II. Precautions

  1. Delay LEEP until after pregnancy
    1. Low risk of progression in pregnancy
    2. Lesions often regress in postpartum period
    3. Yost (1999) Obstet Gynecol 93:359-62 [PubMed]
  2. Refer if inadequate Colposcopy
    1. Adequate Colposcopy requires visualization of SCJ
    2. Colposcopy adequate if SCJ fully visualized and
      1. Lesion not identified and ECC completed or
      2. Lesion responsible for abnormal pap was found

III. Evaluation: HSIL (or ASC-H) identified on Cervical Cytology

  1. Option 1: Colposcopy
    1. CIN 2, 3
      1. See CIN 2 or CIN 3 protocol as below
    2. No CIN 2 or 3: Observe with Colposcopy and repeat cytology every 6 months for 2 years
      1. HSIL cytology or high grade colpo for 1 year
        1. Biopsy and treat as CIN 2,3 if positive biopsy
      2. HSIL cytology without CIN 2,3 on colpo for 2 years
        1. Diagnostic excisional procedure when not pregnant
      3. Cytology negative x2 AND colpo without high grade colpo changes
        1. Return to routine screening
  2. Option 2: Immediate Loop electrosurgical excision
    1. Contraindicated in pregnancy or as initial management in age under 25 years old

IV. Evaluation: CIN 2 or CIN 3 on Colposcopy

  1. Step 1a: Initial management of women over age 25 years based on Colposcopy results
    1. Inadequate Colposcopy or Recurrent CIN 2, 3 or ECC with CIN 2, 3
      1. Diagnostic Excisional Procedure
    2. Adequate Colposcopy
      1. Excision or ablation of transformation zone
  2. Step 1b: Initial management of women under age 25 years based on Colposcopy results
    1. Option 1: Treat using protocol as in 1a (see above)
      1. CIN 3 on Colposcopy
      2. Inadequate Colposcopy
      3. Per patient preference
    2. Option 2: Observation with Colposcopy and cytology every 6 months for 12 months
      1. Cytology and Colposcopy negative at 6 and 12 months
        1. HPV and Cervical Cytology co-testing negative at 1 year
          1. Space co-testing to every 3 years
        2. HPV or Cervical Cytology co-testing positive at any time
          1. Repeat Colposcopy and biopsy
      2. Colposcopy positive for CIN 3 or persistent CIN 2 for 24 months
        1. Treat using protocol as in 1a (see above)
  3. Step 2: Excisional procedure with positive CIN 2,3 margins (or on post-procedure ECC)
    1. Option 1: Repeat Cytology and ECC in 4 to 6 months (preferred)
    2. Option 2: Repeat diagnostic excisional procedure
    3. Option 3: Hysterectomy
  4. Step 3: Repeat HPV and Cervical Cytology (co-testing) at 12 and 24 months
    1. Repeat Colposcopy if either HPV or cytology is abnormal at either 12 or 24 months
    2. Repeat HPV and cytology co-testing in 3 years if all tests are negative at 12 and 24 months
      1. If negative repeat testing may return to routine screening

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: High-Grade Squamous Intraepithelial Lesions (C0333875)

Definition (NCI_NCI-GLOSS) Cells of the uterine cervix that are moderately or severely abnormal and may become cancer.
Definition (NCI) A precancerous neoplastic process characterized by the presence of moderate or severe dysplastic cytological changes which extend to the upper part of the squamous epithelium. Maturation at the surface of the squamous epithelium may or may not be present. Representative examples include the high grade esophageal squamous intraepithelial neoplasia, high grade cervical squamous intraepithelial neoplasia, high grade vaginal intraepithelial neoplasia, and high grade vulvar intraepithelial neoplasia.
Concepts Neoplastic Process (T191)
MSH D065310
SnomedCT 22725004
Spanish lesión intraepitelial escamosa de alto grado, lesión intraepitelial escamosa de alto potencial maligno (anomalía morfológica), lesión intraepitelial escamosa de alto potencial maligno, HSIL, Lesión intraepitelial escamosa de alto grado, lesión intraepitelial escamosa de gran malignidad (anomalía morfológica), lesión intraepitelial pavimentosa de gran malignidad, lesión intraepitelial escamosa de gran malignidad, lesión intraepitelial pavimentosa de alto potencial maligno
Dutch hooggradige squameuze intra-epitheliale laesie, HSIL
French Lésion épidermoïde intra-épithéliale de haut grade (HSIL), Lésion épidermoïde intra-épithéliale de haut grade
German HSIL, High grade squamous intraepithelial lesion
Italian Lesione intraepiteliale squamosa di grado elevato, Lesioni intraepiteliali squamose di alto grado (HSIL)
Portuguese Lesão intra-epitelial por células escamosas de alto grau, HSIL
Japanese 高度扁平上皮内病変, HSIL, コウドヘンペイジョウヒナイビョウヘン, HSIL
Czech Šupinatá intraepitelová léze vysokého stupně, HSIL
English high grade squamous intraepithelial lesion (HGSIL), hsil, high grade sil, High Grade Squamous Intraepithelial Lesions, High-Grade Squamous Intraepithelial Lesions, HSIL, High-Grade Squamous Intraepithelial Lesions, HSIL, High Grade Squamous Intraepithelial Lesions, High grade SIL, High-grade squamous intraepithelial lesion, HSIL, High-grade squamous intraepithelial lesion (morphologic abnormality), high-grade squamous intraepithelial lesion, high-grade squamous intraepithelial neoplasia, High-Grade Squamous Intraepithelial Lesion, High Grade Squamous Intraepithelial Neoplasia, High grade squamous intraepithelial lesion
Hungarian Súlyos fokú intraepithelialis squamosus laesio, HSIL