[Should CIN 2 and 3 be treated the same way?]

Abstract

Although spontaneous regression of cervical intraepithelial neoplasia type 2 (CIN 2) occurs in 40% of cases over a 2 years period, such diagnosis commonly requires the use of excisional techniques exposing to genuine obstetrical and neonatal morbidity as well as the risk of unsatisfactory post-treatment colposcopy. Recent advances in knowledge about CIN 2 natural history and morbidity of conservative therapies brings out the need to optimize therapeutics indications and to reconsider the use of ablative techniques. In order to allow for the lack of histological analysis and final diagnosis, it is therefore crucial not to misdiagnose microinvasive cervical disease. The use of factors significantly related to the risk of microinvasion misdiagnosis allows for a simple and reliable risk assessment in decision-making regarding CIN 2 management. Thus, CIN 2 therapeutic abstention with simple follow up as well as ablative technique might be safely considered in women under 30 whose lesion involves only one cervical quadrant, with type one transformation zone, without any colposcopic sign of severity and whose cervical smear and biopsy results are concordant. Use of ablative techniques will be recommended in all other cases. If necessary, practice of large loop excision of the transformation performed under colposcopic vision by experienced practitioner should be preferred to all other excisional techniques.