Management Of Cervical Intraepithelial Neoplasia Research Articles

Colposcopic Detection of CIN in Patients with Clinically Abnormal Cervix at a Tertiary Care Center in Bangladesh

Background: Cervical cancer poses a significant public health challenge globally, especially in regions like Bangladesh where access to effective screening programs is limited. Early detection and management of cervical intraepithelial neoplasia (CIN) play crucial roles in preventing the progression to cervical cancer. This study investigates the diagnostic accuracy of colposcopy, compared with histopathological findings, in detecting various grades of CIN and cervical cancer. Methods: This retrospective observational study reviewed hospital records of 200 VIA-positive cases from January 2021 to December 2023 at the Obstetrics and Gynecology Department of Holy Family Red Crescent Medical College Hospital Dhaka, Bangladesh. Colposcopic examinations were conducted, followed by histopathological evaluations of biopsied tissues to confirm the presence and grade of CIN. Data on demographic characteristics, clinical findings, and outcomes were analyzed using descriptive statistics. Result: Of the participants, 44% had normal colposcopic findings, while the prevalence of CIN I, CIN II, CIN III, and cervical cancer was 22.5%, 17%, 11%, and 4%, respectively. Histopathological correlation confirmed 46% as normal, with discrepancies noted in higher-grade lesion diagnosis. The study highlighted the high sensitivity but variable specificity of colposcopy in detecting and grading cervical lesions. Conclusion: Colposcopy serves as a valuable diagnostic tool in the early detection of cervical abnormalities. However, discrepancies in lesion grading underscore the need for integrating colposcopy with histopathological evaluations to enhance diagnostic accuracy and optimize patient management.

Advancements in the Management of Cervical Intraepithelial Neoplasia: A Comprehensive Review.

Cervical intraepithelial neoplasia (CIN) represents a significant precursor to cervical cancer, posing a considerable threat to women's health globally. This comprehensive review examines recent advancements in the management of CIN, encompassing screening, diagnosis, and treatment modalities. The etiology and pathogenesis of CIN are explored alongside an analysis of traditional and emerging screening techniques, including liquid-based cytology and molecular biomarkers. Treatment options, from minimally invasive procedures to immunotherapy approaches, are evaluated for efficacy and potential impact on patient outcomes. Furthermore, this review highlights the implications of these findings for clinical practice, emphasizing the importance of staying abreast of evolving guidelines and integrating innovative strategies into routine care. Recommendations for future research and practice are provided, emphasizing personalized approaches, disparities in access to care, and the exploration of novel therapeutic avenues. By addressing these challenges and opportunities, this review aims to contribute to the ongoing efforts to mitigate the burden of CIN and cervical cancer, ultimately improving women's health outcomes worldwide.

Trial in progress: Application of plasma circulating HPV DNA testing to management of cervical intraepithelial neoplasia (1249)

Trial in progress: Application of plasma circulating HPV DNA testing to management of cervical intraepithelial neoplasia (1249)

Efficacy of Loop Electrosurgical Excision Procedure in the Management of Cervical Intraepithelial Neoplasia (CIN) –in A Tertiary Level Hospital

Background: Cervical intraepithelial neoplasia (CIN) is the potentially premalignant transformation and abnormal growth of surface epithelial cells of the cervix. CIN is a precancerous condition and curable. Loop electrosurgical excision procedure (LEEP) is a simple, outpatient procedure of removing the transformation zone of cervix. The aim of our study was to evaluate the efficacy of large loop electrosurgical excision procedure (LEEP) as a treatment procedure for cervical intraepiethelial neoplasia. Methods: This prospective observational study was conducted at Colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from June, 2017 to May, 2019. All consecutive patients having colposcopicaly and histopathologicaly proven high grade lesion by colposcopy directed punch biopsy were included in this study. All eligible patients with high grade lesion were underwent LEEP and followed up on 15 days post-procedure, 6 months, 12 months with colposcopy. Results: Sixty (60) cases were undergone LEEP, among them 48 (80%) cases were diagnosed as CIN2 and 12 (20%) cases were CIN3 by colposcopy- directed biopsy. One patient (1.7%) needed hospital admission to controll intra-operative bleeding and in postoperative period 7 (11.7%) patients had mild to moderate post-operative bleeding which was controlled well after application of morsel’s pastes and electro-cautery, one patient (1.7%) had pelvic infection. On 6 months follow-up, in case of CIN2 patients, cure rate was 93.5% (43 of 46) and 1 (2.2%) patient had persistent CIN-2. Patient with persistent CIN2 had re-excision and followed up at 12 month with colposcopy. Among case of CIN-3, the cure rate was 81.8% (9 of 11) and 1 (9.1%) case had CIN2. P-value was 0.244, which was not statistically significant. Overall cure rate on 6 month follow-up was 91.2%. On 12 months follow-up cure rate for CIN2 was 97.8% and for CIN3 was 90.9%. Overall cure rate was 96.5%. P-value was 0.352, which was not statistically significant. Conclusion: Loop electrosurgical excision procedure (LEEP) has a good outcome as a diagnostic and treatment procedure for cervical intraepithelial neoplasia. Bangladesh Medical Res Counc Bull 2023; 49(2): 113-119

