Currently, the treatment of CIN tends to be conservative, and the principles of treatment are clarified according to the level of CIN to standardize treatment. The treatment is individualized by taking into account the patient’s age, marital status, degree, extent and level of lesions, as well as follow-up and technical conditions.
Treatment of CINⅠ
The pathological diagnosis of CINⅠ is less consistent and generally includes the following 3 treatment methods.
1.1 Observation and follow-up CINⅠ is characterized by mostly natural regression. At present, it is believed that CINⅠ with clear lesions diagnosed satisfactorily by colposcopy and confined outside the cervical canal can be followed up regularly, and those with unfavorable follow-up can be treated again.
The follow-up methods are.
(1) Testing for high-risk HPV in the 12th month and continuing follow-up if negative, colposcopy and treatment if positive;
(2) Cytologic follow-up at month 6 and month 12, with routine follow-up for two negative tests and colposcopy and treatment for positive tests;
(3) HPV follow-up at 6 months, if two consecutive negative cases are referred to routine cytology, if two consecutive positive cases, colposcopy and treatment.
1.2 Eliminative treatment For CINⅠ with clear lesions diagnosed by satisfactory colposcopy as above and confined outside the cervical canal, if no follow-up is available or the patient requests treatment, or for those with unfavorable follow-up or HPV(+), they should receive treatment. Treatment options are mostly elimination means such as laser vaporization or freezing, but also excision means such as LEEP or CKC. Analysis indicates that either CKC procedure or LEEP can increase the risk of preterm delivery and low birth quality, whereas laser vaporization treatment has none of these risks.
1.3 Excisional treatment LEEP or CKC should be chosen for CIN I and recurrent CIN I with lesions extending into the cervical canal, unsatisfactory colposcopic diagnosis, and poorly defined margins. Observational follow-up in this group is limited to pregnant women, immunosuppressed patients and adolescent patients.
Management of CIN II or CIN III
Most lesions of this type will persist and progress rather than recede. Therefore, unlike CIN I, observation is generally not recommended, but prompt treatment is required.
2.1 Management of CIN II or CIN III with satisfactory colposcopic diagnosis Eliminative treatment such as laser vaporization is usually chosen, which is less invasive and has no effect on fertility, while excisional treatment such as LEEP or CKC can also be chosen.
2.2 Management of CIN II or CIN III with unsatisfactory colposcopic diagnosis About 7% of CIN II or CIN III with unsatisfactory colposcopic diagnosis (15%) have specimens showing invasive carcinoma after resection, and resection should be preferred. It has been suggested that preoperative fiberoptic hysteroscopy should be used to evaluate the intracervical canal before conization.
LEEP and CKC are the main treatments for unsatisfactory colposcopic CIN. Comparison of the two LEEP is less invasive, less bleeding, faster surgery, can be treated on an outpatient basis, has the same efficacy as CKC and is generally used as the treatment of choice.
However, CKC is preferred if.
(1) Multiple positive cervical cytology, negative or unsatisfactory colposcopy, or negative microscopic biopsy and negative cervical canal scraping;
(2) Cervical cytology diagnosis is heavier than colposcopic biopsy, or suggests suspicion of invasive cancer;
(3) CIN II-CIN III lesions or positive ECC;
(4) Cervical cytology suggesting abnormal glandular epithelium, regardless of ECC results;
(5) colposcopy or microscopic biopsy suggesting suspicion of early invasive carcinoma or suspicion of adenocarcinoma in situ of the cervix. CKC is also preferably used for recurrent CIN II or CIN III, and hysterectomy is generally not used as the initial treatment for CIN II or CIN III.