Explanation

The goal of cervical cytology and human papillomavirus testing is cervical cancer screening and prevention. Cervical intraepithelial neoplasia refers to squamous abnormalities of the epithelium covering the ectocervix. Malignant transformation rates of cervical intraepithelial neoplasia vary by disease severity. Women with low-grade cervical intraepithelial neoplasia have lower risk of lesion progression to invasive disease, while those with high-grade lesions are at higher risk. Cervical intraepithelial neoplasia grade 2 (CIN 2) is an intermediate stage. Patients with CIN 2 may be observed or managed by a diagnostic excisional procedure. Minimal intervention is generally recommended for patients between the ages of 21 and 24 due to the high rate of spontaneous viral clearance. Consequently, observation of CIN 2 is preferred when confirmed by colposcopic biopsies. Follow-up for those patients consists of a colposcopy and cytology at 6-month intervals for 1 year. If both are negative, follow-up with repeat cotesting is recommended at 1 year. If either is abnormal, a repeat colposcopy and biopsy is indicated. Excision is recommended for persistence of CIN 2 for 24 months.

Patients age ≥ 25 should be observed with colposcopy and human papillomavirus-based testing at 6 and 12 months (B). Colposcopy in 1 year (C) is not appropriate, as it should be done at 6-month intervals with cytology in patients with CIN 2 who are under age 25. Cotesting in 1 year (D) is indicated in patients age ≥ 25 following two consecutive negative results for the initial follow-up evaluation.