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 test Preferred Repeat Cotesting 1 year If Cytology Negative and HPV Negative Repeat Cotesting 3 years If > ASC or HPV positive Colposcopy Acceptable Colposcopy

LSIL with negative HPV test Colposcopy LSIL with no HPV test 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 years Follow-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

Or Cotesting 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 or If 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 LSIL Repeat 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 procedure or 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, Colposcopy Preferred No CIN2,3 (no cytological, histological, or colposcopically suspected CIN2,3 or cancer) Postpartum follow-up CIN2,3 Manage per SCCP Guideline Acceptable Defer 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

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