II. Precautions
- Delay LEEP until after pregnancy
- Low risk of progression in pregnancy
- Lesions often regress in Postpartum Period
- Yost (1999) Obstet Gynecol 93:359-62 [PubMed]
- Refer if inadequate Colposcopy
- Adequate Colposcopy requires visualization of SCJ
- Colposcopy adequate if SCJ fully visualized and
- Lesion not identified and ECC completed or
- Lesion responsible for abnormal pap was found
III. Evaluation: HSIL (or ASC-H) identified on Cervical Cytology (2014 Guidelines)
- Option 1: Colposcopy
- CIN 2, 3
- See CIN 2 or CIN 3 protocol as below
- No CIN 2 or 3: Observe with Colposcopy and repeat cytology every 6 months for 2 years
- HSIL cytology or high grade colpo for 1 year
- Biopsy and treat as CIN 2,3 if positive biopsy
- HSIL cytology without CIN 2,3 on colpo for 2 years
- Diagnostic excisional procedure when not pregnant
- Cytology negative x2 AND colpo without high grade colpo changes
- Return to routine screening
- HSIL cytology or high grade colpo for 1 year
- CIN 2, 3
- Option 2: Immediate Loop electrosurgical excision
- Contraindicated in pregnancy or as initial management in age under 25 years old
IV. Evaluation: CIN 2 or CIN 3 on Colposcopy (2014 Guidelines)
- Step 1a: Initial management of women over age 25 years based on Colposcopy results
- Inadequate Colposcopy or Recurrent CIN 2, 3 or ECC with CIN 2, 3
- Diagnostic Excisional Procedure
- Adequate Colposcopy
- Excision or ablation of transformation zone
- Inadequate Colposcopy or Recurrent CIN 2, 3 or ECC with CIN 2, 3
- Step 1b: Initial management of women under age 25 years based on Colposcopy results
- Option 1: Treat using protocol as in 1a (see above)
- CIN 3 on Colposcopy
- Inadequate Colposcopy
- Per patient preference
- Option 2: Observation with Colposcopy and cytology every 6 months for 12 months
- Cytology and Colposcopy negative at 6 and 12 months
- HPV and Cervical Cytology co-testing negative at 1 year
- Space co-testing to every 3 years
- HPV or Cervical Cytology co-testing positive at any time
- Repeat Colposcopy and biopsy
- HPV and Cervical Cytology co-testing negative at 1 year
- Colposcopy positive for CIN 3 or persistent CIN 2 for 24 months
- Treat using protocol as in 1a (see above)
- Cytology and Colposcopy negative at 6 and 12 months
- Option 1: Treat using protocol as in 1a (see above)
- Step 2: Excisional procedure with positive CIN 2,3 margins (or on post-procedure ECC)
- Option 1: Repeat Cytology and ECC in 4 to 6 months (preferred)
- Option 2: Repeat diagnostic excisional procedure
- Option 3: Hysterectomy
- Step 3: Repeat HPV and Cervical Cytology (co-testing) at 12 and 24 months
- Repeat Colposcopy if either HPV or cytology is abnormal at either 12 or 24 months
- Repeat HPV and cytology co-testing in 3 years if all tests are negative at 12 and 24 months
- If negative repeat testing may return to routine screening
V. Resources
- (2014) ASCCP Guidelines
- (2019) ASCCP Guidelines
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Related Studies
| Definition (NCI_NCI-GLOSS) | Cells of the uterine cervix that are moderately or severely abnormal and may become cancer. |
| Definition (NCI) | A precancerous neoplastic process characterized by the presence of moderate or severe dysplastic cytological changes which extend to the upper part of the squamous epithelium. Maturation at the surface of the squamous epithelium may or may not be present. Representative examples include the high grade esophageal squamous intraepithelial neoplasia, high grade cervical squamous intraepithelial neoplasia, high grade vaginal intraepithelial neoplasia, and high grade vulvar intraepithelial neoplasia. |
| Concepts | Neoplastic Process (T191) |
| MSH | D065310 |
| SnomedCT | 22725004 |
| Spanish | lesión intraepitelial escamosa de alto grado, lesión intraepitelial escamosa de alto potencial maligno (anomalía morfológica), lesión intraepitelial escamosa de alto potencial maligno, HSIL, Lesión intraepitelial escamosa de alto grado, lesión intraepitelial escamosa de gran malignidad (anomalía morfológica), lesión intraepitelial pavimentosa de gran malignidad, lesión intraepitelial escamosa de gran malignidad, lesión intraepitelial pavimentosa de alto potencial maligno |
| Dutch | hooggradige squameuze intra-epitheliale laesie, HSIL |
| French | Lésion épidermoïde intra-épithéliale de haut grade (HSIL), Lésion épidermoïde intra-épithéliale de haut grade |
| German | HSIL, High grade squamous intraepithelial lesion |
| Italian | Lesione intraepiteliale squamosa di grado elevato, Lesioni intraepiteliali squamose di alto grado (HSIL) |
| Portuguese | Lesão intra-epitelial por células escamosas de alto grau, HSIL |
| Japanese | 高度扁平上皮内病変, ＨＳＩＬ, ｺｳﾄﾞﾍﾝﾍﾟｲｼﾞｮｳﾋﾅｲﾋﾞｮｳﾍﾝ, HSIL |
| Czech | Šupinatá intraepitelová léze vysokého stupně, HSIL |
| English | high grade squamous intraepithelial lesion (HGSIL), hsil, high grade sil, High Grade Squamous Intraepithelial Lesions, High-Grade Squamous Intraepithelial Lesions, HSIL, High-Grade Squamous Intraepithelial Lesions, HSIL, High Grade Squamous Intraepithelial Lesions, High grade SIL, High-grade squamous intraepithelial lesion, HSIL, High-grade squamous intraepithelial lesion (morphologic abnormality), high-grade squamous intraepithelial lesion, high-grade squamous intraepithelial neoplasia, High-Grade Squamous Intraepithelial Lesion, High Grade Squamous Intraepithelial Neoplasia, High grade squamous intraepithelial lesion |
| Hungarian | Súlyos fokú intraepithelialis squamosus laesio, HSIL |
