American Journal of Obstetrics & Gynecology
Volume 189, Issue 1 , Pages 295-304 , July 2003

2001 Consensus Guidelines for the management of women with cervical intraepithelial neoplasia

Received 28 January 2003 ,Revised 1 April 2003 ,Accepted 31 May 2003.

References 

  1. Jones BA, Davey DD. Quality management in gynecologic cytology using interlaboratory comparison. Arch Pathol Lab Med. 2000;124:672–681
  2. Wright TC, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002;287:2120–2129
  3. USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. MMWR. 1999;48(No.RR-10):1–26
  4. Kish MA. Guide to development of practice guidelines. Clin Infect Dis. 2001;32:851–854
  5. Robertson AJ, Anderson JM, Beck JS, Burnett RA, Howatson SR, Lee FD, et al.  Observer variability in histopathological reporting of cervical biopsy specimens. J Clin Pathol. 1989;42:231–238
  6. Ismail SM, Colelough AB, Dinnen JS, Eakins D, Evans DM, Gradwell E, et al.  Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia. BMJ. 1989;298:707–710
  7. Stoler MH, Schiffman M. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study. JAMA. 2001;285:1500–1505
  8. Massad LS, Halperin CJ, Bitterman P. Correlation between colposcopically directed biopsy and cervical loop excision. Gynecol Oncol. 1996;60:400–403
  9. Ostor AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993;12:186–192
  10. Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: a meta- analysis. Obstet Gynecol. 1998;92:727–735
  11. Klaes R, Friedrich T, Spitkovsky D, Ridder R, Rudy W, Petry U, et al.  Overexpression of p16(INK4A) as a specific marker for dysplastic and neoplastic epithelial cells of the cervix uteri. Int J Cancer. 2001;92:276–284
  12. Connolly DC, Greenspan DL, Wu R, Ren X, Dunn RL, Shah KV, et al.  Loss of fhit expression in invasive cervical carcinomas and intraepithelial lesions associated with invasive disease. Clin Cancer Res. 2000;6:3505–3510
  13. Lin WM, Michalopulos EA, Dhurander N, Cheng PC, Robinson W, Ashfaq R, et al.  Allelic loss and microsatellite alterations of chromosome 3p14.2 are more frequent in recurrent cervical dysplasias. Clin Cancer Res. 2000;6:1410–1414
  14. Bibbo M, Dytch HE, Alenghat E, Bartels PH, Wied GL. DNA ploidy profiles as prognostic indicators in CIN lesions. Am J Clin Pathol. 1989;92:261–265
  15. Wisman GB, De Jong S, Meersma GJ, Helder MN, Hollema H, de Vries EG, et al.  Telomerase in (pre)neoplastic cervical disease. Hum Pathol. 2000;31:1304–1312
  16. Fu YS, Reagan J, Richart RM. Definition of precursors. Gynecol Oncol. 1981;12:s220
  17. Shafi MI, Luesley DM, Jordan JA, Dunn JA, Rollason TP, Yates M. Randomised trial of immediate versus deferred treatment strategies for the management of minor cervical cytological abnormalities. Br J Obstet Gynaecol. 1997;104:590–594
  18. Cannistra SA, Niloff JM. Cancer of the uterine cervix. N Eng J Med. 1996;334:1030–1038
  19. Nasiell K, Roger V, Nasiell M. Behavior of mild cervical dysplasia during long-term follow-up. Obstet Gynecol. 1986;67:665–669
  20. Luthra UK, Prabhakar AK, Seth P, Agarwal SS, Murthy NS, Bhatnagar P, et al.  Natural history of precancerous and early cancerous lesions of the uterine cervix. Acta Cytol. 1987;31:226–234
  21. Robertson JH, Woodend BE, Crozier EH, Hutchinson J. Risk of cervical cancer associated with mild dyskaryosis. BMJ. 1988;297:18–21
  22. Weaver MG, Abdul-Karim FW, Dale G, Sorensen K, Huang YT. Outcome in mild and moderate cervical dysplasias related to the presence of specific human papillomavirus types. Mod Pathol. 1990;3:679–683
  23. Solomon D, Schiffman M, Tarrone R. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst. 2001;93:293–299
  24. Manos MM, Kinney WK, Hurley LB, Sherman ME, Shieh-Ngai J, Kurman RJ, et al.  Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papanicolaou results. JAMA. 1999;281:1605–1610
  25. Wright TC, Sun XW, Koulos J. Comparison of management algorithms for the evaluation of women with low-grade cytologic abnormalities. Obstet Gynecol. 1995;85:202–210
