A 28-year-old woman with CIN 2 on colposcopic biopsy and no endocervical involvement wants fertility preservation. She is HPV 16 positive. Which management is most appropriate according to current evidence-based guidelines?
- A Immediate LLETZ/LEEP excision of the transformation zone as CIN 2 has significant malignant potential even in young women
- B Conservative surveillance with colposcopy and cytology every 6 months for up to 2 years, as CIN 2 regresses spontaneously in up to 50% of women under 30 ✓
- C Immediate cold-knife conization to obtain adequate margins for assessment
- D HPV vaccination followed by repeat colposcopy at 3 months — if persistent, then excision
Correct answer: B. Conservative surveillance with colposcopy and cytology every 6 months for up to 2 years, as CIN 2 regresses spontaneously in up to 50% of women under 30
Explanation
ASCCP 2019 guidelines and ESGO/EFCS recommendations support conservative management (observation) for CIN 2 in women aged ≤25 years who desire fertility, with 6-monthly colposcopy and cytology for up to 2 years. CIN 2 regresses spontaneously in approximately 40–60% of young women within 24 months. Treatment is indicated if CIN 2/3 persists at 24 months, lesion progresses to CIN 3, or adequate surveillance is not possible. HPV 16/18 positivity may prompt closer follow-up but does not mandate immediate excision in the absence of CIN 3.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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