Cin N87.0 + N87.1

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 19.07.2021

Definition
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Cervical intraepithelial neoplasias (CIN) are incipient precursor lesions for squamous cell carcinomas of the cervix uteri.

Classification
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Subdivision according to the degree of atypia

CIN I	mild dysplasia
CIN II	moderate dysplasia
CIN III	severe dysplasia and carcinoma in situ (Cis)

Diagnosis in smear cytology according to Munich Nomenclature II (according to Soost)

Cytological findings	Pap	Suspected Histology
Inconspicuous cell picture	I
inflammatory regenerative, metaplastic or degenerative changes, hyper- and parakeratosis cells	II
Dyskarioses in superficial and intermediate cells indicate mild to moderate dysplasia	IIID	CIN I, II
Dyskarioses of cells from deeper layers	IVa	CIN II, III (severe dysplasia)
Dyscariosis of cells from deeper layers, incipient invasion cannot be excluded	IVb	CIN II, III (C sharp)
Cells of an invasive cervical carcinoma or other malignant tumours	V	invasive carcinoma

About 85% of invasive cervical carcinomas are squamous cell carcinomas. A distinction is made between keratinizing and non-ceratinizing carcinomas and between large and small cell carcinomas. The proportion of adenocarcinomas is about 10% (9-13%), the proportion of adenosquamous carcinomas is about 5% (2-8%). Adenocarcinomas are treated like squamous cell carcinomas.

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Etiopathogenesis
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The development of a CIN is not as a rule, but rather rarely the consequence of a cervical HPV infection. The persistence of the high-risk HPV infection is decisive for the possible development of cancer. Only chronic infections of the same HPV type can lead successively to the development of in situ carcinomas and later to invasive carcinomas. Cofactors for this are multiparity (> 5 births), long-term use of ovulation inhibitors, cigarette abuse, age > 30 years, immunodeficiency. The average latency period between initial HPV infection and invasive carcinoma is 15-30 years.

Prophylaxis
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For prophylaxis, a bivalent vaccine (Cervarix; against HPV 16, 18) and a quadrivalent vaccine (Gardasil; against HPV 6, 11, 16, 18) are available today. The STIKO recommends vaccination for girls and young women aged between 12-17 years. As a rule, the vaccination in the recommended age range is also reimbursed by the statutory health insurance companies. Women who have not been vaccinated at the age of 12-17 LJ, the age recommended by STIKO, can also benefit from vaccination against HPV. It is the responsibility of the doctor to inform his patients of the benefits and risks of the vaccination on the basis of the vaccine approval.

Literature
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Bollen LJM et al. (1996) Human Papillomavirus DNA after Treatment of Cervical Dysplasia. Low prevalence in normal cytologic smears. Cancer 77: 2538-2543
Causin RL et al (2021) A Systematic Review of MicroRNAs Involved in Cervical Cancer Progression. Cells 10: 668.
Consensus statement. National Institutes of Health consensus development conference. (1997) Statement on cervical cancer. Gynecol Oncol 66: 351-361
Koutsky L et al (1992) A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med 327: 1272-1278
Nobbenhuis MA et al (2002) Addition of high-risk HPV testing improves the current guidelines on follow up after treatment for cervical intraepithelial neoplasia. Br J Cancer 2000 84: 796-801
Nobbenhuis MAE et al (1999) Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: A prospective study. Lancet 354: 20-25
Petry KU (2007) What does HPV vaccination mean for gynaecological cancer screening. Dermatologist 58: 501-506
Schneede P, Hofstetter A (2001) Diagnosis and therapy of genital diseases caused by human papillomaviruses (HPV). Guidelines of the German Society of Urology. AWMF Guidelines Register No. 032/040
Speck LM (2006) Vaccines for the prevention of human papillomavirus infections. Skin Therapy Lett 11: 1-3
Wright TC Jr et al (2002) 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA 287: 2120-2129