Cervical Intraepithelial Neoplasia (CIN) · Surveillance vs Excision

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Grade + age/fertility + colposcopy
   CIN grade? Age/fertility? Satisfactory colposcopy? Glandular lesion?
   • CIN1 → CIN1 → surveillance
   • CIN2, young, wants fertility preservation, satisfactory colposcopy → CIN2 young → may observe
   • CIN2-3 / HSIL (confirmed) → CIN2-3/HSIL → excision
   • Adenocarcinoma in situ (AIS) → AIS → cold-knife conization
2. [End] CIN1 → surveillance
   CIN1 → surveillance (often regresses spontaneously; cytology/HPV at 12 months); persistence ≥2 years or progression → treat.
3. [End] CIN2 young → may observe
   CIN2, young wanting fertility preservation, satisfactory colposcopy → may choose observation (recheck at 6 months); no regression/progression → excision.
4. [End] CIN2-3/HSIL → excision
   CIN2-3/HSIL → cervical excisional treatment: LEEP (loop electrosurgical excision) or cold-knife conization (assess margins); ablation only for satisfactory colposcopy with invasion and glandular disease excluded.
5. [End] AIS → cold-knife conization
   Adenocarcinoma in situ (AIS) → cold-knife conization (negative margins; glandular lesions can skip, assess carefully); completed childbearing may have hysterectomy; positive margins need re-excision.

Source guidelines & references

• Cervical precancer management (ASCCP 2019 risk-based management consensus)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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