AJOG Reviews2001 Consensus Guidelines for the management of women with cervical intraepithelial neoplasia☆,☆☆,★
Section snippets
General comments
The 2001 Consensus Conference and the process used to develop the Consensus Guidelines have previously been reported.2 Each guideline is rated by using a 2-part grading system.3, 4 The “strength of recommendation” for or against the use of a particular option is indicated by the letters A through E. It is important to recognize that several criteria that included the possibility for harm to a patient if a specific intervention did not take place, the possible complications that could be
General comments
Women with a diagnosis of CIN-1 on a colposcopically directed biopsy represent a heterogeneous group. Numerous studies have documented a high level of intraobserver and interobserver variability in the histologic diagnosis of CIN-1.5, 6, 7 In the National Cancer Institute's ASCUS/LSIL Triage Study (ALTS) clinical trial, only 43% of the cervical biopsies initially diagnosed as CIN-1 were classified as CIN-1 by the expert pathology review committee, 41% were downgraded to normal, and 13% were
Women with satisfactory colposcopic examination
Management options for women with biopsy-confirmed CIN-1 are follow-up without treatment or treatment with the use of ablative or excisional modalities, Table II.Follow-up with a program of either repeat cervical cytology, at 6 and 12 months, or HPV DNA testing for high-risk types of HPV at 12 months, is the preferred management approach for women with biopsy-confirmed CIN-1 and a satisfactory colposcopic examination (AII). When follow-up is used, referral to colposcopy is preferred if a repeat
General comments
The term CIN-2,3 is used to refer to lesions previously referred to as moderate dysplasia (ie, CIN-2) and severe dysplasia/carcinoma in situ (ie, CIN-3).49 Although natural history studies of untreated moderate dysplasia, severe dysplasia, and carcinoma in situ have reported differences in the behavior of these lesions during long-term follow-up, the histologic diagnosis of these entities is poorly reproducible.5, 6, 7, 45 Moreover, follow-up studies have found that despite marginal relative
Posttreatment follow-up of women with CIN-2,3
The risk of recurrent/persistent CIN-2,3 or invasive cervical cancer after treatment is relatively low, but remains higher than the background population risk for many years.61, 78, 79, 80, 81, 82 A large, long-term follow-up study from the United Kingdom reported that the cumulative rate of invasive cervical cancer after 8 years of follow-up among women receiving outpatient treatment for CIN was 5.8 per 1000.79 For comparison, the age-adjusted incidence rate of invasive cervical cancer in the
Initial management of biopsy-confirmed CIN-2,3
Management decisions in women with biopsy-confirmed CIN-2,3 are determined by whether the colposcopic examination is classified as satisfactory or unsatisfactory, Table II. Both excision and ablation of the transformation zone are acceptable for women with biopsy-confirmed CIN-2,3 and a satisfactory colposcopy (AI). However, in patients with recurrent CIN-2,3, excisional modalities are preferred (AII). A diagnostic excisional procedure is recommended for women with biopsy-confirmed CIN-2,3 and
Acknowledgements
We would like to thank all of the participating organizations, conference participants, and the members of the working groups. Names of the conference participants are available online at www.asccp.org and names of the participating organizations are in the Appendix.
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This set of guidelines was supported by grant number 1 R13 CA96190-01 from the National Cancer Institute.
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Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or the participating societies and organizations.
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Reprint requests: Thomas C. Wright, Jr, MD, Room 16-404, P&S Building, 630 W 168th St, New York, NY 10032. E-mail: [email protected]