management of women with cin 1 or lsil dr. zohreh yousefi, professo of obstetrics and gynecology,...

Management of Women with CIN 1 or LSIL

Dr. Zohreh Yousefi, Professo of Obstetrics and Gynecology, Fellowship of Gynecology Oncology, Ghaem Hospital, Mahhad

University

website: www.zohrehyousefi.com

Management of Women with

Low-grade Squamous Intraepithelial Lesions (LSIL) > 30years

(2013, A SCC P)

LSIL with positive HPV testPreferred

Repeat Cotesting 1 year

If Cytology Negative and HPV Negative Repeat Cotesting 3 years

If > ASC or HPV positive Colposcopy

AcceptableColposcopy

LSIL with negative HPV testColposcopy

LSIL with no HPV test

Colposcopy

No CIN2,3 Manage per ASCCP Guideline CIN2,3 Manage per ASCCP Guideline

Management of Women with No Lesion or Biopsy-confirmed

(CIN1) Preceded by “Lesser Abnormalities include ASC-US or LSIL Cytology HPV 16+ or 18+ , and persistent HPV

(ASCCP 2013):

Follow-up without Treatment

Co testing at 12 months

a - HPV(-)and Cytology Negative Age appropriate* if age <30 years Cytology if age > 30 years co testing retesting 3 years later

> ASC or HPV(+) Colposcopy If No CIN No CIN2,3 Manage per ASCCP Guideline

CIN1 If persists for at least 2 yearsFollow-up or treatment

Follow-up without Treatment

Cotesting at 12 months

> ASC or HPV(+) Colposcopy

Management of Women with No Lesion or Biopsy-confirmed (CIN1) Preceded by ASC-H or HSIL Cytology (ASCCP 2013)

Diagnostic Excision Procedure Or Review of cytological, histological, and colposcopic findings

Manage per ASCCP Guideline for revised diagnosis

OrCotesting at 12 and 24 months

HSIL Diagnostic Excision Procedure HPV(+) or Any cytology abnormality except HSIL

Colposcopy

HPV(-) and Cytology Negative at both visits Age-specific Retesting in 3 years

If CIN 1 persists for 2 years or more continued follow-up or treatment is appropriate

Treatment can be ablative or excisional

the endocervical sample is positive for CIN or the patient has been previously treated orIf colposcopy is unsatisfactory

a diagnostic excisional procedure is recommended

Management of Women with No Lesion or Biopsy-confirmed (CIN1) Ages 21-24 (ASCCP 2013)

After ASC-H or HSIL

Manage per ASCCP Guideline

After ASC-US or LSILRepeat Cytology 12 months

ASC-H or HSIL > Colposcopy

< ASC-H or HSIL Repeat Cytology 12 months

Repeat Cytology 12 months > ASC Colposcopy

Management of Women with histological diagnosis CIN 1 Preceded by HSIL or AGC-NOS Cytology

or in the assessment of abnormal Pap smears reported as HSIL (CIN 2-3) or (AGC-NOS)

can be managed by either an excisional diagnostic procedureor 6-monthly colposcopy and cytology for 1 year

If CIN 1 is preceded by HSIL or AGC-NOS cytology and colposcopy is unsatisfactory

diagnostic excisional procedure recommended

CIN 1 in Adolescence follow-up with annual cytology

At 24 months, those with ASC-US or greater should be referred for colposcopy

Only those with HSIL or greater at 12 months should be referred for colposcopy.

follow-up by HPV DNA testing in this age group is of no value due to the frequency of positive results.

CIN is not treated in pregnancy, but is

followed up until the postpartum period

Management of Pregnant Women (LSIL)ASCCP 2013,ColposcopyPreferredNo CIN2,3 (no cytological, histological, or colposcopically suspected CIN2,3 or cancer) Postpartum follow-up

CIN2,3 Manage per SCCP Guideline

AcceptableDefer Colposcopy (Until at least 6 weeks postpartum)

Take home message

Current guidelines for the management of biopsy-confirmed CIN 1

strongly recommend conservative follow-up no therapeutic intervention observation alone

Although grater lesions and persisted lesions for a longer time probably less likely to regress spontaneously

Thank you