Management of Cervical Intraepithelial Neoplasia in Pregnant Women.

The aims of the present study were to evaluate the accuracy of colposcopic findings, investigate the way in which untreated cervical intraepithelial neoplasia (CIN) 2/3 develops during pregnancy, and identify factors associated with regression, persistence, or progression rates. In a tertiary gynecology and obstetrics department, 655 pregnant women were seen for colposcopy. The most common reason for referral was abnormal cytology findings. The follow-up findings were analyzed retrospectively on the basis of colposcopic findings and cytological and histological tests. The rate of accuracy for major colposcopic findings was 89.2%. Among the colposcopic findings considered "suspicious for invasion" were invasive carcinoma in 42.9% and CIN 3 in 57.1%. The persistence of CIN 3 postpartum was 80% and the rate of progression 4.1%. The rate of regression for CIN 3 was 21.9%. For CIN 2, the rate of persistence was 37.5%, with a regression rate of 31.3%. The rate of regression was higher after vaginal delivery in comparison with caesarean section. The accuracy rate of colposcopy is comparatively high, at 89.2%. This might be because pregnant women are seen by more experienced examiners in our dysplasia unit. The rate of progression is comparable with that in other studies. Vaginal delivery increases the regression rate. The newborns' birth weight or birth week did not affect the rates of regression or persistence.

Current Trends in the Management of Cervical Intraepithelial Neoplasia

Current Trends in the Management of Cervical Intraepithelial Neoplasia

Comparing loop electrosurgical procedure pathology results in the inpatient and outpatient setting (474)

<b>Objectives:</b> In the management of cervical intraepithelial neoplasia (CIN), loop electrosurgical excision procedure (LEEP) provides diagnostic information and may be therapeutic. Margin status is a key prognostic factor, given that patients with positive margins demonstrate a five-fold increased risk of any grade CIN recurrence. LEEP can be safely performed in inpatient or outpatient settings as dictated by patient preference, equipment availability, and anatomic considerations. However, there is limited evidence comparing outcomes as they relate to the LEEP treatment settings. We sought to evaluate quality outcomes and margin status of inpatient versus outpatient LEEPs. <b>Methods:</b> All patients who underwent LEEP between April 2019 and August 2021 at a single institution were identified. Chart review was conducted to extract patient demographics, clinical risk factors, and pathology outcomes. Mann-Whitney U and Chi-square tests were used for statistical analysis. <b>Results:</b> We analyzed 291 LEEP specimens, 254 (87%) in the outpatient setting and 37 (13%) in the inpatient setting. Table 1 lists patient characteristics and pathologic outcomes data. There was a significant difference in the median age, BMI, and parity between the two groups. The reasons for inpatient LEEP listed were difficult anatomy (<i>n</i>=12, 32%), lack of access to equipment required for LEEP (<i>n</i>=11, 30%), patient preference (<i>n</i>=4, 11%), concern for malignancy (<i>n</i>=3, 8%), patient comorbidity (<i>n</i>=3, 8%), large area of dysplasia (<i>n</i>=2, 5%), and combined case with other inpatient procedure (<i>n</i>=2, 5%). All comorbid conditions were related to bleeding disorders. There were significant differences between colposcopy and LEEP pathology results with respect to grade of dysplasia and evidence of malignancy. No significant differences were identified with respect to the frequency of thermal artifact affecting pathologic interpretation of margin status. Interestingly, LEEPs performed in the inpatient setting were associated with greater specimen depth and multiple tissue samples (not including endocervical curettage) compared to outpatient LEEPs. <b>Conclusions:</b> In this single-institution, retrospective study, there was no significant difference between inpatient and outpatient LEEP procedures with respect to the thermal artifact and margin status. This may result from the more ubiquitous use of P16 immunohistochemical staining to evaluate specimen margins. Although the depth of the resected specimen was significantly greater when performed in the operating room, there was also an apparent increase in specimen number, potentially reflecting larger visible lesions requiring multiple resections. These results suggest that outpatient LEEP procedures may be equally effective in managing CIN, with potential cost implications.

