A 28-year-old woman has a Pap smear showing HSIL (CIN 2-3). Colposcopy is performed with satisfactory examination revealing a lesion entirely within the transformation zone. Biopsy confirms CIN 3. She desires future fertility. What is the MOST appropriate treatment?

• A Simple hysterectomy
• B Loop electrosurgical excision procedure (LEEP) ✓
• C Cryotherapy alone
• D Repeat Pap smear in 12 months

Explanation

CIN 3 (severe dysplasia) requires treatment rather than surveillance, and LEEP (also called large loop excision of transformation zone, LLETZ) is the preferred treatment in women who desire fertility preservation. It provides both treatment and a tissue specimen for histological margins assessment. Simple hysterectomy is reserved for women who have completed childbearing or have recurrent CIN. Cryotherapy is appropriate only for CIN 1-2 with satisfactory colposcopy but not for CIN 3.

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

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Written and medically reviewed by the StethoPrep medical team.