2006 Consensus Guidelines for the Management of Women With Cervical Intraepithelial Neoplasia or Adenocarcinoma In Situ

TLDR

Earlier guidelines tied CIN 1 management to colposcopic adequacy, but the new consensus reflects advances in HPV biology and the potential impact of treatment on future pregnancies. The authors aim to provide updated consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. A panel of 146 experts from 29 professional and governmental organizations convened in Bethesda, MD, in September 2006 to develop the guidelines. The guidelines now recommend cytological follow‑up alone for CIN 1, discourage treatment in adolescents, expand conservative options for adolescent CIN 2/3, introduce recommendations for AIS, and otherwise make only minor adjustments to existing CIN 2/3 management.

Abstract

To provide updated consensus guidelines for the management of women with cervical intraepithelial neoplasia (CIN) or adenocarcinoma in situ (AIS).A group of 146 experts including representatives from 29 professional organizations, federal agencies, and national and international health organizations met on September 18-19, 2006, in Bethesda, MD, to develop the guidelines. MAJOR CHANGES IN THE GUIDELINES: The management of women with CIN grade 1 (CIN 1) has been modified significantly. In the earlier guidelines, management depended on whether the colposcopic examination was satisfactory and treatment using ablative or excisional methods was acceptable for women with CIN 1. In the new guidelines, cytological follow-up is the only recommended management option, regardless of whether the colposcopic examination is satisfactory, for women with CIN 1 who have a low-grade referral cervical cytology. Treatment of CIN 1 is particularly discouraged in adolescents. The basic management of women in the general population with CIN 2,3 underwent only minor modifications, but options for the conservative management of adolescents with CIN 2,3 have been expanded. Moreover, management recommendations for women with biopsy-confirmed AIS are now included.Updated evidenced-based guidelines have been developed for the management of women with CIN or AIS. These guidelines reflect recent changes in our understanding of human papillomavirus-associated diseases of the cervix and the potential impact of treatment on future pregnancies.