management of women with cin 1 or lsil dr. zohreh yousefi, professo of obstetrics and gynecology,...
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![Page 1: Management of Women with CIN 1 or LSIL Dr. Zohreh Yousefi, Professo of Obstetrics and Gynecology, Fellowship of Gynecology Oncology, Ghaem Hospital, Mahhad](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d745503460f94a54a4a/html5/thumbnails/1.jpg)
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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: www.zohrehyousefi.com
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Management of Women with
Low-grade Squamous Intraepithelial Lesions (LSIL) > 30years
(2013, A SCC P)
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LSIL with positive HPV testPreferred
Repeat Cotesting 1 year
If Cytology Negative and HPV Negative Repeat Cotesting 3 years
If > ASC or HPV positive Colposcopy
AcceptableColposcopy
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LSIL with negative HPV testColposcopy
LSIL with no HPV test
Colposcopy
No CIN2,3 Manage per ASCCP Guideline CIN2,3 Manage per ASCCP Guideline
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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):
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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 3 years later
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> ASC or HPV(+) Colposcopy If No CIN No CIN2,3 Manage per ASCCP Guideline
CIN1 If persists for at least 2 yearsFollow-up or treatment
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Follow-up without Treatment
Cotesting at 12 months
> ASC or HPV(+) Colposcopy
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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
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OrCotesting 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
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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 orIf colposcopy is unsatisfactory
a diagnostic excisional procedure is recommended
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Management of Women with No Lesion or Biopsy-confirmed (CIN1) Ages 21-24 (ASCCP 2013)
After ASC-H or HSIL
Manage per ASCCP Guideline
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After ASC-US or LSILRepeat Cytology 12 months
ASC-H or HSIL > Colposcopy
< ASC-H or HSIL Repeat Cytology 12 months
Repeat Cytology 12 months > ASC Colposcopy
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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 procedureor 6-monthly colposcopy and cytology for 1 year
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If CIN 1 is preceded by HSIL or AGC-NOS cytology and colposcopy is unsatisfactory
diagnostic excisional procedure recommended
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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.
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CIN is not treated in pregnancy, but is
followed up until the postpartum period
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Management of Pregnant Women (LSIL)ASCCP 2013,ColposcopyPreferredNo CIN2,3 (no cytological, histological, or colposcopically suspected CIN2,3 or cancer) Postpartum follow-up
CIN2,3 Manage per SCCP Guideline
AcceptableDefer Colposcopy (Until at least 6 weeks postpartum)
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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
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Thank you