Italian Society of Colorectal Surgery. No guidelines were identified on the management of <jats:styled-content style=\"fixed-case\">AIN III<\/jats:styled-content> from human papilloma virus associations and societies. All three guidelines agree that a high index of clinical suspicion is essential for diagnosing <jats:styled-content style=\"fixed-case\">AIN<\/jats:styled-content> with a disease\u2010specific history, physical examination, digital rectal examination and anal cytology. There is interchange of terminology from high\u2010grade <jats:styled-content style=\"fixed-case\">AIN<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">HGAIN<\/jats:styled-content>) (which incorporates <jats:styled-content style=\"fixed-case\">AIN II<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">AIN III<\/jats:styled-content> in the literature leading to confusion in therapy use. Treatment varies from immunomodulation and photodynamic therapy to targeted destruction of areas of <jats:styled-content style=\"fixed-case\">HGAIN<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">AIN II<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> using infrared coagulation, electrocautery, cryotherapy or surgical excision but with little consensus between the guidelines. Recommendations on surveillance strategies are similarly discordant, ranging from 6\u2010monthly physical examination to annual anoscopy \u00b1 biopsy. Over 50% of the recommendations are based on Level 3 or Level 4 evidence and many were compiled using studies that were more than 10\u00a0years old.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite concordance regarding diagnosis, there is significant variation in the guidelines over recommendations on the treatment and surveillance of patients with <jats:styled-content style=\"fixed-case\">HGAIN<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">AIN II<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>. All three sets of guidelines are based on low level, outdated evidence originating from the 1980s and 1990s.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13215","type":"journal-article","created":{"date-parts":[[2015,11,12]],"date-time":"2015-11-12T10:03:49Z","timestamp":1447322629000},"page":"135-146","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Systematic review of guidelines for the assessment and management of high\u2010grade anal intraepithelial neoplasia (<scp>AIN<\/scp>\u00a0<scp>II<\/scp>\/<scp>III<\/scp>)"],"prefix":"10.1111","volume":"18","author":[{"given":"N. N.","family":"Alam","sequence":"first","affiliation":[{"name":"Exeter Surgical Health Services Research Unit (HeSRU) Royal Devon and Exeter Hospital Barrack Road Exeter Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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