Laser conization for cervical intraepithelial neoplasia: Effectiveness and obstetric outcomes

PurposeTo evaluate the effectiveness and obstetric outcomes after laser conization for cervical intraepithelial neoplasia. MethodsThis retrospective study included 757 patients who underwent laser conization between 2014 and 2020. Patients with a diagnosis of invasive lesions or adenocarcinoma in situ were excluded. Histological data from the conization specimen, pre and postoperative histological and virological data (Human PapillomaVirus (HPV) test) and obstetric outcomes were collected from the medical record. The primary endpoint was the negative surgical margin rates after laser conization. The secondary endpoint were the size of the operative specimen, the postoperative virological test results (3 to 6 months after surgery), factors associated with negative or positive margin and postoperative obstetric outcomes (prematurity). Patient characteristics and outcomes were compared using Student's t-test, χ² test, or Fisher exact test. Values of p ≤ 0.05 were considered significant. ResultsThis study included 757 patients. Negative surgical margins were obtained in 76.1% of the cases and were associated with more negative HPV tests at 6 months (64.9% vs. 52.5%, p = 0.006) and fewer repeat surgeries (0.2% vs. 2.2%, p = 0.013) than for patients with positive margins. Among the patients under 43 years at the time of conization, 71 achieved a pregnancy with a term >22 weeks, and of these 66 (93%) delivered at term (≥37 weeks). ConclusionLaser conization appears to be an effective technique for the management of cervical intraepithelial neoplasia both in terms of the quality of the resection margins and the obstetric prognosis.

Tissue Characterization Using an Electrical Bioimpedance Spectroscopy-Based Multi-Electrode Probe to Screen for Cervical Intraepithelial Neoplasia.

The successful management of cervical intraepithelial neoplasia (CIN) with proper screening and treatment methods could prevent cervical cancer progression. We propose a bioimpedance spectroscopic measurement device and a multi-electrode probe as an independent screening tool for CIN. To evaluate the performance of this screening method, we enrolled 123 patients, including 69 patients with suspected CIN and 54 control patients without cervical dysplasia who underwent a hysterectomy for benign disease (non-CIN). Following conization, the electrical properties of the excised cervical tissue were characterized using an electrical bioimpedance spectroscopy-based multi-electrode probe. Twenty-eight multifrequency voltages were collected through the two concentric array electrodes via a sensitivity-optimized measurement protocol based on an electrical energy concentration method. The electrical properties of the CIN and non-CIN groups were compared with the results of the pathology reports. Reconstructed resistivity tended to decrease in the CIN and non-CIN groups as frequency increased. Reconstructed resistivity from 625 Hz to 50 kHz differed significantly between the CIN and non-CIN groups (p < 0.001). Using 100 kHz as the reference, the difference between the CIN and non-CIN groups was significant. Based on the difference in reconstructed resistivity between 100 kHz and the other frequencies, this method had a sensitivity of 94.3%, a specificity of 84%, and an accuracy of 90% in CIN screening. The feasibility of noninvasive CIN screening was confirmed through the difference in the frequency spectra evaluated in the excised tissue using the electrical bioimpedance spectroscopy-based multi-electrode screening probe.

A retrospective analysis of clinical profile of patients with cancer cervix in a rural medical college in Karnataka

