Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Cervical intraepithelial neoplasia: Management of low-grade and high-grade lesions

Jason D Wright, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Cervical intraepithelial neoplasia (CIN) is a premalignant condition of the uterine cervix [1]. The ectocervix (surface of the cervix that is visualized on vaginal speculum examination) is covered in squamous epithelium, and the endocervix, including the cervical canal, is covered with glandular epithelium. CIN refers to squamous abnormalities. Glandular cervical neoplasia includes adenocarcinoma in situ and adenocarcinoma. (See "Cervical cytology: Evaluation of atypical and malignant glandular cells" and "Cervical adenocarcinoma in situ" and "Invasive cervical adenocarcinoma".)

Screening tests for cervical cancer include cervical cytology and testing for oncogenic subtypes of human papillomavirus (HPV) (table 1). Follow-up of abnormalities in screening tests with colposcopy and cervical biopsy may result in a diagnosis of CIN, glandular neoplasia, or cervical cancer [2].

CIN may be low grade or high grade. Women with low-grade CIN have a low potential for developing cervical malignancy, while those with high-grade lesions are at high risk of progression to malignancy. In managing women with CIN, the goal is to prevent possible progression to invasive cancer while avoiding overtreatment of lesions that are likely to regress.

Management of CIN is reviewed here. Related issues are discussed separately:

Treatment of CIN (see "Cervical intraepithelial neoplasia: Treatment and follow-up")

