2. 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:

3. Management of Women with
Low-grade Squamous Intraepithelial Lesions (LSIL) > 30years
(2013, A SCC P)

4. 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

5. LSIL with negative HPV test
Colposcopy
LSIL with no HPV test
No CIN2,3 Manage per ASCCP Guideline
CIN2,3 Manage per ASCCP Guideline

6. 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):

7. 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 years later

8. > 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

9. Follow-up without Treatment
Cotesting at 12 months
> ASC or HPV(+) Colposcopy

10. 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

11. 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

12. 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

13. Management of Women with
No Lesion or
Biopsy-confirmed (CIN1)
Ages 21-24
(ASCCP 2013)
After ASC-H or HSIL
Manage per ASCCP Guideline

14. 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

15. 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

16. If CIN 1 is preceded by HSIL or AGC-NOS cytology
and colposcopy is unsatisfactory
diagnostic excisional procedure recommended

17. 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.

18. CIN is not treated in pregnancy, but is followed up until the postpartum period

19. Management of Pregnant Women (LSIL)
ASCCP 2013,
Colposcopy
Preferred
No CIN2,3 (no cytological, histological, or
colposcopically suspected CIN2, or cancer)
Postpartum follow-up
CIN2,3 Manage per SCCP Guideline
Acceptable
Defer Colposcopy (Until at least 6 weeks postpartum)

20. 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

21. Thank you