A Pap smear reports HSIL (High-grade Squamous Intraepithelial Lesion). HPV genotyping shows HPV 16. Colposcopy-directed biopsy confirms CIN 3. The patient is 32 years old and nulliparous. The most appropriate management is:
- A Cryotherapy of the cervix
- B LLETZ (Large Loop Excision of Transformation Zone) / LEEP procedure ✓
- C Cold-knife conization as the only acceptable procedure for CIN 3
- D Hysterectomy as definitive treatment for CIN 3 in nulliparous women
Explanation
CIN 3 requires excisional treatment rather than ablative therapy because histological confirmation and assessment of margins are required to exclude microinvasion. LLETZ/LEEP is the preferred excisional procedure for CIN 3, offering both treatment and complete histological assessment with clear margins. Cryotherapy and laser ablation are unsuitable for CIN 3 as they do not provide a specimen. Cold-knife conization is reserved for CIN 3 with endocervical extension not visualized colposcopically, or when LLETZ may be inadequate. Hysterectomy is not indicated for CIN 3 in women desiring fertility, and even in those who have completed family, excision is preferred as first-line.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.