Julianne M. Dunne, MD

Colposcopy Follow-up

If my biopsy is abnormal, how will I be treated?

ð Low-Grade Squamous Intraepithelial Lesion, includes mild dysplasia (CIN1) and HPV changes

LSIL is considered a very mild abnormality and between 50 and 70% of these lesions may resolve spontaneously without treatment. 

NO TREATMENT

ð Observation only

Because both genital warts and low-grade cervical dysplasia often go away without treatment, you have the option of “no treatment”.  This consists of repeating the Pap test every 3 to 6 months, with or without occasional colposcopy.  If the lesion does not resolve over a period of up to two years of follow-up, then this lesion should be treated, as persistent lesions are more likely to progress to high-grade dysplasia.

TREATMENT

ð Cryotherapy

This is an ablative procedure in which the lesion is destroyed by freezing.  Nitrous oxide creates a very low temperature (-65°C to -85°C) in a probe that is placed directly on the cervix.  The procedure causes some mild to moderate lower abdominal pressure and crampy sensation, which can be minimized by taking 3 to 4 Motrin or Advil an hour prior to the procedure.  The advantages of this procedure are minimal discomfort thus not requiring anesthesia and low complication rate—low risk of bleeding or infection.  It is appropriate for most forms of LSIL unless the lesion is extensive or if the lesion extends into the endocervical canal.  Your doctor will tell you if you are an appropriate candidate for this procedure.  The disadvantages of cryotherapy include lack of a tissue specimen since the cells are destroyed, a profuse watery discharge (may soak from 2-6 pads per day and may last 1-4 weeks), and infection. 

ð LEEP (Loop electrosurgical excision procedure)

This is an excisional procedure in which the lesion is “cut out”.  LEEP uses a thin wire loop through which an electrical current is passed that turns the loop into an effective cutting tool.  LEEP is recommended for LSIL when the scraping from the endocervical canal is positive for disease or when the lesion covers more than half of the cervix as well as most cases of HSIL.  Other treatments may have a lower cure rate in these cases.  The advantages of LEEP are that a specimen is produced which is sent to the laboratory for confirmation of the diagnosis as well as confirming that the entire lesion was removed.  It is a simple procedure performed in the office with minimal discomfort.  The disadvantages include post-LEEP bleeding heavy enough to require medical attention in 1-3% of cases, infection in 1-3%, stenosis (narrowing of the opening of the cervical canal) in 1-2%.  The risk of infertility or premature delivery does not appear to be increased with a single LEEP, but may be increased when LEEP is done twice or more for recurrent disease.

Your decision to treat versus observe a low-grade lesion will be made by you and your doctor depending on the following factors: (1) your age—if you are over 35, the lesion is less likely to regress spontaneously; (2) future childbearing—if you are done having children, treatment of the cervix can be more aggressive; (3) your comfort level of NOT treating an abnormality that is known to be pre-cancerous; (4) the likelihood that you will be diligent in follow-up.

ð High-Grade Squamous Intraepithelial Lesion, includes moderate (CIN2) and severe dysplasia (CIN3)

High-grade dysplasia is always treated due to the higher risk of progression to cancer. 

ð LEEP (see above) is the primary treatment option for HSIL. 

Other options for HSIL include laser ablation and cold-conization.  These two procedures are done in an outpatient hospital operating room.