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cervical intraepithelial neoplasia (CIN)

Etiology: - infection with human papillomavirus types 16, 18, 31, 33, 35, 45, 51, 52, 56 Laboratory: - HPV testing - Pap smear (cytology) (6 & 24 months follow-up) [3] Complications: - cervical cancer - high-grade CIN increases risk for cervical cancer & vaginal cancer as later in life [4] - does not raise obstetric risk [2] - grade 2 CIN lesions - 1/2 of regress spontaneously within 2 years [6] - 0.5% develop into invasive cervical cancer [6] Management: 1) high grade lesion a) colposcopy with directed biopsy b) ablation - CO2 laser therapy - cone biopsy - loop electrosurgical excision procedure (LEEP) - seems to be modality of choice (WHO NGC) - cryotherapy if LEEP not available 2) low grade lesion (grade 2 or lower) - repeat PAP smear in 3 months - colpsocopy 3) pregnancy - minimize tissue removed during CIN treatment to reduce subsequent risk for preterm birth [2] - treatment of CIN increases risk of subsequent 2nd trimester miscarriage (1.6% vs 0.4%) [5] 4) follow-up - combined HPV testing & cytology at 6 months & 24 months [3]

Related

cervical cancer colposcopy Papanicolaou (Pap) smear papillomavirus

General

abnormal morphologic structure (malformation) intraepithelial neoplasia

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Castanon A et al Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: Retrospective-prospective cohort study. BMJ 2012 Aug 17; 345:e5174 PMID: 22899563
  3. Rebolj M et al Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: population based cohort study BMJ 2012;345:e6855 PMID: 23117059 http://www.bmj.com/content/345/bmj.e6855 - Legood R et al Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study. BMJ 2012;345:e7086 PMID: 23117060 http://www.bmj.com/content/345/bmj.e7086 - Bleeker MCG Follow-up after treatment for cervical intraepithelial neoplasia. BMJ 2012;345:e7186 PMID: 23117061 http://www.bmj.com/content/345/bmj.e7186
  4. Strander B et al Effect of ageing on cervical or vaginal cancer in Swedish women previously treated for cervical intraepithelial neoplasia grade 3: population based cohort study of long term incidence and mortality. BMJ 2014;348:f7361 PMID: 24423603 http://www.bmj.com/content/348/bmj.f7361 - Arbyn M et al Long term outcomes for women treated for cervical precancer. BMJ 2014;348:f7700 PMID: 24423750 http://www.bmj.com/content/348/bmj.f7700
  5. Kyrgiou M et al Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis. BMJ 2014;349:g6192 PMID: 25352501 http://www.bmj.com/content/349/bmj.g6192
  6. Tainio K, Athanasiou A, Tikkinen KAO. Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ 2018;360:k499 PMID: 29487049 http://www.bmj.com/content/360/bmj.k499 - Cruickshank M Treatment or surveillance for CIN2? BMJ 2018;360:k771 PMID: 29487080 http://www.bmj.com/content/360/bmj.k771