A 29-year-old woman has a Pap smear showing atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). HPV testing is positive for high-risk HPV. Colposcopy reveals a dense acetowhite lesion with coarse punctation at the transformation zone. Biopsy confirms CIN 2. What is the next best step?
- A Repeat Pap smear in 6 months
- B HPV genotyping
- C Excisional procedure (LEEP or cold knife conization) ✓
- D Hysterectomy
Correct answer: C. Excisional procedure (LEEP or cold knife conization)
Explanation
CIN 2 in a woman with ASC-H cytology and high-risk HPV positivity requires excisional treatment (LEEP or cold knife conization) to exclude occult invasive carcinoma and provide definitive therapy. Observation is acceptable only for CIN 1 or CIN 2 in specific young patient scenarios. Hysterectomy is not indicated for preinvasive disease.
Reference: WHO Guidelines for Screening and Treatment of Cervical Pre-Cancer Lesions, 2021 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.