Low‐grade squamous intraepithelial lesion, cannot rule out high‐grade lesion: Diagnosis, histological outcomes and human papillomavirus results

• Published in: Cytopathology (Oxford) 2019-01, Vol.30 (1), p.99-104
• Main Authors: Segura, Sheila E., Ramos‐Rivera, Gloria, Hakima, Laleh, Suhrland, Mark, Khader, Samer
• Format: Article
• Language: English
• Subjects: Cervix; Cytology; Human papillomavirus; LSIL cannot rule out high‐grade lesion; Papanicolaou test; Squamous cells; squamous intraepithelial lesion
• ISSN: 0956-5507; 1365-2303
• DOI: 10.1111/cyt.12629

Background The 2014 Bethesda System for Reporting Cervical Cytology classifies squamous intraepithelial lesions (SILs) of cervix into two main categories: low‐grade SIL (LSIL) and high‐grade SIL (HSIL). In some clinical practices, the LSIL cannot rule out high‐grade lesion (LROH) interpretive category is used in cases with LSIL and findings that may raise the possibility of HSIL. Our purpose is to assess follow‐up histopathology and high‐risk human papillomavirus (hrHPV) results in patients with LROH, in comparison with LSIL, atypical squamous cells, cannot rule out HSIL (ASC‐H), and HSIL in our institution. Design Cervical Papanicolaou tests with LROH, LSIL, ASC‐H and HSIL interpretation, surgical follow‐up, and hrHPV status were retrieved from the computer database from May 2014 to December 2016. Results Of 109 963 total Papanicolaou tests, LROH comprised 0.3%, LSIL 3.1%, ASC‐H 0.2% and HSIL 0.4%. Only 3272 cases with surgical diagnoses were included in the study. The most common histological outcome for ASC‐H was cervical intraepithelial neoplasia (CIN)2/3 (32.6%); LSIL was CIN 1 (45.7%); LROH was CIN 1 (46.7%) and HSIL was CIN 2/3 (64.4%). For LROH and LSIL, 31.1% and 7.5% respectively, had CIN 2/3. Approximately 79% of cases were hrHPV positive. Of LROH cases with surgical follow‐up, 86.9% tested hrHPV positive, accounting for the second most common positive group after HSIL (92.6%). Conclusion In our study cohort, LROH interpretation is associated with a higher number of CIN 2 or higher lesions on follow‐up compared to patients with LSIL (P