CONTEXT
precancerous cervical lesions, precancerous lesions, cancerous lesion
CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 2, PRECANCEROUS LESIONS, DISEASE, CERVICAL CANCER, TRANSFORMATION


Does thermal ablation (TA), used in the treatment of precancerous cervical lesions in low- and middle-income countries, change the cervical anatomy?
A shift of the transformation zone (TZ) into the endocervical canal 6-12 months after treatment by TA has been observed in 36% of patients. In total, 56% of patients had a non–fully visible TZ (type 3 TZ) after TA, compared with 24% before TA.
Visual inspection with acetic acid (VIA) is traditionally used for diagnosis and follow-up of precancerous cervical lesions in low- and middle-income countries. A high proportion of women with a type 3 TZ—and thus, out of sight on visual assessment—may limit the value of VIA as a primary follow-up examination after TA. Further studies are needed to determine the diagnostic performance of VIA after TA, and guidelines on the follow-up after TA should be established taking the endocervical shift of the TZ into consideration.To successfully reduce cervical cancer incidence, effective treatment and appropriate follow-up of women screened positive for precancerous lesions are needed. In high-income countries, Large Loop Excision of the Transformation Zone (LLETZ) and other excisional procedures have become the standard of treatment for women having a cervical intraepithelial neoplasia grade 2 or worse (CIN2+), with a very low rate of persistent disease.The WHO has adopted in its guidelines the squamous columnar junction (SCJ) and TZ nomenclature of the International Federation of Cervical Pathology and Colposcopy for visual inspection with acetic acid (VIA) assessment and treatment.Follow-up after TA is important as women who have been treated for CIN2+ have a risk of persistent disease and a higher risk than the general population to develop a new CIN2+ or a cancerous lesion.