Management of Hsil (cin Ii) in Nulliparous Patients

MANAGEMENT OF HSIL (CIN II) IN NULLIPAROUS PATIENTS (Abstract): Cervical carcinogenesis evolves in several stages over a relatively long period of time (7-20 years) and it can be diagnosed by multiple non-invasive screening methods (PAP smear, HPV genotyping, colposcopy) and consecutively treated. It is known that 50% of CIN II cases regress spontaneous and 30% progress to CIN III or cervical cancer. Management of HSIL (CIN II) has a major importance for clinicians because many patients are young and it is important to preserve the obstetrical outcome. Therefore, in this study, 3 types of management for CIN II were proposed in nulliparous patients: 1. conservative management; 2. LOOP / LLETZ; 3. conization. The main goal of the study was to evaluate if, in very carefully selected cases, conservative and minimally invasive management may be a viable therapeutical option, in order to preserve obstetrical outcome of the patients, knowing that conization determine a moderate to severe shortening of the cervix and increases the risk of second trimester abortion or preterm delivery, especially by premature rupture of membranes; conization can determine infertility by cervical stenosis. In our limited study a less aggressive management of cervical lesions provided better obstetrical outcomes both in terms of getting pregnant and in duration of pregnancy. Although current management of CIN II is considered to be similar to CIN III, in carefully selected nulliparous patients (high social status, high education, compliant patients), with satisfactory colposcopy (squamous-cylinder junction visible in colposcopy, lesions at a distance from the cervical os and endocervical cytology without pathological changes) and the CL less than 30-32 mm, we can opt for conservative management (by follow-up) or loop diathermy (single or multiple) or LLETZ, with a rigorous follow-up, thus preserving the obstetrical outcome.