Follow-Up Protocol for Cervical Cold Knife Cone Biopsy with CIN 2/3 and Clear Margins

Primary Follow-Up Options

The American College of Obstetricians and Gynecologists recommends follow-up using either cervical cytology alone or a combination of cervical cytology and colposcopy at 4-6 month intervals until at least 3 consecutive cytologic results are "negative for squamous intraepithelial lesion or malignancy" 1, 4
Annual cytology follow-up is recommended after 3 negative cytologic results are obtained, as stated by the American College of Obstetricians and Gynecologists 3, 5
The American College of Obstetricians and Gynecologists suggests that during cytologic follow-up, the recommended threshold for referral to colposcopy is any result of ASC (atypical squamous cells) or greater 1, 3
HPV DNA testing performed at least 6 months after treatment is an acceptable alternative for surveillance, according to the American College of Obstetricians and Gynecologists 4, 5

If HPV testing is chosen, it should be performed at least 6 months after treatment to allow sufficient time for clearance of HPV infection, as recommended by the American College of Obstetricians and Gynecologists 4, 6
If high-risk types of HPV are identified, colposcopy is recommended by the American College of Obstetricians and Gynecologists 3, 4
If HPV testing is negative, the patient can proceed to annual cytology follow-up, according to the American College of Obstetricians and Gynecologists 4, 5
Repeat conization or hysterectomy based solely on a single positive HPV test without corroborating findings (abnormal cytology, colposcopy, or histology) is unacceptable, as stated by the American College of Obstetricians and Gynecologists 4, 6

If abnormal cytology is detected during follow-up (ASC or greater), colposcopy should be performed, as recommended by the American College of Obstetricians and Gynecologists 1, 3
For recurrent CIN 2/3, excisional modalities are preferred over ablative treatments, according to the American College of Obstetricians and Gynecologists 2, 7
Hysterectomy is acceptable for treatment of recurrent/persistent biopsy-confirmed CIN 2/3 when repeat diagnostic excision is not feasible, as stated by the American College of Obstetricians and Gynecologists 5, 7

Do not discharge patients from follow-up too early; longitudinal studies show that recurrent disease can occur many years after treatment, as noted by the American College of Obstetricians and Gynecologists 4, 6
Do not perform repeat conization or hysterectomy based solely on a single positive HPV test without other corroborating findings, as recommended by the American College of Obstetricians and Gynecologists 4, 5
Do not use hysterectomy as primary therapy for CIN 2/3 unless there are other indications for hysterectomy, as stated by the American College of Obstetricians and Gynecologists 2, 5