  26. Guido R, Solomon D, Schiffman M, Burke L. Comparison of managment strategies for women diagnosed as CIN 1 or less, postcolposcopic evaluation: Data from the ASCUS and LSIL Triage Study (ALTS), a Multicenter Randomized Trial. J Lower Gen Tract Dis. 2002;6:176
  27. Nobbenhuis MA, Walboomers JM, Helmerhorst TJ, Rozendaal L, Remmink AJ, Risse EK, et al.  Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: a prospective study. Lancet. 1999;354:20–25
  28. Holowaty P, Miller AB, Rohan T, To T. Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst. 1999;91:252–258
  29. Spitzer M, Chernys AE, Shifrin A, Ryskin M. Indications for cone biopsy: pathologic correlation. Am J Obstet Gynecol. 1998;178:74–79
  30. Shafi MI, Luesley DM. Management of low grade lesions: follow-up or treat?. Baillieres Clin Obstet Gynaecol. 1995;9:121–131
  31. Richart RM, Wright TC. Controversies in the management of low grade cervical intraepithelial neoplasia. Cancer. 1993;71:1413–1421
  32. Fine BA, Feinstein GI, Sabella V. The pre- and postoperative value of endocervical curettage in the detection of cervical intraepithelial neoplasia and invasive cervical cancer. Gynecol Oncol. 1998;71:46–49
  33. Hatch KD, Shingleton HM, Orr JW, Gore H, Soong SJ. Role of endocervical curettage in colposcopy. Obstet Gynecol. 1985;65:403–408
  34. Sevin B-U, Ford JH, Girtanner Rd, Hoskins WJ, Ng ABP, Nordqvist SRB, et al.  Invasive cancer of the cervix after cryosurgery: pitfalls of conservative management. Obst Gynecol. 1979;53:465–471
  35. Townsend DE, Richart RM, Marks E, Nielsen J. Invasive cancer following outpatient evaluation and therapy for cervical disease. Obstet Gynecol. 1981;57:145–149
  36. Schmidt C, Pretorius RG, Bonin M, Hanson L, Semrad N, Watring W. Invasive cervical cancer following cryotherapy for cervical intraepithelial neoplasia or human papillomavirus infection. Obstet Gynecol. 1992;80:797–800
  37. Singer A, Monaghan JM. Lower genital tract precancer: colposcopy, pathology and treatment. London: Blackwell Scientific Publications; 1994;
  38. Lopes A, Mor-Yosef S, Pearson S, Ireland D, Monaghan JM. Is routine colposcopic assessment necessary following laser ablation of cervical intraepithelial neoplasia?. Br J Obstet Gynaecol. 1990;97:175–177
  39. Cullimore J, Woodman CB, Luesley DM, Jordan JA, Byrne P. When laser vaporisation for CIN fails, what next?. Lancet. 1989;8646:1081–1082
  40. Murdoch JB, Morgan PR, Lopes A, Monaghan JM. Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment. Br J Obstet Gynaecol. 1992;99:990–993
  41. Paraskevaidis E, Jandial L, Mann EMF, Fisher PM, Kitchener HC. Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol. Obstet Gynecol. 1991;78:80–83
  42. Mitchell MF, Tortolero-Luna G, Cook E, Whittaker L, Rhodes-Morris H, Silva E. A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol. 1998;92:737–744
  43. Alvarez RD, Helm CW, Edwards RP, Naumann RW, Partridge EE, Shingleton HM, et al.  Prospective randomized trial of LLETZ versus laser ablation in patients with cervical intraepithelial neoplasia. Gynecol Oncol. 1994;52:175–179
  44. Ferenczy A. Comparison of cryo- and carbon dioxide laser therapy for cervical intraepithelial neoplasia. Obstet Gynecol. 1985;66:793–798
  45. Nuovo J, Melnikow J, Willan AR, Chan BK. Treatment outcomes for squamous intraepithelial lesions. Int J Gynaecol Obstet. 2000;68:25–33
  46. Oyesanya O, Amerasinghe C, Manning EAD. A comparison between loop diathermy conization and cold-knife conization for management of cervical dysplasia associated with unsatisfactory colposcopy. Gynecol Oncol. 1993;50:84–88
  47. Girardi F, Heydarfadai M, Koroschetz F, Pickel H, Winter R. Cold-knife conization versus loop excision: histopathologic and clinical results of a randomized trial. Gynecol Oncol. 1994;55:368–370
  48. Giacalone PL, Laffargue F, Aligier N, Roger P, Combecal J, Daures JP. Randomized study comparing two techniques of conization: cold knife versus loop excision. Gynecol Oncol. 1999;75:356–360
