High Grade Intraepithelial Lesions
HSIL
28.1.2012
Dr Barbara Kerkhoff
Consultant Gynaecologist & Obstetrician
Bon Secours GP Study Day

High Grade Intraepithelial Lesion
• Preinvasive lesion
• Prevalence: 0.45% (USA)
• 70 – 75% HSIL  CIN 2/3
• 1 – 2% HSIL  Invasive cancer
28.1.2012
Bon Secours GP Study Day

1 Excisional Techniques
1 LLETZ/ LEEP
2 Laser/ Knife cone biopsy
2 Local destructive Techniques
1 Laser Vaporisation
2 Cryotherapy
3 Diathermy
4 Cold Coagulation
3 Wedge biopsy (Pregnancy)
4 Hysterectomy
28.1.2012
Bon Secours GP Study Day

1. Low risk
< 50yrs, complete excision
2. Medium risk
< 50yrs, incomplete excision
> 50yrs, complete excision
3. High risk
> 50yrs, incomplete excision
Free of disease 5 yrs
92%
86%
58%
28.1.2012
Bon Secours GP Study Day

Those women most likely to have persistent disease
• Large volume disease
• High grade disease
• Incomplete excision
• Immunosuppressed women
28.1.2012
Bon Secours GP Study Day

For every 1000 women treated for CIN:
- 4 will develop invasive cancer
- 5.8% for women treatment for CIN 3
28.1.2012
Bon Secours GP Study Day

• High-Risk HPV DNA testing is more sensitive in detecting high grade disease than smear test.
1
• A positive high-risk HPV result is an objective risk indicator for the development of highgrade disease and cancer.
2
1
.
Clavel et al Brit J Cancer 2001;89;1616-1623
2. Lorenz A, Arch Pathol Lab med 2006;127;959-968
28.1.2012
Bon Secours GP Study Day

Post Tx
CIN 2/3
3 month
6 month
12 month
24 month
Sensitivity
HPV
93%
90%
90%
93%
Sensitivity
Smear
58%
62%
72%
93%
Specificity
HPV
86%
92%
96%
99%
Double negative (Smear and HPV DNA) over 2 years  CURE!
Nobbenhuis et all, Brit.J. Cancer 2001;84:796-801
28.1.2012
Bon Secours GP Study Day
Specificity
Smear
91%
91%
95%
96%

Follow up guidelines
CIN or CGIN
Negative cytology or HPV r/v 6 month cytology and
HPV
Positive cytology or HPV
LLETZ or ablation
YES
Invasion
Cytopath or
MDT
Negative cytology or
HPV
2. r/v in 18 month d/c to routine
Positive cytology or
HPV
Repeat colposcopy
+/- bx
Repeat tx if required no
Bon Secours GP Study Day
Cytological surveillance annual smears for
10 years

• HPV is an infection, not a disease
• HPV is not a marker for sexual behaviors, infidelity or timing of infection
• HPV is very common
• HPV is usually cleared by the immune system
(90%)
• HPV does not require tx in absence of CIN
28.1.2012
Bon Secours GP Study Day

Cervical cancer should be considered a very rare complication of a very common virus.
Thank you!
Dr Barbara Kerkhoff
Consultant Gynaecologist
Bon Secours GP Study Day 28.1.2012