Management of Relapsing Cervical Intraepithelial Neoplasia

OBJECTIVE: To evaluate relapsing cervical intraepithelial neoplasia (CIN) and establish the criteria of recurrence to assess management by laser COT STUDY DESIGN: Patients with histologically proved CIN after a primary conservative approach were the study population. Disease relapse was considered as residual or recurrent if diagnosed within or after the first year of follow-up. RESULTS: There were 333 patients assessed in our study. Residual disease was found in 80 patients (24%) and recurrent disease in 253 patients (76%). Histologic findings were compatible with CIN 2-3 in 127 and with CIN I in 206 patients. Laser CO(2) conization was offered to 240 patients, laser ablation to 10 patients and combination treatment to 31 patients, whereas 52 patients were assigned to follow-up. Involved resection margins were present in 37 patients, but only when the endocervical margin was involved was there a significant association with recurrence rate. CONCLUSION: Relapsing CIN creates difficulties in management; we recommend that patients should be treated in tertiary centers with high expertise. Laser CO(2) seems to be a safe and efficacious method for treating relapsing CIN. (J Reprod Med 2009;54:499-505)