CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts : Dr Sharda Jain

1. CERVICAL
INTRAEPITHELIAL
NEOPLASIA UPDATED
MANAGEMENT
by
DGF / NIGF Experts
Dr Sharda Jain

2. Cervical Intraepithelial Neoplasia (CIN) refers to the presence
of abnormal, precancerous cells on the cervix.
As a gynecologist, staying updated on the management of
CIN is essential for providing the best care to your patients.
Here are some key points to consider in your discussions:

3. SCREENING in INDIA
NFHS 5
3%

4. Screening and Diagnosis:
 Emphasize the importance of regular cervical cancer screening,
including Pap smears and HPV testing, as early detection is key.
 If follow up is issue do VIA / VILI which are 1 rupee , 5 rupee
tests .
 Discuss the latest guidelines for screening intervals and the age at
which screening should begin and end.

5. VIA / VILI
VIA
40%
VIA
+
VILI
100%

6. < Half
Camp Setting
No Colposcopy
See & Treat
Single Visit

7. > Half
Clinic Setting of
Gynae
Trained in
Colposcopy
Screen & Treat
Single Visit

8. Not for See & Treat Clinic
PCB
PMB
Not for Screen & treat

9. Screening :
begin at 30 yrs
2 MINIMUM
IDEAL 30,35,45 YEARS
STOP AT 50 YRS

10. Grading CIN Lesions:
Explain the grading system for CIN lesions, which includes CIN1 (mild dysplasia), CIN2
(moderate dysplasia), and CIN3 (severe dysplasia or carcinoma in situ).
Highlight that CIN2 and CIN3 are considered high-grade lesions and carry a higher risk
of progression to cervical cancer.

11. PROGRESSION TO INVASIVE CANCER
CIN 1 1 %
CIN 2 5 %
CIN 3  30-70%

12. Management Options
Discuss the management options for CIN, which can range
from watchful waiting to various treatment modalities
Treatment decisions should be individualized based on the
patient's age, lesion grade, fertility desires, and other clinical
factors , whether LMIC

13. Watchful Waiting
Explain that watchful waiting may be appropriate for CIN1
lesions, as many of these lesions regress spontaneously.
This is followed in western world ‘
Emphasize the need for close follow-up in these cases.
20 years F/U is must.

14. Treatment Modalities:
Discuss the various treatment options for CIN, including
excisional procedures (e.g., LEEP, cold knife conization), laser
therapy, and cryotherapy / Thermal ablation
Highlight the pros and cons of each treatment method,
considering factors such as fertility preservation and recurrence
rates.

15. 20 yrs
We do Cryo Cautry / Thermal Ablation in CIN 1 & 2
west
INDIA
UK Study
Is Eye Opener

16. TREATMENT RECOMMENDED IN
INDIA BY EXPERTS OF CIN

17. TREATMENT- Simplified
CIN -I :- Cryo / Thermal Ablation
CIN II :- Cryo / Thermal Ablation
CIN III :-THERMAL ABLATION
FEW Experts Discourage conservative Rx 

18. HPV Vaccination:
Encourage HPV vaccination for eligible patients to prevent
new HPV infections and reduce the risk of CIN
development.

19. Post-Treatment Monitoring:
 Explain the need for follow-up after CIN treatment to
monitor for recurrence or persistence of the disease.
 Discuss the appropriate follow-up schedule and the
importance of regular screenings even after successful
treatment.

20. Fertility Considerations:
 Address fertility concerns and family planning with patients,
especially if they require excisional procedures.
 Explain that treatments like LEEP may have minimal impact
on fertility, but conization procedures could have a more
significant effect.
 All of you must know about 5 years follow up in very large
study in UK where residual disease is significant using LEEP
THERAPY.

21. (UK STUDY) TREATMENT- F/U
CIN-I :- 8-10%
CIN II :- 15%
CIN III :- 50%
Disease is seen at end of 5 yrs after Leep Therapy

22. Psychological Support:
Recognize the emotional impact that a CIN diagnosis and
its management can have on patients.
Offer support and counselling resources.

23. Preventing Future CIN:
Stress the importance of risk reduction
strategies, including safe sexual practices,
HPV vaccination, and regular follow-up
appointments.

24. Emerging Technologies:
Stay informed about emerging diagnostic and treatment
technologies, such as the use of biomarkers or molecular
testing to enhance CIN management.

25. Multidisciplinary Approach:
Collaboration with other healthcare professionals, such as
pathologists and oncologists, can be essential for
managing complex CIN cases.

26. • Cervical Intraepithelial Neoplasia management is an evolving
field, and it's crucial for gynecologists to stay updated on the
latest guidelines and research to provide the most up-to-date
and evidence-based care to their patients.
• Additionally, patient education and emotional support are
integral aspects of managing CIN effectively.

27. THANK YOU