A 25-year-old woman has a Pap smear showing HSIL (CIN III equivalent). Colposcopy-directed biopsy confirms CIN III at the squamocolumnar junction with negative endocervical sampling. What is the recommended management according to ASCCP 2019 guidelines?

• A Repeat Pap smear in 6 months
• B Observation with colposcopy and Pap smear at 6-month intervals for 2 years
• C Hysterectomy as definitive treatment
• D Excisional treatment (LEEP or cold knife conisation) ✓

Explanation

CIN III confirmed on biopsy requires excisional treatment (LEEP — loop electrosurgical excision procedure, or cold knife conisation) per ASCCP 2019 guidelines, regardless of patient age. The goal is excision with clear margins to confirm absence of microinvasive disease and to treat the CIN III lesion. Observation/surveillance without treatment is not acceptable for confirmed CIN III. Hysterectomy is reserved for recurrent/persistent CIN III after excision or those who are not surgical candidates.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.