Cancer cervix is most common cause of cancerous deaths in females especially in developing countries. The pre-invasive stage of cervical cancer lasts for a long period and a small proportion progresses to an invasive lesion. In Indian set up, majority of the patients are presenting with an invasive lesion. To describe the clinical profile of patients presented with cervical cancer and to describe various treatments received by those patients.: The present study is a retrospective observational study done on confirmed cases of carcinoma cervix who attended rural medical college in Karnataka. Clinical records of the patients, who presented between November 2019 and November 2020 and were diagnosed with cervical cancer, were retrieved. The data related to demographic and clinical variables like age, socioeconomic status, education, symptoms, clinical staging, treatment and histopathology report were recorded. Data collected were entered in Microsoft Excel Office 2007and data analysed. Data were presented using descriptive statistics. The data was expressed in the form of frequencies and percentagesA total of 30 patients with the median age of 46 years were studied. Most common presentation was post coital bleeding (40%) followed by white discharge per vagina in 33%. Majority were under low socioeconomic status (70%). 60% presented in stage II and 30% in stage I. Chemoradiation was treatment of choice in 60% followed by surgery in 33% and 7% were lost to follow up. On histopathology, majority had squamous cell carcinoma (70%).The appropriate management of Cervical intraepithelial neoplasia(CIN) can prevent invasive cervical cancer. In this study most of them presented in advanced stage which could have been prevented with the regular screening and awareness among women in the reproductive age group. : Detection of pre invasive lesions or in situ cases remains important key to decreasing cervical cancer morbidity and mortality.

Understanding women's choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study.

Active surveillance for cervical intraepithelial neoplasia 2 (CIN2) would allow time for most cases to regress naturally and in turn avoid potentially unnecessary and harmful treatment. To determine reasons for choosing active surveillance over surgery among women given a hypothetical diagnosis of CIN2. Women residing in Australia aged 25-40years with no prior diagnosis of cervical cancer, cervical abnormality CIN2 or above, and/or previous hysterectomy, were randomised to one of four identical hypothetical scenarios of testing human papillomavirus (HPV)-positive: high-grade cytology and a diagnosis of CIN2 that used alternate terminology to describe resolution of abnormal cells and/or inclusion of an overtreatment statement. Participants selected active surveillance or surgery after viewing the scenario and free-text reason/s for their choice were thematically analysed. Of the 1638 women randomised, 79% (n=1293) opted for active surveillance. The most common reasons for choosing active surveillance included concerns about surgery and associated risks, preferring to 'wait and see', trusting the doctor's recommendations and having an emotional response toward surgery. For women who chose surgery, being risk-averse, addressing the issue straight away and perceiving surgery to be the better option for them were the most common themes identified. When presented with balanced information on the benefits and harms of different management options for CIN2 and given a choice, most women in this hypothetical situation chose active surveillance over surgery. Addressing women's concerns about active surveillance may open up the possibility that if deemed safe, it could be an acceptable alternative for women.

Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues.

A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters.

A comparative study between results of different modalities of management of cervical intraepithelial neoplasia I

Background: Carcinoma cervix is a preventable disease. It runs a long preinvasive stage, such as Normal - CIN I - CIN II - CIN III - Cancer cervix. It can be prevented at early stage of development with proper diagnosis, treatment &amp; follow up. A major portion of CIN I spontaneously regress but some need treatment.&#x0D; Obiective: The purpose of this study was to determine the frequency of abnormal colposcopic findings during the 1 year follow up period in patients of CIN I treated with cold coagulation, LEEP and expectant management.&#x0D; Materials and Methods: This retrospective study was conducted in colposcopic centre of Khulna medical college hospital, Khulna, Bangladesh from January 2018 to December 2019. After confirmation of CIN I, ladies were arranged in three groups according to their treatment modalities - Expectant management (group A), Cold coagulation (group B) &amp; LEEP (group C). They were reexamined with colposcopy after 6 months, or after one year of first visit. Persistence or reappearance of CIN was assayed &amp; correlation between colposcopic results during follow up of different groups was analysed.&#x0D; Results: Total 195 ladies were diagnosed colposcopically as CIN I. Of them 75 women were confirmed by histological examination. Among 75 ladies, 25 ladies received no treatment, grouped as group A. Forty ladies treated with cold coagulation falls in group B, whereas 10 ladies who treated with LEEP were grouped as group C. Distribution of age, parity, monthly income, education, marital age, age at first delivery was similar in different group. During follow up persistence of disease were found in 2(13.3%) ladies who did not receive any form of treatment, 3(10.7%) who were treated with cold coagulation (p value 0.333) and 1(12.5%) lady who received treatment with LEEP (p value 0.667), were not significant.&#x0D; Conclusion: Colposcopic surveillance without treatment appears reasonable in treating CIN I because of the high rate of spontaneous regression of CIN 1, but adherence to the follow up should be emphasized to the patients during the follow up visits.&#x0D; Bang Med J Khulna 2020: 53 : 8-12

Screening for the prevention and early detection of cervical cancer: protocol for systematic reviews to inform Canadian recommendations

