There is an association between the presence of abnormal cervical cytology and the presence of high-grade cervical neoplasia. Patients whose premalignant cytology disappears after appropriate treatment have a low risk of high-grade cervical disease. With appropriate treatment, high-grade cervical intraepithelial neoplasia may vanish.
About 12,000,000 cervical intraepithelial neoplasia cases are diagnosed on a given year, of which approximately half are atrophic. Overall, women 30 years of age and older show the greatest increase.
This disorder may occur in women or men of any age group. Cervical intraepithelial neoplasia is graded from 0 to 3; grade 1 does not represent or lead to more dysplasia, or abnormal histopathology. However, if found on screening, and a high grade is suspected, then further assessment such as colposcopy should be offered in order to detect, and possibly treat, premalignant or malignant disease, if present, before it progresses to invasive carcinoma.
A wide diversity of approaches is used for treatment of CIN 2 or 3. The most used approaches are surgery, especially for LSIL, followed by conization with abrasion and cryotherapy. Ablation is used mainly or wholly for HSIL.
CIN usually develops from an underlying cervical transformation and is almost always caused by human papilloma virus. Most women with low grade CIN will clear the disease without treatment.
NCCL or CIN were detected in 70.9% of women. NCCL was detected in 9.1% in the second (2-4 years) of the three consecutive biopsies; while CIN was detected in 28.5% in the third (5-10 years) of the biopsies. CIN-2 was detected the most frequently (41.4% of women).
The high sensitivity and specificity of digital video colposcopy in detecting CIN grades 2-3 in patients 35–65 years of age suggest that those patients with CIN of grade 3 could be candidates for a more intensive treatment schedule with followup cytology. Additional trials of digital colposcopy with excisional biopsy are still needed before conclusions can be drawn.
This in vitro study using multiple different dosage regimes demonstrated a significant reduction in proliferation, cell death, and migration in human primary cervical cancer cells. Based on in vitro findings, these results strongly suggest that imiquimod represents a new class of immune modulators (Immudex or Biovail) for clinical cervical cancer treatments in the future.
CIN is often caused by human papilloma virus (HPV), usually of low-risk HPV type. The main cause of CIN 3 that does not regress spontaneously is either high-risk HPV of any type or multiple types. CIN 2 and 1 are caused by low-risk HPV that is not viral.
(1) In patients with CIN 3 and CIN 4 biopsy findings, the 5-year survival rate is 50%. (2) In patients with CIN 2 biopsy results, the 5-year survival rate for CIN 3 and CIN 4 is 90%. (3) In patients with CIN 1 biopsy findings, the 5-year survival rate for CIN 3 and CIN 4 is 40%, and for CIN 1 is 31%. For patients diagnosed with HSIL, 5-year survival is 53%. The probability of progression to invasive squamous cell carcinoma is 18-40%.
There were no statistically significant differences between the topical combinations studied. There were some significant changes in the occurrence of adverse events requiring treatment in each group, but the conclusions of the study do not allow definite conclusions about the risks and benefits of imiquimod+salicylic acid, imiquimod+metronidazole-aluminium hydroxide, imiquimod+salicylic-aluminium hydroxide, and imiquimod+aluminium hydroxide. It remained unknown whether topical and systemic treatment with imiquimod alters the natural history of HSIL in patients with high grade cervical intraepithelial neoplasia. The investigators recommend that treatment be determined by local practice.
Imiquimod improved quality of life in women with CIN. Additional research is needed to explore the mechanisms and to determine whether treatment-related quality improvements outweigh the discomfort associated with using a topical treatment in this group for CIN.