CIN3 Diagnosis: Questions About Pap Smear and Cervical Health

Questions regarding the diagnosis of CIN3?

Hello, doctor.
I recently had a Pap smear at the clinic, and it was later diagnosed as CIN3.
However, I am confused because the progression from CIN1 to CIN3 typically takes about ten years.
Three years ago (in 2017), I had a Pap smear that came back normal.
Then, two years ago (in 2018), I underwent in vitro fertilization (IVF), during which a hysteroscopy was performed.
How could the doctor not have detected anything at that time? Is it possible that the hysteroscopy performed during the IVF process does not examine the cervix?

Yu, 40~49 year old female. Ask Date: 2020/12/12

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, a Pap smear is just a preliminary test; a cervical biopsy should be performed.
Wishing you good health.

Reply Date: 2020/12/12

More Info

Cervical intraepithelial neoplasia (CIN) is a term used to describe the abnormal growth of cells on the surface of the cervix. CIN is categorized into three grades: CIN1, CIN2, and CIN3, with CIN3 being the most severe and often referred to as high-grade squamous intraepithelial lesion (HSIL). The progression from CIN1 to CIN3 can indeed take several years, but it is important to understand that this timeline can vary significantly among individuals due to various factors, including the immune response, the presence of human papillomavirus (HPV), and other health conditions.

Your concern about the rapid progression from a normal Pap smear to a diagnosis of CIN3 within three years is valid. It raises questions about the sensitivity of the screening methods used and whether any abnormalities were missed during previous examinations. Pap smears are designed to detect precancerous changes in cervical cells, but they are not infallible. False negatives can occur, meaning that a Pap smear may not detect existing abnormalities. This is particularly true if the abnormal cells are not present in the sampled area or if the sample was not collected properly.

Regarding the hysteroscopy performed during your IVF process, it is important to note that this procedure primarily focuses on the uterine cavity and may not adequately assess the cervical tissue. Hysteroscopy is typically used to evaluate and treat issues within the uterus, such as polyps or fibroids, rather than to perform a thorough examination of the cervix. Therefore, it is possible that any cervical abnormalities present at that time were not identified.

The transition from CIN1 to CIN3 can occur relatively quickly in some cases, especially if the underlying cause, such as persistent HPV infection, is present. HPV is a significant risk factor for the development of cervical cancer and its precursors. Regular screening and follow-up are crucial for early detection and management of cervical changes.
If you have been diagnosed with CIN3, it is essential to follow up with your healthcare provider for appropriate management. Treatment options may include excisional procedures such as Loop Electrosurgical Excision Procedure (LEEP) or conization, which aim to remove the abnormal tissue and prevent progression to cervical cancer. Regular monitoring through Pap smears and HPV testing is also recommended to ensure that any changes are detected early.

In summary, while it is concerning to have a rapid progression from a normal Pap smear to CIN3, it is not entirely uncommon. Factors such as the limitations of screening methods and the nature of cervical lesions can contribute to this situation. It is crucial to maintain open communication with your healthcare provider, adhere to follow-up recommendations, and discuss any concerns you may have regarding your cervical health. Regular screenings and timely interventions are key to managing cervical health effectively.

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