PurposeTo inform recommendations by the Canadian Task Force on Preventive Health Care on screening in primary care for the prevention and early detection of cervical cancer by systematically reviewing evidence of (a) effectiveness; (b) test accuracy; (c) individuals’ values and preferences; and (d) strategies aimed at improving screening rates.MethodsDe novo reviews will be conducted to evaluate effectiveness and to assess values and preferences. For test accuracy and strategies to improve screening rates, we will integrate studies from existing systematic reviews with search updates to the present. Two Cochrane reviews will provide evidence of adverse pregnancy outcomes from the conservative management of cervical intraepithelial neoplasia. We will search Medline, Embase, and Cochrane Central (except for individuals’ values and preferences, where Medline, Scopus, and EconLit will be searched) via peer-reviewed search strategies and the reference lists of included studies and reviews. We will search ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. Two reviewers will screen potentially eligible studies and agree on those to include. Data will be extracted by one reviewer with verification by another. Two reviewers will independently assess risk of bias and reach consensus. Where possible and suitable, we will pool studies via meta-analysis. We will compare accuracy data per outcome and per comparison using the Rutter and Gatsonis hierarchical summary receiver operating characteristic model and report relative sensitivities and specificities. Findings on values and preferences will be synthesized using a narrative synthesis approach and thematic analysis, depending on study designs. Two reviewers will appraise the certainty of evidence for all outcomes using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and come to consensus.DiscussionThe publication of guidance on screening in primary care for the prevention and early detection of cervical cancer by the Task Force in 2013 focused on cytology. Since 2013, new studies using human papillomavirus tests for cervical screening have been published that will improve our understanding of screening in primary care settings. This review will inform updated recommendations based on currently available studies and address key evidence gaps noted in our previous review.

Relationship between cervical excisional treatment for cervical intraepithelial neoplasia and obstetrical outcome.

The aim of our systematic review was the assessment of effects of excisional treatments for the management of cervical intraepithelial neoplasia (CIN) on preterm delivery (PD), lower birth weight (LBW), preterm premature rupture of membrane (PPROM) and obstetrical outcomes. A structured search was carried out in PubMed-Medline, Embase, and Cochrane Controlled Trials Register databases through November 30, 2019. The search included a combination of the following terms: "loop electrosurgical excision procedure (LEEP)," "large loop excision of transformation zone (LLETZ)," "cold-knife conization (CKC)," "laser cervical conization (CLC)," "preterm delivery" and "neonatal outcome." Thirty-two of 561 publications considered were included: 28 retrospective series, 2 prospective studies and 2 multicenter trials. Globally in several studies there was a significant increase in PD, measured by the relative risk, in the women underwent a surgical procedure for the CIN. In their majority, the studies were retrospective and therefore a high risk of bias. This systematic review shows that the surgical treatment of the CIN was associated with an increased risk of PD, LBW and pPROM before 37 pregnancy weeks compared to untreated women, especially in a CKC and LLETZ procedure. Moreover, the increase of the of PD was associated with cone size, cervical length, repeated treatment and a short conization-to-pregnancy interval.

Evaluation of guidelines for observational management of cervical intraepithelial neoplasia 2 in young women

A high rate of regression in young women with cervical intraepithelial neoplasia grade 2 has been recorded. However, there are few prospective data by which to evaluate management guidelines. This study evaluates the American Society for Colposcopy and Cervical Pathology recommendations for follow-up of young women with cervical intraepithelial neoplasia 2 using data created by a large prospective multicenter study of observational management. Participants were 616 women under 25 years with biopsy-diagnosed cervical intraepithelial neoplasia 2 following a referral to colposcopy for an abnormal smear with no previous high-grade abnormality. The protocol included colposcopy, cytology, and colposcopically directed biopsy at the initial visit and at 6- and 12-month follow-ups visits, and these data were analyzed. Histology from the corresponding cervical biopsy was treated as the reference diagnostic test. For young women with cervical intraepithelial neoplasia 2, we aimed to determine the following: (1) the ability of colposcopy to identify women with cervical intraepithelial neoplasia 3 or worse at 6 months; and (2) the ability of colposcopy, cytology, and a combination of cytology and colposcopy to identify residual high-grade abnormalities at 12 months. In addition, although not specified in the guidelines, we investigated the ability of high-risk human papillomavirus positivity alone or with cytology as a co-test to identify residual high-grade abnormalities at 12 months. At 6 months, cervical intraepithelial neoplasia 3+ colposcopic appearance identified only 28% (95% confidence interval, 18-40%) of women diagnosed with cervical intraepithelial neoplasia 3. At 12 months, a high-grade colposcopic appearance identified only 58% (95% confidence interval, 48-68%) of women with residual histological cervical intraepithelial neoplasia 2 or 3. At 12 months, high-grade cytology identified only 58% (95% confidence interval, 48-68%) of women with cervical intraepithelial neoplasia 2 or 3. However, the combination of either high-grade cytology or colposcopic appearance proved substantially more sensitive (81%; 95% confidence interval, 72-88%). High-risk human papillomavirus positivity at 12 months was a sensitive (96%; 95% confidence interval, 89-99%) indicator of persisting high-grade histology. However, this sensitivity came at the expense of specificity (52%; 95% confidence interval, 45-58%). A co-test of high-risk human papillomavirus positivity or high-grade cytology at 12 months provided a high sensitivity (97%; 95% confidence interval, 90-99%) but low specificity (51%; 95% confidence interval, 45%-58%). Colposcopy and cytology are limited in their ability to exclude persistent high-grade abnormality for young women undergoing observational management for cervical intraepithelial neoplasia 2. We recommend biopsy for all women at 12 months. High-risk human papillomavirus positivity is a sensitive indicator of persistent abnormality and should be considered in those not having a biopsy.

