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

2. 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

3. 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

4. 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

5. 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.

6. 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.

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

8. 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

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

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

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

12. 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

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

14. 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

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

16. 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