  49. Wright TC, Ferenczy AF, Kurman RJ. Precancerous lesions of the cervix. In:  Kurman RJ editors. Blaustein's pathology of the female genital tract. New York: Springer-Verlag; 2002;
  50. Mitchell MF, Tortolero-Luna G, Wright T, Sarkar A, Richards-Kortum R, Hong WK, et al.  Cervical human papillomavirus infection and intraepithelial neoplasia: a review. J Natl Cancer Inst Monogr. 1996;21:17–25
  51. Genest DR, Stein L, Cibas E, Sheets E, Zitz JC, Crum CP. A binary (Bethesda) system for classifying cervical cancer precursors: criteria, reproducibility, and viral correlates. Hum Pathol. 1993;24:730–736
  52. Bjerre B, Eliasson G, Linell F, Soderberg H, Sjoberg NO. Conization as only treatment of carcinoma in situ of the uterine cervix. Am J Obstet Gynecol. 1976;125:143–152
  53. Burke L, Covell L, Antonioli D. Carbon dioxide laser therapy of cervical intraepithelial neoplasia: factors determining success rate. Lasers Surg Med. 1980;1:113–122
  54. Pearson SE, Whittaker J, Ireland D, Monaghan JM. Invasive cancer of the cervix after laser treatment. Br J Obstet Gynaecol. 1989;96:486–488
  55. Wright TC, Gagnon MD, Richart RM, Ferenczy A. Treatment of cervical intraepithelial neoplasia using the loop electrosurgical excision procedure. Obstet Gynecol. 1992;79:173–178
  56. Tidbury P, Singer A, Jenkins D. CIN 3: the role of lesion size in invasion. Br J Obstet Gynaecol. 1992;99:583–586
  57. Andersen ES, Nielsen K, Pedersen B. The reliability of preconization diagnostic evaluation in patients with cervical intraepithelial neoplasia and microinvasive carcinoma. Gynecol Oncol. 1995;59:143–147
  58. Duggan BD, Felix JC, Muderspach LI, Gebhardt JA, Groshen S, Morrow CP, et al.  Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized, prospective study. Am J Obstet Gynecol. 1999;180:276–282
  59. Naumann RW, Bell MC, Alvarez RD, Edwards RP, Partridge EE, Helm CW, et al.  LLETZ is an acceptable alternative to diagnostic cold-knife conization. Gynecol Oncol. 1994;55:224–228
  60. Felix JC, Muderspach LI, Duggan BD, Roman LD. The significance of positive margins in loop electrosurgical cone biopsies. Obstet Gynecol. 1994;84:996–1000
  61. Zaitoun AM, McKee G, Coppen MJ, Thomas SM, Wilson PO. Completeness of excision and follow up cytology in patients treated with loop excision biopsy. J Clin Pathol. 2000;53:191–196
  62. Gardeil F, Barry-Walsh C, Prendiville W, Clinch J, Turner MJ. Persistent intraepithelial neoplasia after excision for cervical intraepithelial neoplasia grade III. Obstet Gynecol. 1997;89:419–422
  63. Vedel P, Jakobsen H, Kryger-Baggesen N, Rank F, Bostofte E. Five-year follow up of patients with cervical intra-epithelial neoplasia in the cone margins after conization. Eur J Obstet Gynecol Reprod Biol. 1993;50:71–76
  64. Kobak WH, Roman LD, Felix JC, Muderspach LI, Schlaerth JB, Morrow CP. The role of endocervical curettage at cervical conization for high-grade dysplasia. Obstet Gynecol. 1995;85:197–201
  65. Moore BC, Higgins RV, Laurent SL, Marroum MC, Bellitt P. Predictive factors from cold knife conization for residual cervical intraepithelial neoplasia in subsequent hysterectomy. Am J Obstet Gynecol. 1995;173:361–366
  66. Kalogirou D, Antoniou G, Karakitsos P, Botsis D, Kalogirou O, Giannikos L. Predictive factors used to justify hysterectomy after loop conization: increasing age and severity of disease. Eur J Gynaecol Oncol. 1997;18:113–116
  67. Lapaquette TK, Dinh TV, Hannigan EV, Doherty MG, Yandell RB, Buchanan VS. Management of patients with positive margins after cervical conization. Obstet Gynecol. 1993;82:440–443
  68. Economos K, Perez Veridiano N, Delke I, Collado ML, Tancer ML. Abnormal cervical cytology in pregnancy: a 17-year experience. Obstet Gynecol. 1993;81:915–918
  69. Yost NP, Santoso JT, McIntire DD, Iliya FA. Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol. 1999;93:359–362
  70. Connor JP. Noninvasive cervical cancer complicating pregnancy. Obstet Gynecol Clin North Am. 1998;25:331–342
  71. Robinson WR, Webb S, Tirpack J, Degefu S, O'Quinn AG. Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision. Gynecol Oncol. 1997;64:153–155