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Montz FJ. Management of high-grade cervical intraepithelial neoplasia and low-grade squamous intraepithelial lesion and potential complications. Clin Obstet Gynecol 2000; 43:394.
  2. Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17:S1.
  3. Waxman AG, Chelmow D, Darragh TM, et al. Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix. Obstet Gynecol 2012; 120:1465.
  4. Darragh TM, Colgan TJ, Thomas Cox J, et al. The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol 2013; 32:76.
  5. Bansal N, Wright JD, Cohen CJ, Herzog TJ. Natural history of established low grade cervical intraepithelial (CIN 1) lesions. Anticancer Res 2008; 28:1763.
  6. Cox JT, Schiffman M, Solomon D, ASCUS-LSIL Triage Study (ALTS) Group. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol 2003; 188:1406.
  7. Castle PE, Gage JC, Wheeler CM, Schiffman M. The clinical meaning of a cervical intraepithelial neoplasia grade 1 biopsy. Obstet Gynecol 2011; 118:1222.
  8. Elit L, Levine MN, Julian JA, et al. Expectant management versus immediate treatment for low-grade cervical intraepithelial neoplasia : a randomized trial in Canada and Brazil. Cancer 2011; 117:1438.
  9. Katki HA, Gage JC, Schiffman M, et al. Follow-up testing after colposcopy: five-year risk of CIN 2+ after a colposcopic diagnosis of CIN 1 or less. J Low Genit Tract Dis 2013; 17:S69.
  10. http://www.asccp.org/ (Accessed on March 22, 2012).
  11. Guido R, Schiffman M, Solomon D, et al. Postcolposcopy management strategies for women referred with low-grade squamous intraepithelial lesions or human papillomavirus DNA-positive atypical squamous cells of undetermined significance: a two-year prospective study. Am J Obstet Gynecol 2003; 188:1401.
  12. Benard VB, Watson M, Castle PE, Saraiya M. Cervical carcinoma rates among young females in the United States. Obstet Gynecol 2012; 120:1117.
  13. Winer RL, Lee SK, Hughes JP, et al. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol 2003; 157:218.
  14. Moscicki AB, Hills N, Shiboski S, et al. Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females. JAMA 2001; 285:2995.
  15. Schmeink CE, Massuger LF, Lenselink CH, et al. Prospective follow-up of 2,065 young unscreened women to study human papillomavirus incidence and clearance. Int J Cancer 2013; 133:172.
  16. Ferris DG, Litaker MS, ALTS Group. Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS. Am J Obstet Gynecol 2006; 194:704.
  17. Massad LS, Jeronimo J, Schiffman M, National Institutes of Health/American Society for Colposcopy and Cervical Pathology (NIH/ASCCP) Research Group. Interobserver agreement in the assessment of components of colposcopic grading. Obstet Gynecol 2008; 111:1279.
  18. Massad LS, Collins YC. Strength of correlations between colposcopic impression and biopsy histology. Gynecol Oncol 2003; 89:424.
  19. Melnikow J, Nuovo J, Willan AR, et al. Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998; 92:727.
  20. Robertson AJ, Anderson JM, Beck JS, et al. Observer variability in histopathological reporting of cervical biopsy specimens. J Clin Pathol 1989; 42:231.
  21. Mitchell MF, Tortolero-Luna G, Wright T, et al. Cervical human papillomavirus infection and intraepithelial neoplasia: a review. J Natl Cancer Inst Monogr 1996; :17.
  22. Ostör AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 1993; 12:186.
  23. Chan JK, Monk BJ, Brewer C, et al. HPV infection and number of lifetime sexual partners are strong predictors for 'natural' regression of CIN 2 and 3. Br J Cancer 2003; 89:1062.
  24. Castle PE, Schiffman M, Wheeler CM, Solomon D. Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol 2009; 113:18.
  25. Nucci MR, Crum CP. Redefining early cervical neoplasia: recent progress. Adv Anat Pathol 2007; 14:1.
  26. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin number 66, September 2005. Management of abnormal cervical cytology and histology. Obstet Gynecol 2005; 106:645.
  27. McIndoe WA, McLean MR, Jones RW, Mullins PR. The invasive potential of carcinoma in situ of the cervix. Obstet Gynecol 1984; 64:451.
  28. Gustafsson L, Adami HO. Natural history of cervical neoplasia: consistent results obtained by an identification technique. Br J Cancer 1989; 60:132.
  29. Peto J, Gilham C, Fletcher O, Matthews FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004; 364:249.
  30. McCredie MR, Sharples KJ, Paul C, et al. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol 2008; 9:425.
  31. Duggan BD, Felix JC, Muderspach LI, et al. Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized, prospective study. Am J Obstet Gynecol 1999; 180:276.
  32. Fine BA, Feinstein GI, Sabella V. The pre- and postoperative value of endocervical curettage in the detection of cervical intraepithelial neoplasia and invasive cervical cancer. Gynecol Oncol 1998; 71:46.
  33. Moscicki AB, Schiffman M, Burchell A, et al. Updating the natural history of human papillomavirus and anogenital cancers. Vaccine 2012; 30 Suppl 5:F24.
  34. McAllum B, Sykes PH, Sadler L, et al. Is the treatment of CIN 2 always necessary in women under 25 years old? Am J Obstet Gynecol 2011; 205:478.e1.
  35. Moscicki AB, Ma Y, Wibbelsman C, et al. Rate of and risks for regression of cervical intraepithelial neoplasia 2 in adolescents and young women. Obstet Gynecol 2010; 116:1373.
  36. Matsumoto K, Oki A, Furuta R, et al. Predicting the progression of cervical precursor lesions by human papillomavirus genotyping: a prospective cohort study. Int J Cancer 2011; 128:2898.
  37. Herbert A, Holdsworth G, Kubba A. Why young women should be screened for cervical cancer: the distinction between CIN2 and CIN3. Int J Cancer 2010; 126:2256.
  38. Yost NP, Santoso JT, McIntire DD, Iliya FA. Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol 1999; 93:359.
  39. Economos K, Perez Veridiano N, Delke I, et al. Abnormal cervical cytology in pregnancy: a 17-year experience. Obstet Gynecol 1993; 81:915.
  40. Connor JP. Noninvasive cervical cancer complicating pregnancy. Obstet Gynecol Clin North Am 1998; 25:331.