Cervical intraepithelial neoplasia. Examination, treatment and follow-up

In inflammatory cytology without suspicion of cervical neoplasia (Papanicolaou II) a pelvic examination is done in order to exclude a macroscopic visible tumor. After treatment of an inflammation a repeat cytology and a colposcopy is performed preferably 8 to 12 weeks later. If the cytology or the colposcopy is abnormal, or if the colposcopy is inconclusive, or if the inflammation is of viral origin, the patient is referred to colposcopy-directed biopsies and endocervical curettage like the patients with an initial cytology suspicious of cervical neoplasia (Papanicolaou III to V). A histologically verified CIN I is treated as soon as it proves itself stable, that is, if biopsies or ECC 3 to 6 months after the initial ones again show CIN I. In very young women treatment may be postponed another 3 to 6 months. Histologically verified CIN II and III are treated without postponement. In CIN I and II treatment by means of destruction is recommended if the neoplasia is located on the exocervix and the preoperative ECC is normal and if colposcopy can exclude (micro-)invasion. A CIN III fulfilling the same criteria may be destructed, too, preferably by the CO2 laser--partly because of the well defined and precise destruction especially with regard to the depth into the stroma and partly because the laser contrary to the cryoapparatus is very suitable of treating CIN involving large areas of the exocervix including neoplasias extending into the vagina. In this connection the combined excision and destruction by the laser should be mentioned, a treatment modality made accessible by the appearance of the laser.(ABSTRACT TRUNCATED AT 250 WORDS)