The EXCISE Study - EXcisional treatment Comparison for In Situ Endocervical adenocarinoma

Eligible participants reported on screening cytology referred to a gynaecologist or gynaecological oncologist will be randomised to undergo a LEEP or CKC procedure. Participants randomised to the Intervention arm LEEP, will have their procedure performed either under local or general anaesthesia in an outpatient setting or operating theatre at the discretion of the treating specialist as per local routine practice. All participants will undergo endocervical curettage at the time of their LEEP or CKC. The approximate duration of the procedure is 15 - 30 minutes. Loop diathermy (LEEP) is the most commonly used treatment for high grade squamous dysplasia of the cervix in developed countries. The dimensions of the loop should be chosen after colposcopy preceding therapy to meet the width of the transformation zone and the planned type (length) of excision. Excisions are classified according to the length of cervix excised. Type I - usually to 8 mm and not more than 10 mm length of cervical tissue excised Type 2 - not more than 15 mm length of tissue excised Type 3 - equivalent to ‘cone biopsy’ and > 15 mm length In this Study only type 2 and 3 Excision are permitted. Diathermy settings should be significantly higher than used in most open or laparoscopic surgeries to reduce thermal artefact (this should be minimised to 0.2 mm). It is imperative that the clinician obtain the recommended power settings from the electrosurgical system manufacturer. It should be noted that each clinician will have a personal preference (to suit their surgical technique, loop size, speed of excision and other factors) that determine their personal ‘best settings’ for electrosurgical procedures. Extensive application of coagulation current should be avoided, especially at the endocervical margin, which rarely bleeds. A single pass of the loop (side to side or posterior to anterior) to produce a specimen in one piece is optimal. LEEP may be performed in an operating theatre, outpatient clinic or consulting rooms under local or general anaesthesia in accordance with local practice and at the discretion of the treating specialist. A cold knife cone biopsy uses a scalpel to excise a cone shaped piece of cervical tissue where the glandular abnormality (AIS) is located. The shape of the excision is not in reality a true cone, but a cone on top of a cylinder. The initial incision is perpendicular to the external cervical surface to ensure the excision of glands originally exposed in the post-menarche transformation zone now overlain by mature squamous metaplasia. Cone biopsies are type 3 excisions. The procedure is performed in an operating theatre under general anaesthesia by a gynaecological oncologist or gynaecologist with experience in the technique. All treating Investigators will be highly experienced providers and certified under the Colposcopy Quality Improvement Program (CQUIP) in accordance with the requirements of the Royal Australian and New Zealand College of Obstetrics and Gynaecology. Following treatment all patients will undergo the 'Test of Cure' management pathway. * Colposcopy and cervical cytology at 6 months' post excisional treatment * cervical cytology on oncongenic HPV typing at 12 month's post treatment and then annually in accordance with the revised NHMRC guidelines.