What does a diagnosis of high-grade squamous intraepithelial lesion (CIN II) of the cervix mean?

Understanding High-Grade Squamous Intraepithelial Lesion (HSIL/CIN II) of the Cervix

High-grade squamous intraepithelial lesion (HSIL/CIN II) is a significant precancerous condition that requires prompt treatment with an excisional procedure such as LEEP, laser conization, or cold-knife conization to prevent progression to invasive cervical cancer.

What Your Diagnosis Means

Your cervical biopsy shows a high-grade squamous intraepithelial lesion (HSIL), specifically classified as cervical intraepithelial neoplasia grade II (CIN II). This represents moderate dysplasia of the cervical cells 1. The biopsy was taken from the 9:00 position on your cervix.

The additional test results in your report provide important confirmatory information:

• P16 IHC stain showing "block positivity" confirms the high-grade nature of the lesion
• Ki-67 staining above the lower one-third of the epithelium further supports the diagnosis of a high-grade lesion

Clinical Significance

CIN II is considered a significant precancerous condition with the following characteristics:

• It represents moderate dysplasia of cervical cells 1
• It is classified as a high-grade squamous intraepithelial lesion (HSIL) in the Bethesda system 1
• Without treatment, approximately 40-50% of CIN II lesions may progress to more severe disease 2
• The remaining lesions may persist or regress spontaneously 3

Recommended Management

The National Comprehensive Cancer Network (NCCN) and other guidelines recommend the following approach:

1. Treatment with excisional procedure 4:

   • Loop Electrosurgical Excision Procedure (LEEP) - preferred option
   • Laser conization
   • Cold-knife conization (CKC)

2. Follow-up after treatment 1, 4:

   • Cervical cytology at 6 months or HPV DNA testing at 12 months
   • Continue follow-up at 4-6 month intervals until at least 3 consecutive negative cytology results
   • Return to annual cytologic screening after 3 negative results

Special Considerations

• Age and fertility desires: In certain clinical circumstances (young women who desire fertility), CIN II may be followed without immediate treatment at the physician's discretion 1
• Predictors of regression: Factors that predict higher likelihood of spontaneous regression include 3:
  • Minor changes on colposcopy
  • Low-grade lesions on cytology
  • HPV types other than HPV-16

Important Caveats

1. Long-term surveillance is essential: Recurrence can occur many years after treatment, making indefinite follow-up necessary 4

2. Avoid inappropriate management:

   • Hysterectomy is not recommended as primary treatment for CIN II unless other indications exist 4
   • Overreliance on a single positive HPV test is inappropriate for making treatment decisions 4

3. Diagnostic accuracy: The correlation between Pap smears showing HSIL and actual CIN II or greater on biopsy is approximately 67-78% 5, which is why biopsy confirmation is important before treatment

Risk of Progression

Without treatment, CIN II has a significant risk of progression to more severe disease, with approximately 6% of surgically treated women experiencing recurrence 2. This underscores the importance of appropriate treatment and diligent follow-up.