Clinical importance of “low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H)” terminology for cervical smears

• Published in: Gynecologic oncology 2011-04, Vol.121 (1), p.152-156
• Main Authors: Ince, Umit, Aydin, Ozlem, Peker, Onder
• Format: Article
• Language: English
• Subjects: Bethesda System; Cervical intraepithelial neoplasia (CIN); Cervical smear; Diagnostic category; Hematology, Oncology and Palliative Medicine; Obstetrics and Gynecology; Pap test; Squamous intraepithelial lesion (SIL)
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2010.12.004

Abstract Objective We compared follow-up biopsy findings and positive predictive values (PPVs) for cervical intraepithelial neoplasia 2 or worse (CIN 2+) in cases that were cytologically interpreted as low-grade squamous intraepithelial lesions (LSIL); high-grade squamous intraepithelial lesions (HSIL); LSIL, cannot exclude HSIL (LSIL-H); and atypical squamous cells, cannot exclude HSIL (ASC-H) during a 5-year period to evaluate the clinical significance of LSIL-H as a distinct cytological category. Methods All Pap tests with a diagnosis of LSIL-H, ASC-H, LSIL, and HSIL (January 1, 2004–July 20, 2009) were retrieved from our computer database. PPVs of cytological diagnostic categories for detecting CIN 2+ were compared. Results Of all Pap tests ( n = 163,315), 1713 cases that had histological confirmation were included in the study. The LSIL-H diagnosis represented only 0.23% ( n = 387) of all Pap tests and 9.3% of all cytological SILs ( n = 4119). LSIL alone was associated with a significantly lower risk for CIN 2+ (PPV = 21%) as compared with LSIL-H (PPV = 40%). The results showed that the risk of CIN 2+ was intermediate for LSIL-H compared with unqualified LSIL ( p < 0.005) and HSIL ( p < 0.0001). Conclusions The current study is one of the largest LSIL-H series to date. Because of its intermediate status between LSIL and HSIL, LSIL-H should be considered a distinct diagnostic category, and specific cytomorphological criteria should be defined. The results suggest that an LSIL-H diagnostic category would aid in more rapid detection and treatment in some patients with CIN 2+.