The treatment of CIN: what are the risks?
Article first published online: 13 MAY 2009
© 2009 The Author. Journal compilation © 2009 Blackwell Publishing Ltd
Volume 20, Issue 3, pages 145–153, June 2009
How to Cite
Prendiville, W. (2009), The treatment of CIN: what are the risks?. Cytopathology, 20: 145–153. doi: 10.1111/j.1365-2303.2009.00669.x
- Issue published online: 13 MAY 2009
- Article first published online: 13 MAY 2009
- Accepted for publication 28 April 2009
- cervical intraepithelial neoplasia;
- pregnancy-related morbidity
The treatment of squamous cervical intraepithelial neoplasia is to remove or destroy the transformation zone (TZ). It is likely that no method of treatment is superior to another if it is performed properly and the limited available evidence supports this view. The significant advantages of excision (simplicity, cost, outpatient procedure, histological examination of the entire TZ) mean that treatment thresholds may have lowered over the last decade. Long-term pregnancy-related morbidity associated with excision has been reported recently. The evidence would suggest that this increase equates to a genuine increase in serious adverse outcome for cone biopsy but not large loop excision of the transformation zone (LLETZ). The available data also point to an increase in both incomplete excision and premature labour associated with the excision of large endocervical TZs. The clinical implications arising from this are firstly that women with large type 2 and 3 TZs need appropriate counselling before treatment and that the threshold for treating young women with mild abnormalities needs review.