Conservative management of cervical intraepithelial neoplasia.
A brief review of cervical intraepithelial neoplasia has been presented. Attempts have been made to identify the high-risk patient, and etiologic considerations have been detailed. The conservative management of cervical intraepithelial neoplasia is available and applicable to many patients. Regardless of the definitive therapy used in CIN, it is absolutely mandatory that proper pretreatment evaluation be performed. This includes cytology, colposcopy, colposcopy-directed biopsies, and clinical examination to rule out invasive cancer. If this can be done according to the stated criteria, one may proceed with outpatient treatment. If performed accurately, such treatment can be very effective, saving the patient a major surgical procedure. This is of tremendous benefit to the patient in time and money saved, as well as to the saving of hospital bed space and operating-room time. For the young patient who has not yet completed her family or the patient who is pregnant, outpatient evaluation is probably the optimal method. If the techniques are unavailable or the physician managing the patient does not have the expertise to perform them, standard management by means of conization, which historically has been used in this disease, should continue to be used. The consequence of inadequate outpatient management of CIN can be catastrophic. If the procedures are properly followed, then the patient with CIN can be managed safely and effectively.