Cervical intraepithelial neoplasia (CIN) is a premalignant lesion that is diagnosed by histology as CIN1, CIN2, or CIN3. If left untreated, CIN2 or CIN3 (collectively referred to as CIN2+) can progress to cervical cancer. There are three principal treatments for CIN available in low- and middle-income countries: cryotherapy, large loop excision of the transformation zone (LLETZ, or LEEP), and cold knife conization (CKC).

This guideline builds upon the "WHO guidelines: use of cryotherapy for cervical intraepithelial neoplasia" published in 2011, and provides recommendations for the use of cryotherapy versus LEEP versus CKC for the treatment of histologically confirmed CIN2+, and additional recommendations for the treatment of histologically confirmed adenocarcinoma in situ (AIS).

Contents

• Lists of participants
• Process for managing declarations and conflicts of interest
• Acknowledgements
• Acronyms and abbreviations
• Executive summary
• Summary treatment recommendations
• 1. Introduction
  • Target audience
  • Purpose
• 2. Methods
  • Guideline groups
  • Formulating questions and determining outcomes
  • Synthesis of the evidence and preparation of evidence profiles
  • Development of the recommendations
  • Guideline review and approval process
• 3. Recommendations
  • Recommendation 1 The expert panel recommends cryotherapy over no treatment for women who have histologically confirmed CIN2+ disease (strong recommendation, ⊕⊖⊖⊖ evidence)
  • Recommendation 2 The expert panel recommends LEEP over no treatment for women who have histologically confirmed CIN2+ disease (strong recommendation, ⊕⊕⊖⊖ evidence)
  • Recommendation 3 The expert panel recommends cold knife conization (CKC) over no treatment for women who have histologically confirmed CIN2+ disease (strong recommendation, ⊕⊖⊖⊖ evidence)
  • Recommendation 4 The expert panel suggests cryotherapy or LEEP for women who have histologically confirmed CIN2+ disease (conditional recommendation, ⊕⊖⊖⊖ evidence)
  • Recommendation 5 The expert panel recommends cryotherapy over CKC for women who have histologically confirmed CIN2+ disease and for whom cyrotherapy or CKC could be appropriate (strong recommendation, ⊕⊖⊖⊖ evidence)
  • Recommendation 6 The expert panel recommends LEEP over CKC for women who have histologically confirmed CIN2+ disease and for whom LEEP or CKC could be appropriate (strong recommendation, ⊕⊖⊖⊖ evidence)
  • Recommendation 7 The expert panel suggests CKC over LEEP for women who have histologically confirmed AIS disease (conditional recommendation, ⊕⊖⊖⊖ evidence)
• 4. Research gaps and further considerations
• 5. Use of the guidelines
  • Guideline dissemination
  • Guideline evaluation
  • Guideline update
• References
• Annexes
  • Annex 1 Declarations of interest
  • Annex 2 Search strategy for evidence reviews
  • Annex 3 PRISMA flow diagram for inclusion and exclusion of studies for evidence reviews
  • Annex 4 List of references for studies included in evidence reviews
• Supplemental material

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