Review of All Findings †
EITHER Observation OR Observation with ^ Except in special populations † Includes referral cytology, colposcopic fndings, and all biopsies * Provided colposcopy is satisfactory and endocervical sampling is negative. If not, diagnostic excisional procedure.
Copyright 2006, 2007, American Society for Colposcopy and Cervical Pathology. All rights reserved.
Management of Adolescent Women (20 Years and Younger) with a Histological Diagnosis of Cervical Intraepithelial Neoplasia Grade 1 (CIN 1)
Adolescent Women with CIN 1
Copyright 2006, 2007, American Society for Colposcopy and Cervical Pathology. All rights reserved.
Figure 19.16 A–F: Algorithms from the 2006 Consensus Guidelines for the Management of Women with Cervical Histologic Abnormalities. Reprinted from the Journal of Lower Tract Disease, vol. 11, issue 4, with the permission of the ASCCP (c American Society for Colposcopy and Cervical Pathology 2007. No copies of the algorithms may be made without the prior consent of the ASCCP.)
Management of Women with a Histological Diagnosis of Cervical Intraepithelial Neoplasia (CIN 2,3) *
Satisfactory Colposcopy Unsatisfactory Colposcopy OR Recurrent CIN 2,3
Either Excision or Diagnostic Excisional Ablation of T-zone * Procedure * * Management options will vary in special  circumstances Copyright 2006, 2007, American Society for Colposcopy and Cervical Pathology. All rights reserved.
E Management of Adolescent and Young Women with a Histological Diagnosis of Cervical Intraepithelial Neoplasia Grade 2,3 (CIN 2,3)
Adolescents and Young Women with CIN 2,3
Either treatment or observation is acceptable, provided colposcopy is satisfactory. When CIN 2 is specifed, observation is preferred. When CIN 3 is specifed, or colposcopy is unsatisfactory, treatment is preferred.
@ 6 mos intervals for up to 24 mos
OR Ablation of T-zone
CIN 3 OR CIN 2,3
Copyright 2006, 2007, American Society for Colposcopy and Cervical Pathology. All rights reserved.
F Management of Women with Adenocarcinoma in-situ (AIS) Diagnosed from a Diagnostic Excisional Procedure * Using a combination of cytology, HPV testing, and colposcopy with endocervical sampling Copyright 2006, 2007, American Society for Colposcopy and Cervical Pathology. All rights reserved.
Figure 19.16 (continued)
In recognition of the small but real risk for preterm birth, young women less than 20 years may be offered a program of surveillance with cytology and colposcopy at 6-month intervals with treatment only for persistence at 24 months (75). The heterogeneity of CIN 2 lesions is significant and regression rates are higher than for CIN 3. The histological distinction between CIN 2 and CIN 3 remains subjective and these diagnoses are combined in the 2006 Consensus Guidelines.
Although CIN can be treated with a variety of techniques, the preferred treatment for CIN 2 and 3 is LEEP. This allows a specimen to be sent for evaluation and enables the pathologist to identify occult microinvasive cancer or adenomatous lesions to ensure these lesions were treated adequately. The persistent and recurrent disease rate posttreatment is estimated at 4% to 10% (91,92).
Most of the excisional and ablative techniques used to treat CIN can be performed in an outpatient setting, which is one of the main objectives in the management of this disease.