Management of cervical premalignant lesions

Area of Science:

• Gynecology
• Oncology
• Pathology

Background:

• Cervical preneoplasia management begins with abnormal cervical cytology results.
• The Bethesda system is the standard for classifying these abnormalities.
• Management strategies for low-grade lesions vary globally, necessitating clear guidelines.

Purpose of the Study:

• To outline current management protocols for cervical preneoplasia based on cytological findings.
• To discuss the role of colposcopy and large loop excision of the transformation zone (LLETZ) in diagnosis and treatment.
• To highlight factors influencing recurrence risk and fertility preservation.

Main Methods:

• Classification of cervical cytology using the Bethesda system, including atypical squamous cells of undetermined significance (ASCUS) and atypical squamous cells where high-grade squamous intra-epithelial lesions (HSIL) cannot be excluded (ASCH).
• Referral criteria for colposcopy based on cytological grade (ASCH, low-grade squamous intra-epithelial lesions, HSIL).
• Treatment modalities including large loop excision of the transformation zone (LLETZ) for CIN and adenocarcinoma in situ, and considerations for micro-invasive squamous carcinoma.

Main Results:

• Patients with ASCH and low-grade squamous intra-epithelial lesions require colposcopy; HSIL necessitates prompt colposcopy and often LLETZ.
• LLETZ is effective for CIN, but approximately 15% of patients experience persistent or recurrent disease.
• Positive human papillomavirus DNA tests and age over 50 are associated with higher recurrence risks.
• LLETZ preserves fertility but carries risks of preterm birth; its efficacy for adenocarcinoma in situ is lower than for CIN.

Conclusions:

• Effective detection and treatment of cervical premalignant lesions have significantly altered the natural history of cervical cancer.
• Conservative treatments like LLETZ are safe and effective, particularly for preserving fertility.
• While guidelines exist, ongoing research addresses persistent uncertainties in managing cervical preneoplasia.