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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 CO2.


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 1 in 206 patients. Laser CO2 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 CO2 seems to be a safe and efficacious method for treating relapsing CIN.