Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Abstract

Objective: The aim of the study was to investigate the importance of consumption of the epidermis as an additional diagnostic criteria for malignant melanoma and to evaluate its relationship to clinicopathological findings. Material and Method:The age, gender, localization of the lesion and the histopathological parameters such as tumor type, Breslow thickness, ulceration, Clark's level, mitosis/mm 2 , lymphocytic infiltration were noted in 40 malignant melanoma cases. Consumption of the epidermis was evaluated in tumor sections. Consumption of the epidermis (CoE) due to thinning of the epidermis and loss of rete ridges was noted as (+) or (-). Furthermore, CoE was compared with clinical and histopathological parameters. The Shapiro Wilk and Logistic regression tests were used for statistical analysis. The results were accepted as significant if the p value was <0.05. Results:CoE was detected in 60% (24/40) of malignant melanoma cases. a positive correlation was present between CoE and head and neck localization (p=0,698), superficial spreading melanoma (p=0,341), ulceration (p=0,097) and brisk lymphocytic infiltration (p=0,200) but the results were not statistically significant. CoE was frequently detected in males but the difference was not statistically significant (p=0.796). There was no correlation or significant statistical association between CoE and age, Breslow thickness, Clark's level or the mitotic index. Conclusion:The detection of CoE in most of the patients suggests that CoE could be a histopathological criterion in the diagnosis of malignant melanoma. The frequent association between CoE and the presence of ulceration could also direct attention to CoE as regards prognostic importance. Bulgular: Epidermal yapısal değişiklikler malign melanom olgularının %60'ında (24/40) mevcuttu. Epidermal yapısal değişiklikler ile baş-boyun yerleşimi (p=0,698), yüzeyel yayılan tümör tipi (p=0,341), ülserasyon varlığı (p=0,097) ve şiddetli lenfositik infiltrasyon (p=0,200) arasında pozitif korelasyon vardı. ancak istatistiksel olarak anlamlı değildi. Epidermal yapısal değişiklikler erkeklerde kadınlara göre daha sık olarak izlendi, ancak aradaki fark istatistiksel olarak anlamlı bulunmadı (p=0,796). Epidermal yapısal değişiklikler ile yaş, Breslow kalınlığı, Clark düzeyi ve mitoz sayısı arasında herhangi bir korelasyon veya anlamlı istatistiksel birliktelik saptanmadı.Sonuç: Epidermal yapısal değişikliklerin olguların çoğunda saptanmış olması, malign melanom tanısında epidermal yapısal değişikliklerin bir histopatolojik kriter olabileceğini düşündürmektedir. ayrıca epidermal yapısal değişikliklerin, ülserasyon varlığı ile olan sık birlikteliği, kötü prognostik gösterge olabilirliği açısından dikkat çekicidir.

The impact of LSIL‐H terminology on patient follow‐up patterns

“…Our results regarding the biopsy outcomes of LSIL‐H are similar to others: the rate of discovery of high grade dysplasia is higher than for unqualified LSIL and about the same as for ASC‐H . These findings have been recently reviewed elsewhere and are consistent across studies, supporting the robustness of the LSIL‐H category.…”

“…The interpretive category most commonly known as “low grade squamous intraepithelial lesion, cannot exclude high grade squamous intraepithelial lesion” (LSIL‐H), though not recognized by the 2001 Bethesda System, has been extensively studied and used. The Bethesda authors briefly refer to the category as “squamous intraepithelial lesions of indeterminate grade.” Other authors refer to this category as a combination of the Bethesda classifications of “low grade squamous intraepithelial lesion” (LSIL) and “atypical squamous cells, cannot rule out high grade squamous intraepithelial lesion” (ASC‐H) . Regardless of terms, as a practical matter, there seems to be agreement that this category consists of cases with definite low grade dysplastic changes in combination with rare or obscured cells concerning for, but not diagnostic of, high grade squamous intraepithelial lesion (HSIL).…”

“…Previous reports have documented that the risk of high grade dysplastic lesions, cervical intraepithelial neoplasia grades 2 or 3 (CIN 2 or 3), discovered on follow‐up biopsies following a Papanicolaou (Pap) test interpreted as LSIL‐H is roughly halfway between the risk associated with LSIL and HSIL . In this respect, LSIL‐H is similar to ASC‐H.…”

Evidence for increasing usage of low‐grade squamous intraepithelial lesion, cannot exclude high‐grade squamous intraepithelial lesion (LSIL‐H) Pap test interpretations

“…LSIL‐H is a cytologic interpretation that is equivocal for HSIL and is now recognized to harbor an intermediate risk of CIN2+ compared with LSIL and HSIL . Our study of more than 350,000 PTs including more than 17,000 abnormal tests demonstrates that the frequency of LSIL‐H interpretations increased at our institution over a 6‐year period with a simultaneous decrease in HSIL interpretations.…”

“…LSIL‐H refers to smears fulfilling criteria for both LSIL and atypical squamous cells, cannot exclude HSIL (ASC‐H) or smears with squamous intraepithelial lesions (SIL) of indeterminate grade. Various studies investigating LSIL‐H relative to the other TBS diagnostic categories have consistently found an intermediate risk of histologic follow‐up of cervical intraepithelial neoplasia 2 or greater (CIN2+) relative to LSIL and HSIL and significantly greater prevalence of high‐risk HPV (hrHPV) relative to ASC‐H . For these reasons several investigators have concluded that LSIL‐H warrants a distinct diagnostic category in cervical cytology reporting.…”