cervical intraepithelial neoplasia (CIN)
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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
- high grade lesion
- colposcopy with directed biopsy
- ablation
- CO2 laser therapy
- cone biopsy
- loop electrosurgical excision procedure (LEEP)
- cryotherapy if LEEP not available
- low grade lesion (grade 2 or lower)
- repeat PAP smear in 3 months
- colpsocopy
- 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]
- follow-up
- combined HPV testing & cytology at 6 months & 24 months[3]
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 2.0 2.1 2.2 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: https://www.ncbi.nlm.nih.gov/pubmed/22899563
- ↑ 3.0 3.1 3.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23117059 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23117060 <Internet> http://www.bmj.com/content/345/bmj.e7086
Bleeker MCG Follow-up after treatment for cervical intraepithelial neoplasia. BMJ 2012;345:e7186 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23117061 <Internet> http://www.bmj.com/content/345/bmj.e7186 - ↑ 4.0 4.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24423603 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24423750 <Internet> http://www.bmj.com/content/348/bmj.f7700 - ↑ 5.0 5.1 Kyrgiou M et al Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis. BMJ 2014;349:g6192 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25352501 <Internet> http://www.bmj.com/content/349/bmj.g6192
- ↑ 6.0 6.1 6.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29487049 <Internet> http://www.bmj.com/content/360/bmj.k499
Cruickshank M Treatment or surveillance for CIN2? BMJ 2018;360:k771 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29487080 <Internet> http://www.bmj.com/content/360/bmj.k771