Long time follow-up in patients treated for high grade cervical intraepithelial lesion

C. Grigoriu

Rezumat: The mainstays of treatment of high-grade cervical intraepithelial neoplasia (CIN) are excision or ablation of the transformation zone of the cervix, conization, or hysterectomy. Non-excisional procedures are not recommended. The most important issues are the severity of the lesion and the patient’s obstetrical future. After excision of a high grade intraepithelial cervical lesion (HSIL, according to WHO 2014 classification) follow-up comprises co-testing at 6 and 12 months after the procedure. If both co-tests are negative, co-testing should be repeated in three years. If co-testing is again negative, the patient may resume routine screening. If there is abnormal cytology or a positive HPV test during follow-up, colposcopy with endocervical sampling should be performed. If HSIL is identified at the margins of an excisional procedure or post-procedure endocervical curettage (ECC), cytology and ECC at four to six months is preferred, but either repeat excision or hysterectomy may be performed. Immuno-histologic testing is recommended (p16INK4a si Ki67). HPV testing at 6 and 12 months post procedure is highly sensitive (90%), leading to identifying of persistent or recurrent disease. Women who have a history of HSIL or adenocarcinoma in situ and who have been appropriately treated or had spontaneous regression of cervical neoplasia should be routinely screened for at least 20-25 years following diagnosis.
Cuvinte cheie: high grade cervical intraepithelial lesion, post-therapeutical follow-up.