A 28-year-old woman has a cervical smear showing high-grade squamous intraepithelial lesion (HSIL/CIN 2–3). Colposcopy is satisfactory (entire transformation zone visible). The MOST appropriate management is:
- A Hysterectomy to prevent progression to invasive cancer
- B Repeat smear in 12 months
- C Photodynamic therapy
- D Large loop excision of transformation zone (LLETZ/LEEP) ✓
Explanation
LLETZ (large loop excision of the transformation zone), also known as LEEP, is the standard treatment for colposcopically confirmed CIN 2–3 (HSIL) with satisfactory colposcopy showing the entire transformation zone. It provides a histological specimen for diagnosis and treatment simultaneously. Hysterectomy is not indicated for CIN without invasion. Repeat smear alone is insufficient for confirmed CIN 2–3 due to significant progression risk. LLETZ is preferred over cold-knife cone biopsy for CIN 2–3 with satisfactory colposcopy due to equivalent outcomes and outpatient practicability.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.