How Cervical Intraepithelial Neoplasia Is Diagnosed

Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is a medical condition where cells on a cervix change.

Since the cervix is deep inside at the lowermost part of the uterus which connects to the vagina, you usually can’t see this internal area at home. To see if you have CIN, you’ll need to go to a qualified medical professional (ie. a doctor, nurse, or gynecologist) who can examine through Pap smear exam and Human papillomavirus (HPV) testing to determine your risk factors.

A type of biopsy called a cone biopsy may also be necessary to test any internal skin lesions on the cervix. This is why you can’t self-diagnose CIN. However, there are options for at-home STI testing that can help in the overall diagnostic process.

At-Home Testing

Human papillomavirus is the leading underlying cause of infection that comes before cell changes of the outer lining of the cervix (AKA the intraepithelial lining). HPV is also the infection that, if left untreated over years (these cells change slowly), can eventually progress to cervical cancer.

HPV is also responsible for several other types of cancers including vulva, penis, anus, and back of the throat or oropharynx cancer. Doing at-home STI testing is an option for first-line detection of a potential problem.

If you get a positive test result from your at-home HPV test, don’t panic. This does not mean you have cancer. It may not even mean you have a strain of HPV that causes cervical cancer, either. Human papillomaviruses are common and pretty much everywhere, but they’re relatively harmless. Still, if you have a positive home test, check with your doctor to see if you need further testing to check for the 14 out of the more than 100 HPV-related viruses linked to cancer.

At-home HPV tests range from about $50 to $100. Depending on your age, HPV testing may be combined with your routine Pap smear at you doctor’s office or clinic, which is often covered by insurance. If not, the cost may vary depending on where it is done.

Physical Examination

The earlier you find cervical cancer, the easier it is to treat. This is why you should always follow the most recent screening guidelines:

The American College of Obstetricians and Gynecologists (ACOG) recommends the following:

• Women ages 21 to 29 should get a Pap test every three years.
• Women ages 30 to 65 should have a Pap test combined with an HPV test every five years. 
• Some women with certain conditions may need more frequent testing, including women with a history of cervical cancer, HIV/AIDS, or a weakened immune system. 

Your physical examination consists of these tests. The Pap test looks for the precancerous cells that could indicate the presence of CIN. This test is done in a clinic. If indicated, the HPV test is usually done at the same time.

During a Pap test, a plastic or metal tool will be slowly inserted into the vaginal canal to the point where it reaches the bottom of your cervix. The instrument, technically called a speculum, will open to widen the vagina so the professional can see and have enough space to collect a small cell sample as well as any cervical mucus. These cells will be sent for diagnostic examination. 

Your Pap test will come back reported as one of the following:

• Normal: Everything looked as it should and you can continue following the regular screening protocol.
• Unclear or inconclusive: The cell sample may not have been large enough or may be showing inconsistent results for other reasons. Depending on your medical history, your doctor may decide to do another Pap to confirm or wait 6 months to a year to have another test. 
• Abnormal: The cells examined looked abnormal but this doesn’t mean you have an HPV infection or cancer. Your doctor may suggest further testing to get a better understanding of what’s happening. 

Labs and Tests

If your Pap tests are abnormal and suggest abnormal cell growth, there are a few other methods of testing your doctor will consider. Imaging can be done to examine the cells in better detail and various biopsy types may be done to determine if it is nonmalignant (precancerous) or if it’s malignant (cancerous). 

• Colposcopy: Similar procedure to a Pap smear test except it includes a lit-up magnifying instrument that is used in conjunction with the speculum. It can be used to look for cell changes, growths or lesions, and inflammation. It does not go all the way to the uterus.
• Endocervical curettage: Cells are scraped and collected for testing from the cervical canal.
• Punch biopsy: Cervical tissue is removed for testing.
• Cone biopsy: A cone biopsy gets its name from the shape of tissue removed (a cone). This shape allows the doctor to examine deep into the tissue without taking as much tissue from the area.

Cone biopsies can be used to diagnose and, in many cases, treat CIN.

Three ways of performing a cone biopsy:

• Laser surgery, which uses a laser beam to take out or excise a portion of tissue.
• Loop electrosurgical excision (LEEP), which uses a thin wire loop attached to a generator to electrically remove a piece of tissue.
• Cold knife conization (CKC) in which tissue is removed with a surgical scalpel.

Misinterpreted Results

A diagnosis of CIN isn’t the same as a diagnosis of HPV. Only an HPV test can detect the presence of the human papillomavirus. A positive result doesn’t mean you have the type of HPV that may one day develop into cervical cancer (if left undetected and untreated), either. Even more, a positive HPV test doesn’t necessarily mean you need to do anything right away. Your doctor can help determine your level of risk.

Other reasons for unclear results include life changes like:

• Pregnancy
• Menopause
• Infection

A Word From Verywell

The diagnostic process for CIN may sound like a lot, but it really comes down to going and getting a Pap test and sticking to the recommendations for screening, which includes screening for HPV, the infection that most commonly is the culprit behind the cell changes that later lead to cervical cancer.

The good news is, Paps are relatively quick and painless routine procedures and most of the time everything is totally fine. When there’s something outside the norm, you’ll know with plenty of time to take action.