SH-sheikhhasani Gyn-oncologist CIN I MANAGEMENT SH-sheikhhasani Gyn-oncologist

endocervix:, is covered with glandular epithelium. ectocervix: covered in squamous epithelium, endocervix:, is covered with glandular epithelium. CIN refers to squamous abnormalities. Glandular cervical neoplasia includes adenocarcinoma in situ and adenocarcinoma

CIN :low-grade or high-grade CIN :low-grade or high-grade. low-grade CIN : a low potential for developing cervical malignancy, high-grade lesions: at high risk of progression to malignancy. In managing women with CIN, the goal is to prevent possible progression to invasive cancer while avoiding overtreatment of lesions that are likely to regress

MANAGEMENT  two management approaches to cervical intraepithelial neoplasia (CIN): continued observation (with cervical cytology,HPV, and colposcopy) treatment with an excision or ablation of the cervical transformation zone less commonly, hysterectomy In some clinical contexts, "see-and-treat" protocols are used, in which evaluation and management are performed at the same visit

LOW-GRADE LESIONS: CIN 1 (CIN) 1 is a low-grade lesion caused by (HPV) subtypes of both low and high oncogenic risk. management of women with CIN 1 depends upon the preceding cytology.

CIN 1 low-grade cytologic findings ( [ASC-US] or [LSIL]), observation is advised rather than treatment, unless CIN 1 persists for two or more years.

risk of high-grade preinvasive disease or cancer is higher (ASC-H) or (HSIL) CIN 1 observation or immediate treatment

Risk of malignant disease CIN 1 lesions will regress in most women. ●CIN 1 preceded by ASC-US or LSIL cytology : 4 to 13 percent will be diagnosed with CIN 2,3 within 6 to 24 months of follow-up. No studies have reported invasive cervical cancer ●CIN 1 preceded by ASC-H or HSIL cytology : (In one study) five-year risk of CIN 3+ of 15 percent

CIN 1 preceded by lesser abnormalities ASC-US cytology, LSIL cytology, HPV 16 or 18 infection persistent HPV infection

Women ages 25 or older with CIN 1 (or no lesion) preceded by lesser abnormalities

co-testing should be performed in 12 months NEG co-test age-appropriate screening tests in three years NEG routine screening

Cytology should be repeated in 12 months Women ages 21 to 24 with CIN 1 (or no lesion) preceded by ASC-US or LSIL Cytology should be repeated in 12 months negative, ASC-US, or LSIL, ASC-H or HSIL colposcopy cytology repeated in 12 months cytologic abnormality is found at the 24-month follow-up, NEG routine screening colposcopy

why management of CIN differ for women ages 21 to 24 years???

CIN 1 preceded by ASC-H or HSIL In addition to ASC-H and HSIL, CIN 1 preceded by atypical glandular cells is also associated with an increased risk of subsequent high-grade disease

Women ages 25 years or older with CIN 1 (or no lesion) preceded by ASC-H or HSIL

co-testing at 12 and 24 months diagnostic excisional procedure review of cytologic, histologic, and colposcopic findings HPV + Or Cytology+(except HSIL) NEG age-appropriate tests in three years. colposcopy diagnostic excisional procedure