Cervical Intraepithelial Neoplasia 2- 3 is considered a premalignant lesion but during pregnancy the consensus guidelines are to treat it only if invasive cancer is suspected. The aim of this study is to describe our experience with women diagnosed with CIN 2-3 during pregnancy. We summarize data from the literature about the risk of CIN 2-3 progressing to invasive cancer during pregnancy and the safety of LLETZ during the first trimester.
The aim of the present study was to describe our experience with pregnant women diagnosed with CIN 2-3 that were followed up and treated after delivery and women who had LLETZ performed during the first 15 weeks of pregnancy. 84 pregnant women were diagnosed with CIN 2-3 between January 2006 and December 2015.43 women were followed and 41 had LLETZ . We summarize the literature about the outcome of CIN 2-3 during pregnancy and information about excisional treatments performed during the first 15 weeks of pregnancy.
43 women were followed up and the final pathological diagnosis was: 3 women (7.5%) cervical cancer, 26 (65%) had CIN 2-3 and 11 (27.5%) had CIN 1 or normal histology .Two women are still pregnant, two women had spontaneous abortion and one woman did not return for evaluation after delivery. Of the 41 women who underwent LLETZ during the first 15 weeks invasive cancer was diagnosed in 2 women (4.9%), CIN 2-3 in 36 women (87.9%) and 3 (7.3%) women had CIN 1 or normal histology. Severe bleeding needing suture occurred in one woman, minor bleeding occurred in two women and one woman had cervical cerclage at 21 weeks. In 7 women the LLETZ was performed together with termination of the pregnancy or treatment of missed abortion which was diagnosed before the LLETZ .34 women continued their pregnancy, 31(91.2%) of them had term deliveries, two (5.9%) had late premature deliveries (at 34and 36 weeks), one woman had early missed abortion.Invasive cancer was the final diagnosis in 5 women (6.2%) of the 81 women that had completed the evaluation for CIN 2-3 during pregnancy.Summarizing 16 articles about 656 women diagnosed with CIN 2-3 during pregnancy the final diagnosis was invasive cancer in 45(6.9%).8 authors describe excisional treatments during the first 15-18 weeks of pregnancy with minimal complications, and term delivery in 90% of the women.
According to the presented data the LLETZ procedure during the first 15 weeks of pregnancy appears to be safe and has the advantage of diagnosing or preventing cervical cancer in 6.9% of the cases.Based on these results, we believe it is time to reconsider the indications and contraindications of CIN 2-3 treatment during the first 15 weeks of pregnancy.
Siegler E, Amit A, Lavie O, Auslender R, Mackuli L, Weissman A. Cervical intraepithelial neoplasia 2, 3 in pregnancy: time to consider loop cone excision in the first trimester of pregnancy?J. Low Genit Tract Dis. 2014; 18:162-8.