  72. Tate DR, Anderson RJ. Recurrence of cervical dysplasia in the human immunodeficiency virus- seropositive patient. Obstet Gynecol. 2001;97:S60
  73. Holcomb K, Matthews RP, Chapman JE, Abulafia O, Lee YC, Borges A, et al.  The efficacy of cervical conization in the treatment of cervical intraepithelial neoplasia in HIV-positive women. Gynecol Oncol. 1999;74:428–431
  74. Wright TC, Koulos J, Schnoll F, Swanbeck J, Ellerbrock TV, Chiasson MA, et al.  Cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus: outcome after loop electrosurgical excision. Gynecol Oncol. 1994;55:253–258
  75. Maiman M. Management of cervical neoplasia in human immunodeficiency virus-infected women. J Natl Cancer Inst. 1998;23:43–49
  76. Maiman M, Watts DH, Andersen J, Clax P, Merino M, Kendall MA. Vaginal 5-fluorouracil for high-grade cervical dysplasia in human immunodeficiency virus infection: a randomized trial. Obstet Gynecol. 1999;94:954–961
  77. SEER Program, National Cancer Institute, USA. Available at http://seer.ims.nci.nih.gov/ScientificSystems/ 2001September 2002.; Accessed
  78. Reich O, Pickel H, Lahousen M, Tamussino K, Winter R. Cervical intraepithelial neoplasia III: long-term outcome after cold- knife conization with clear margins. Obstet Gynecol. 2001;97:428–430
  79. Soutter WP, de Barros Lopes A, Fletcher A, Monaghan JM, Duncan ID, Paraskevaidis E, et al.  Invasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia. Lancet. 1997;349:978–980
  80. Kolstad P, Klem V. Long-term followup of 1121 cases of carcinoma in situ. Obstet Gynecol. 1976;48:125–129
  81. Anderson MC. Invasive carcinoma of the cervix following local destructive treatment for cervical intraepithelial neoplasia. Br J Obstet Gynaecol. 1993;100:657–663
  82. Brown JV, Peters WA, Corwin DJ. Invasive carcinoma after cone biopsy for cervical intraepithelial neoplasia. Gynecol Oncol. 1991;40:25–28
  83. National Cancer Institute . SEER Cancer Statistics Review: 1973-1996. Available at http://seer.ims.nci.nih.gov/ 2000September 2002.; vol 2000 Accessed
  84. Ferenczy A, Choukroun D, Arseneau J. Loop electrosurgical excision procedure for squamous intraepithelial lesions of the cervix: advantages and potential pitfalls. Obstet Gynecol. 1996;87:332–337
  85. Chan KS, Yu KM, Lok YH, Sin SY, Tang LC. Conservative management of patients with histological incomplete excision of cervical intraepithelial neoplasia after large loop excision of transformation zone. Chin Med J. 1997;110:617–619
  86. Paraskevaidis E, Kitchener H, Adonakis G, Parkin D, Lolis D. Incomplete excision of CIN in conization: further excision or conservative management?. Eur J Obstet Gynecol Reprod Biol. 1994;53:45–47
  87. Strand A, Wilander E, Zehbe I, Rylander E. High risk HPV persists after treatment of genital papillomavirus infection but not after treatment of cervical intraepithelial neoplasia. Acta Obstet Gynecol Scand. 1997;76:140–144
  88. Jain S, Tseng CJ, Horng SG, Soong YK, Pao CC. Negative predictive value of human papillomavirus test following conization of the cervix uteri. Gynecol Oncol. 2001;82:177–180
  89. Nagai Y, Maehama T, Asato T, Kanazawa K. Persistence of human papillomavirus infection after therapeutic conization for CIN 3: is It an alarm for disease recurrence?. Gynecol Oncol. 2000;79:294–299
  90. Gross PA, Barrett TL, Dellinger EP, Krause PJ, Martone WJ, McGowan JE, et al.  Purpose of quality standards for infectious diseases. Infectious Diseases Society of America. Clin Infect Dis. 1994;18:421

☆ This set of guidelines was supported by grant number 1 R13 CA96190-01 from the National Cancer Institute.

☆☆ Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or the participating societies and organizations.

★ Reprint requests: Thomas C. Wright, Jr, MD, Room 16-404, P&S Building, 630 W 168th St, New York, NY 10032. E-mail: tcw1@columbia.edu

PII: S0002-9378(03)00694-X

doi: 10.1067/mob.2003.633

American Journal of Obstetrics & Gynecology
Volume 189, Issue 1 , Pages 295-304 , July 2003

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