Application of Plasma Circulating HPV DNA Testing to Management of Cervical Intraepithelial Neoplasia

Application of Plasma Circulating HPV DNA Testing to Management of Cervical Intraepithelial Neoplasia

Low Dose 5-Fluorouracil Intravaginal Therapy for the Treatment of Cervical Intraepithelial Neoplasia 2/3: A Case Series

Objective: There are no currently approved options for medical management of cervical intraepithelial neoplasia (CIN) 2/3. This article describes the use of intravaginal 5% 5-fluorouracil (5-FU) fo...

Clinical efficacy and mechanism for focused ultrasound (FUS) in the management of cervical intraepithelial neoplasia 1 (CIN1)

Objective This study was aimed at investigating the clinical efficacy and studying the possible mechanism of FUS applications to treat cervical intraepithelial neoplasia 1 (CIN1). Methods This was a prospective clinical study, in which 30 patients with CIN1 (28/30 of the patients were HPV positive) were enrolled and treated with FUS therapy by gynecologist. All patients were followed up for 3 months after FUS therapy. Telephone interviews, PAP smear, colposcopic examinations, cervical biopsies and HPVDNA tests were performed to assess the safety and effectiveness of FUS therapy for HPV-positive CIN1. The expression of p16, Ki-67 and Fas in the cervical tissues were examined in order to account for the possible mechanism of FUS therapy for CIN1 with HPV infection. Results FUS therapy was tolerated well, and no severe complications were observed in any patient. After FUS treatment, twenty-five patients were cured completely, and two cases were improved with the cervical smear results reversed to normal, and three cases remained the same status as before treatment. The total effectiveness rate was 90.00% (27/30). The expression of P16 and Ki-67 in the treated cervical tissues was significantly lower than that before treatment, and the expression of Fas was found up-regulated (all p < .05). Conclusion FUS therapy appears to be a feasible and effective treatment for patients with HPV positive CIN1. FUS therapy may help to reduce the expression of p16 and Ki-67 and enhance the expression of Fas in the treated cervical tissues to regulate cell proliferation and increase apoptosis, and thus prevent the disease from evolving into high grade lesions.

Clinical and paraclinical correlations in the management of cervical intraepithelial neoplasia

The treatment of cervical intraepithelial neoplasia aims at removing the junction area, including abnormal tissues. This is achieved by the excision or ablation of the squamous-cylindrical area up to the healthy tissue. In the case of persistence of high-grade lesions after repeated excision and if the patient does not want to preserve fertility, hysterectomy may be indicated. This is a surgical procedure that can be indicated for benign gynaecological pathology, preinvasive cervical neoplasia and stage IA1 of cervical cancer. The objective of the study was to select patients regarding the management of cervical intraepithelial neoplasia, taking into account the grade of cervical lesion, the extension area, patients’ age and maternal desire, as well as the pathology associated with cervical lesions. Conization was the surgical choice in patients with cervical intraepithelial neoplasia, under 35 years of age, who wanted to conserve fertility and did not have other gynaecological lesions. Hysterectomy was the surgical treatment in patients over 35 years of age, with finished pregnancy planning and associated uterine pathology to intraepithelial cervical neoplasia.