General consideration:

1. CIN is most like to begin either during menarche or following pregnancy, when metaplasia is most active.

2. A woman who has reached menopause without developing CIN has little metaplasia and is at a low risk.

3. HPV (human papillomavirus) plays an important role in the development of CIN.

 Clinical features:

1. Asymptomatic

2. Presents only as an abnormal pap smear

3. Postcoital bleeding or spotting but his may be related to cervicitis found in association with the CIN. 

Diagnosis:

1. The pap test

a. not to douche for 48hr

b. not to vaginal creams for 1 wk

c. abstain form coitus for 24hr

2. Colposcopy and biopsy

3. Human papilloma virus - a means of secondary assessment of abnormal cytology

4. Cervicography - a secondary means of assessment of patient with pap test result, and use to identify lesions

Cervix intraepithelial neoplasm Treatment:

1. Before treatment:

(1) The histologic diagnosis must be accurate.

(2) The extent of the lesion must be determined.

2. Ablative techniques:

(1) Cryotherapy:

Indications

a. CIN I - II

b. Small lesion

c. Ectocervical location only

d. Negative endocervical curettage

e. No endocervical gland involvement on biopsy

(2) Laser vaporization therapy:

Indications

a. Large lesions that the cryoprobe cannot adequately cover.

b. Irregular cervix with a "fish month" appearance an deep clefts

c. Extension of disease to the vagina or satellite lesions on the vagina

d. Lesions with extensive glandular involvement in which the treatment must beyond the deepest gland cleft.

(3) Loop electrosurgical excision:

Contraindications

a. patient anxiety

b. contraindication to local anesthesia or vasoconstrictor

c. extremely large lesions

d. vaginal extension

e. obvious clinical carcinoma

(4) Conization:

Indications

a. Limits of the lesion cannot be visualized with colposcopy.

b. The squamocolumnar junction (SCJ) is not seen at colposcopy.

c. Endocervical curettage histologic findings are positive for CIN 2 or CIN 3.

d. There is a lack of correlation between cytology, biopsy, and colposcopy results.

e. Microinvasion is suspected based on biopsy, colposcopy, or cytology results.

f. The colposcopist is unable to rule out invasive cancer.

(5) Hysterectomy:

Indications

a. microinvasion

b. cervical intraepithelial neoplasia at limits of conization specimen

c. poor compliance with follow-up

d. other gynecologic problems requiring hysterectomy, such as fibroids, prolapse, endometriosis and pelvic inflammatory disease

e. cancer phobia

f. CIN I, II are not indications of hysterectomy.

3.After treatment - complications:

(1) Cryotherapy:

a. Cervical stenosis

b. Post-treatment bleeding

c. Infection

(2) Laser vaporization therapy

a. clear vaginal discharge:  3-5 days

b. spotting

(3) Loop electrosurgical excision

a. Intraoperative hemorrhage

b. Post-operative hemorrhage

c. Cervical stenosis

(4) Hysterectomy

a. bleeding

b. infection

c. death 

Follow-up: by pap smeas

1. an inherent recurrence rate:  up to 10%

2. at approximately 3-month intervals for 1 year

 Prognosis

1. each of the recommended therapies, if properly applied, provides care in at least 90% of patient after one treatment (some patients require as many as four appllications)

2. With proper follow-up and treatment, over 99% of women with CIN are ultimately cured with preservation of reproductive function. 

 *Pap smear應取到endocervical cell才算合格的採樣，採樣時宜用木棒(spatula)不宜用棉枝(cotton swah)。採樣錯誤常發生在只取到後穹隆內的子宮頸脫落細胞。