Cervical intraepithelial neoplasia (CIN1) is a histologically low-grade (mild) cervical precancerous lesion, 50% of which will return to normal naturally, while the other 50% will progress to high-grade (severe) cervical precancerous lesions, also known as CIN2 and CIN3. So, what should you do if you have a colposcopic biopsy and are diagnosed with CIN1? This question may seem simple, but the answer is quite complicated. I can quickly tell the answer, but as to why is difficult to say. So, we need a little patience to read.
What to do if you have a colposcopy biopsy and a diagnosis of CIN1
1. Need to know the results of your TCT report
TCT result reports are quite complicated, but we can simply divide them into three main categories.
(1) Approximately normal, including reported as normal, no malignant cells found, benign reactive changes, inflammation.
②Low grade lesions of cytology including atypical squamous cells of unknown significance (ASCUS), atypical squamous cells tending to be highly lesional (ASC-H), and low grade lesions of squamous epithelium (LSIL).
(3) High grade lesions of cytology High grade lesions of squamous epithelium (HSIL), squamous cell carcinoma (SCC), adenocarcinoma, etc.
2. It is also necessary to know whether the colposcopy is satisfactory or not
①Satisfactory
It means that the junction between the columnar epithelium and the squamous epithelium of the cervix (called the migratory zone, which is the site where cervical precancerous lesions are most likely to occur) is seen by the examining physician, and biopsies are taken from this area and sent for pathological examination, then we can assume that there will be no more serious lesions than CIN1 in the cervix.
② Unsatisfactory
It means that the aforementioned migratory zone cannot be seen by the doctor for various reasons and biopsies were not taken at these sites, then we have to suspect that the place of biopsy may not be the most heavily lesioned site, in other words, there may be heavier lesions than CIN1 on the cervix.
3. To understand the advantages and disadvantages of the treatment of cervical lesions (CIN)
①Follow-up observation
It actually means no treatment and regular review.
②Physical therapy
Cautery destruction of the affected cervical tissue, including cervical freezing, laser, electrocautery, radiofrequency, condensation, etc. The advantage is that the operation is simple and can be done on an outpatient basis. The disadvantage is that tissue specimens cannot be obtained. If you burn it, you can’t see anything.
③Surgical treatment
Conical excision of a portion of cervical tissue, referred to as cervical conization. The advantage is that it provides a specimen for further examination to detect more serious lesions that may be present. The disadvantage is that it is slightly more invasive and requires hospitalization.
Well, with this information, we can choose the management options for CIN1.
1. The results of cytology and colposcopy match both
If your cytology (TCT) reports a low-grade lesion, including ASC-US, ASC-H or LSIL, and the colposcopic biopsy results are CIN1, which means that the two are compatible, then treatment depends mainly on the combined symptoms. If there is a combination of bleeding after intercourse and cervical erosion, physical therapy, such as cervical laser, can be performed. If there are no symptoms and it is just a cervical problem found by routine physical examination, it can be reviewed periodically.
The timing and items for regular review are: repeat TCT every 6 or 12 months, or test for human papillomavirus (HPV) every 6 or 12 months. If the retest is positive for HPV, or if the retest is ASC-US or a more severe lesion, then colposcopy will be required again. If HPV is negative, or if two consecutive cervical cytologies are normal, you can return to your regular cytology screening cohort, which is currently every two years.
2. Cytology and colposcopy results do not match both
If your cytology (TCT) report is HSIL or AGC but your colposcopy biopsy result is only CIN1 and the colposcopy suggests an unsatisfactory examination, then it is best to have a cervical conization. If colposcopy is satisfactory but combined with cervical erosion, bleeding after intercourse, etc., cervical laser treatment can be done. If there are no symptoms or if the cervix is smooth, you can also have regular follow-ups. Cytology and colposcopy are done every 6 months for a time limit of one year. At the regular review, if HSIL or AGC is found again at the 6th or 12th month review, cervical conization is required.
If after one year of observation, two consecutive cytologic exams are normal, you can return to the routine screening cohort. If CIN1 persists for more than 2 years, treatment is preferable, although observation can still be continued. If colposcopy is satisfactory, physical therapy or cervical conization is fine. If colposcopy is unsatisfactory and if you have been treated previously for cervical lesions, cervical conization is required.
Warm tip: See a doctor you trust. You only need to know the answer and it is up to the doctors as to why.