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