Potential risks of treatment of high-grade CIN

Local ablation or excision of the transformation zone has been highly successful in treating high-grade CIN and greatly reduces the risk of progression to invasive carcinoma but it is not itself without risk (Kyrgiou 2014). 

It is probable that the increase in second trimester miscarriages due to premature rupture of membranes reported after excision biopsy is related to the size of biopsy, making knife cone biopsy a greater risk than LLETZ (Khalid et al. 2012).  Although the risk with LLETZ relates to excisions deeper than 10 mm (Castanon et al. 2013), it is clearly important to avoid unnecessary excision treatment of women in early reproductive life.  

Thus cytological over-diagnosis is just as important as under-diagnosis, which is the reason why rigorous quality control measures are essential 

Potential risks of treatment of high-grade CIN

  • Excision of high-grade CIN carries a risk of premature rupture of membranes in pregnancy
  • The risk is related to the size of the biopsy and is greater with knife cone biopsy than LLETZ
  • Unnecessary treatment of women in early reproductive life should be avoided
  • Over-diagnosis is as important as under-diagnosis
  • Rigorous quality control is essential

 

X