Cervical squamous and glandular intraepithelial neoplasia: identification and current management approaches

Certain types of human papillomaviruses (HPV) are associatedwith squamous intraepithelial lesions and cancerand these are termed high-risk. HPV type 16 is detectedin approximately half of the high-grade squamous intraepitheliallesions and cancer. Because of the high rate of spontaneousregression of low-grade squamous lesions, follow-upby cytology, colposcopy and possible biopsy appears preferable.Due to the higher rate of progression to malignancy ofthe high-grade lesions conservative treatment is recommended.One of the most common reasons for persistencerelates to the human immunodeficiency virus. Adenocarcinomain situ is an uncommon disorder and not well identifiedby cytologic sampling or colposcopic inspection. Thediagnosis is made by cone biopsy, the specimen having negativemargins for disease. Hysterectomy is the treatmentprocedure of choice unless fertility is an issue. Excisionalmethods (particularly electrosurgical loop) can interferewith accurate histological interpretation in some casesof both squamous disease and adenocarcinoma in situ.This paper is available too at: http://www.insp.mx/salud/index.html