A 28-year-old nulliparous woman has CIN 3 on colposcopic biopsy. HPV genotyping shows HPV 16. She wishes to preserve fertility. The most appropriate management is:

• A Simple hysterectomy
• B Cryotherapy
• C Radical trachelectomy
• D Large loop excision of transformation zone (LLETZ) ✓

Explanation

CIN 3 (high-grade cervical intraepithelial neoplasia) is treated with excisional therapy; LLETZ (loop electrosurgical excision procedure, LEEP) is the standard of care, providing both treatment and diagnostic material with clear margins assessment. Hysterectomy is over-treatment for pre-invasive disease when fertility preservation is desired. Cryotherapy is suitable for CIN 1–2 meeting specific criteria but not first-line for CIN 3. Radical trachelectomy is reserved for early invasive carcinoma.

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

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Written and medically reviewed by the StethoPrep medical team.