Regression or Intervention

While some CIN 2 lesions may regress on their own, they have a higher likelihood of persisting or progressing to CIN 3.

Moderate cervical dysplasia CIN2 / HSIL

CIN 1 cervical dysplasia rarely becomes cancer and often goes away on its own. CIN 2 and 3 are more likely to require treatment to prevent cancer. Cervical intraepithelial neoplasia grade 2 (CIN 2) represents a more advanced stage of dysplasia, indicating moderate abnormalities in the cervical cells.

How long does it take for CIN1 to become CIN2?

CIN is graded as 1, 2, or 3 depending on the how much of the epithelial layer contains atypical cells. CIN1, or mild dysplasia, often spontaneously regresses, usually within 6 to 12 months. When cellular atypia involves two-thirds of the thickness of the epithelium, it is designated as CIN2.

Can HPV CIN2 go away?

There was evidence that approximately 40% of undiagnosed CIN-2 will regress over 2 years but CIN-2 caused by HPV16 may be less likely to regress than CIN-2 caused by other high-risk HPV genotypes

Loop electrosurgical excision procedure (LEEP)

The Loop Electrosurgical Excision Procedure (LEEP) is one of the most commonly used approaches to treat high grade cervical dysplasia (CIN II/III, HGSIL) discovered on colposcopic examination. In the UK it is known as Large Loop Excision of the Transformation Zone (LLETZ).

This uses a thin looped wire charged with an electric current to remove a thin layer of a section of the cervix . The goal is to remove all the abnormal cells, including most or all of the cells with HPV.

Process

When performing a LEEP, the physician uses a wire loop through which an electric current is passed at variable power settings. Various shapes and sizes of loop can be used depending on the size and orientation of the lesion. The cervical transformation zone and lesion are excised to an adequate depth, which in most cases is at least 8 mm, and extending 4 to 5 mm beyond the lesion. A second pass with a more narrow loop can also be done to obtain an endocervical specimen for further histologic evaluation.

How painful is LEEP?

During the procedure, you may feel a little discomfort or cramping. Because numbing medicines are used, though, a lot of people don’t feel anything. After LEEP, you may have mild cramping for a day or so. Over-the-counter pain medicine can help.

The procedure has many advantages including low cost, high success rate, and ease of use. The procedure can be done in an office setting and usually only requires a local anesthetic, though sometimes IV sedation or a general anesthetic is used.

About 1% to 2% of people may experience complications following the procedure, such as delayed bleeding or narrowing of their cervix (stenosis).

How do I know my cervix is healed after LEEP?

Don’t place anything inside your vagina (such as tampons or douches) or have vaginal intercourse for at least 4 weeks after your procedure. It usually takes about this long for your cervix to heal. During your follow-up appointment, your doctor will examine you and see if your cervix has healed.

What is the next step after a LEEP procedure?

The most common next step after a LEEP procedure is to get a pap smear in six months.

What is the success rate of LEEP procedure for CIN 2?

The success rate for LEEP is excellent, with a 90% cure rate. A LEEP’s success depends on various actors, including how advanced your cervical dysplasia is and how much tissue must be removed. In those instances where abnormal cells grow back, your provider may recommend an additional LEEP or other treatments.

Does cervix grow back after LEEP?

Does the cervix grow back after a LEEP procedure? Yes. During the four- to six-week recovery time, new healthy tissue grows on your cervix to replace the removed abnormal tissue.

Positive margin after LEEP

A positive margin after LEEP (defined as a histopathological finding of CIN along the specimen margin regardless of the CIN grade) is a well-defined predictor of persistent/recurrent disease.

Some investigations have suggested that secondary conization (including cold knife conization and LEEP) or hysterectomy should be applied in patients who have positive margins, while other studies have demonstrated that this population can be followed-up without the need for secondary surgery.

As the spontaneous regression rate of HSIL is much lower than that of LSIL it is reasonable to assume that patients with HSIL margins are more likely to have persistence/recurrence than patients with LSIL margins; therefore, a “wait-and-see” strategy would carry a high risk for persistence/recurrence in patients with HSIL margins in the initial cervical cone specimen. In contrast, if this hypothesis cannot be validated, secondary surgery for these patients may result in overtreatment to a certain extent.

A previous study demonstrated that HSIL can regress, which definitely challenged this hypothesis. However, as data on the persistence/recurrence rate in patients with HSIL, LSIL margins or HSIL margins are not available, the optimal treatment for patients with HSIL with positive margins remains controversial.

Therefore, it should be analyzed the data of patients with HSIL and HSIL margins to distinguish the factors that influence persistent/recurrent disease.

Is LEEP better than laser?

While it is unclear if one technique is superior to another, LEEP has largely replaced laser because laser is expensive, technically difficult, and can cause harm to medical personnel. Laser is still occasionally utilized.

Laser therapy

This uses light to burn away abnormal cells. This treatment is less common. Laser therapy is sometimes called laser ablation. This just means the laser burns away the abnormal cells. You have this treatment as an outpatient.

A laser beam is a very strong, hot beam of light. It burns away the abnormal area. You may notice a slight burning smell during the treatment. This is nothing to worry about. It is just the laser working. You can go home as soon as this treatment is over.

Freezing (cryosurgery) Cryotherapy

This involves freezing the abnormal cells with liquid nitrogen or carbon dioxide.

What is the success rate of cryotherapy for HPV?

Cryotherapy may be performed after abnormal cells are found during a Pap test, colposcopy, or biopsy. In most cases (about 85-90% of the time), cryotherapy cures abnormal cells so that the problem does not come back.