支持

 1.建议诊断中不要用CIN1-2这样的用词

2.诊断CIN不需要报湿疣

Agree.

You can call focal CIN2 in the background of CIN 1 if you are sure the presence of CIN2. Order Ki67 and p16 stain if you are not sure the presence of high grade dysplasia is present.

Also do not call CIN with HPV infection or effect.

This is the common problem existing in Chinese pathologists community by calling CIN 1-2. I have a pathologist from Nanjing with me this week. She also used the CIN1-2 diagnosis. If you want to be a good pathologist and want winning over the trust of your diagnosis from your clinician colleagues, PLEASE never ever make diagnosis of CIN 1-2!!!

I have emphasized this problem in my teachings in different situations in China in last couple years. You have to understand that clinian will make decision of LEEP or not based on if you make diagnosis of CIN2 or not. CIN2-3 will trigger LEEP procedure; while no LEEP will be done for patients with CIN1 diagnosis. IF you call CIN 1-2, you not only left a puzzle to clinician, but also downgrade your diagnostic ability in GYN clinicians' minds. Therefore, if you are not sure about CIN2, showing to your colleagues or perform p16 immunostaining to help out. If in a very rare situation you cannot make definitive diagnosis due to very small piece of tissue or loss in deeper recuts or other reasons, you can make diagnosis as such" A minute fragment of detached dysplastic squamous epithelium, favor CIN 2". You basically communicate with your clinicians about the limitation you have on this specimen. They will understand it and will place the patient in a "high rick group" for closer follow up in younger patients and may do LEEP in older patients. So please, if you want to win the respect from clinicians, please do yourself a huge favor by not making diagnosis of "CIN 1-2"!

 cazhao老师意见：

同意全子意见。如果你能确定有CIN2的存在，那么你可以报：CIN1背景中存在局灶性CIN2。如果不确定，建议做Ki-67和P16.还有就是不要诊断CIN伴HPV感染。

杨斌老师意见：

诊断CIN1-2是在国内病理医生中存在的一个比较常见的问题。这周我遇到一个从南京来的病理医生，她也在用CIN1-2这样的诊断。如果你想成为一个好的病理医生，赢得临床医生对你的诊断的信任的话，那么再也不要用这样的词语了。最近几年我曾在国内不同场合的教学中强调过这个问题。你要意识到，临床会根据你诊断CIN2还是不是CIN2而决定给患者用不用Leep治疗。CIN2-3就会对患者进行Leep治疗，CIN1则没必要。如果你报CIN1-2那么不仅仅是将皮球踢给了临床，同时也降低了临床医生对你诊断水平的信任。所以如果你不能确定有CIN2，那么可以让同事帮忙看一下或者染个P16辅助诊断。如果因为组织细碎或者深切后也没看到或者其他原因等，实在不能做出明确的时候，可以这样写：组织细碎，可见异形鳞状上皮，倾向于CIN2.然后与临床医生沟通一下，说明在切片中遇到的困难和局限性，他们会理解的。然后临床上对于年轻患者将归为高危类型，嘱其更加积极的随访；对于年纪大一些的患者可能直接就做Leep治疗了。所以如果想赢得临床的信任和尊重，那么从自身做起，不要再用CIN1-2这样的字眼了