An Alternative to Excision: Use of Trichloroacetic Acid for Management of High-Grade Cervical Intraepithelial Neoplasia in Young Women

Objective: To assess the efficacy of trichloroacetic acid (TCA) as treatment for high-grade cervical intraepithelial neoplasia (CIN 2 or 3). Methods: Retrospective study of patients with CIN 2 or greater treated with TCA from 2016 to 2022. Patients who desired future childbearing had a satisfactory colposcopy and had not received prior treatment for CIN. Patients were offered excision as initial treatment and for lesions that did not regress. TCA was discussed as an alternative, off-label treatment. Under colposcopic guidance, 85% TCA was applied to the transformation zone and distal endocervix. Patients were followed with colposcopy and cytology every 3–6 months and subsequently underwent excision or reapplication of TCA. Primary outcomes were regression and remission after a minimum of 6 months of treatment with TCA. Results: A total of 43 patients elected treatment with TCA. The mean age was 28.6 years with a median follow-up time of 12 months. The majority of patients were nonsmokers (95.3%) and White (73.9%). Pretreatment diagnosis was CIN3 and CIN2 in 32.6% and 67.4% of cases, respectively. After a median of three TCA treatments, 23.3% regression and 55.8% remission were noted for an overall cytological response rate of 79.1%. 16.3% required excision within 1 year. There were no cervical cancer diagnoses. The median time to regression and remission was 9 months and 6 months, respectively. Conclusion: In patients with high-grade CIN, treatment with TCA may have favorable short-term outcomes. TCA may represent an alternative to excision in reproductive-aged patients, though additional studies are needed with a larger cohort in a prospective manner.