A 38-year-old woman from Tamil Nadu, HPV-16 positive, presents with abnormal cervical cytology (CIN 2). She has completed 2 doses of quadrivalent HPV vaccine 6 months ago. Colposcopy-directed biopsy confirms CIN 2 with negative margins. She declines excisional treatment and requests conservative management. According to current FIGO and Indian guidelines, which of the following is the most appropriate management?

Explanation

## Management of CIN 2 in Young Women: Conservative vs Excisional Approach **Key Point:** Current FIGO 2019 guidelines and Indian Society of Colposcopy and Cervical Pathology (ISCCP) recommendations allow **conservative management of CIN 2 in women <25 years or those desiring fertility**, with **HPV-based surveillance** as the gold standard follow-up. **Clinical Pearl:** In this 38-year-old with CIN 2 and negative margins on biopsy: - **HPV testing at 12 months** is the most sensitive surveillance tool (NPV >99% if HPV-negative) - If HPV-16/18 **persists or recurs**, excisional treatment is indicated - If HPV-negative at 12 months, risk of progression is <5%; annual HPV testing can continue **High-Yield:** CIN 2 has ~40% spontaneous regression rate, especially in younger women or those with negative HPV at follow-up. HPV persistence (not cytology alone) predicts progression to CIN 3/cancer. **Rationale for Option 2 (Correct):** - HPV testing at 12 months is the **most specific and sensitive** marker for persistent/recurrent disease - Guides treatment decisions without over-treating transient lesions - Aligns with FIGO 2019 and WHO/ISCCP protocols for conservative management