A 25-year-old woman with CIN 3 on colposcopy-directed biopsy has a satisfactory colposcopy with the entire transformation zone visible. She is HPV 16 positive. She desires future fertility. Which management is most appropriate?
- A Observation with repeat colposcopy in 6 months
- B Total abdominal hysterectomy
- C Loop electrosurgical excision procedure (LEEP) ✓
- D Cold knife conization with endocervical curettage
Correct answer: C. Loop electrosurgical excision procedure (LEEP)
Explanation
For CIN 3 with satisfactory colposcopy and a visible transformation zone, excisional treatment (LEEP or cold knife conization) is indicated because CIN 3 has a high risk of progression to invasive cancer. LEEP is preferred in most settings as it is office-based with comparable efficacy. Hysterectomy is not indicated for preinvasive disease in a young woman desiring fertility. Observation is inappropriate for CIN 3.
Reference: American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines, 2019 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.