It covers high-grade cellular changes.
HSIL is seen in 0.7% of all PAP smear reports.
Cases with HSIL are at high risk for cervical cancer.
CIN 2-3 is detected in 53-66% of HSIL cases that undergo colposcopy.
CIN 2-3 is detected in 84-97% of HSIL cases that undergo LEEP.
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The detection rate of HPV DNA positivity and CIN 2-3 is high in HSIL cases. Therefore, there is no need for cytological follow-up with PAP smear and HPV DNA tests in the follow-up of HSIL.
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Excisional-surgical methods (LEEP) are recommended for HSIL cases.
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LEEP is recommended at the 6th postpartum week in pregnant women with HSIL.
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CIN 2-3 spontaneously regresses in adolescent cases under the age of 20. LEEP is not recommended.
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Colposcopy is recommended in adolescent cases under 20 years of age. If colposcopy is sufficient and ECC-endo cervical curettage is negative, PAP cytology follow-up is recommended at 6-month intervals for 24 months.
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In adolescent cases under 20 years of age, if HSIL is detected in colposcopy or HSIL in cytology for one year. If it persists permanently, biopsy-LEEP is recommended. If CIN 2-3 persists during the 24-month follow-up, LEEP-excisional surgical intervention is recommended.
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If CIN 2-3 cannot be detected after the LEEP procedure, Colposcopy and/or Colposcopy and/or surgery at 6-month intervals. Cytological follow-up is recommended.
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HSIL cases reported to be negative for two consecutive PAP smears are included in normal routine follow-up.
Situations where HSIL is diagnosed and LEEP is not recommended
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If colposcopy is not performed
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If there is no histological diagnosis of CIN 2-3
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If CIN is not detected in endocervical sampling
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If only HPV DNA and cytology are performed, LEEP is not recommended.
HSIL management in pregnant cases
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If HSIL is detected during pregnancy, Colposcopy is recommended.
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Cervical biopsy is recommended if there are lesions that raise suspicion of CIN 2-3 or cancer.
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Endo cervical curettage is not an acceptable method during pregnancy.
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LEEP is not recommended during pregnancy if there is no suspicion of invasive cancer in cytological examination-colposcopy or cervical biopsy.
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If there is no CIN 2-3. Cytology and colposcopy are performed in the 6th week postparum.
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