Management of low-grade squamous intraepithelial lesions of the uterine cervix

Abstract

Strategies of management for low-grade squamous intraepithelial lesion (SIL) vary even on a national level. We evaluated the diversity of management algorithms. This should serve as a source to find a common basis for the management of low-grade SIL. A total of 38 representatives and specialists for colposcopy and cervical pathology were contacted to provide national guidelines, recommendations or consensus for the management of patients diagnosed with the cytologic diagnosis of low-grade SIL. In all, 23 addressees (60%) responded. The algorithms provided varied considerably. Three variants of algorithms could be defined. Variant 1 was proposed in 14 countries and recommended colposcopy immediately after cytologic diagnosis of low-grade SIL or at the same time the smear is taken. If available, HPV testing was recommended as a triage option in some countries. Variant 2 is used in three countries and colposcopy is only performed after a repeated abnormal cytologic result within a 6-month interval or after an optional test positive for high-risk HPV. Variant 3, as proposed in six countries, takes into account the socio-economic status of the patient: In patients with poor compliance, 'see and treat' management is recommended; in patients where compliance can be assured, follow-up is carried out by cytology and colposcopy. Global policy of management of patients with low-grade SIL can be summarised in three algorithms. Quality standards and outcome parameters must be defined in order to improve the management of women with lowgrade SIL.

High‐grade histologic lesions in women with low‐grade squamous intraepithelial lesion cytology from a region of Thailand with a high incidence of cervical cancer

“…The unique finding from the present study was an extremely high prevalence of CIN 2-3 (30.3%) and invasive cervical cancer (1.9%) on initial evaluation of women with LSIL. Recommended management of LSIL varies between countries [10]. Because of a notably high prevalence of underlying high-grade disease, performing immediate colposcopy might be the first choice for management.…”

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

“…The significant finding noted in some studies in Thailand is a relatively high incidence of underlying high-grade cervical lesion (11.2%-30.3%) and invasive lesion (1.3%-1.9%) (Khuakoonratt et al, 2008;Kiatiyosnusorn et al, 2010). Recommended management of LSIL cytology might be either colposcopy or cytological follow-up and varies between countries (Scheungraber et al, 2004). Nevertheless, immediate colposcopy might be appropriate in Thailand in which the patients' compliance is suboptimal (Rattanalappaiboon et al, 2014).…”

Evaluation of RNA Markers for Early Detection of Cervical Neoplasia in Exfoliated Cervical Cells

“…Although the implementation of the Papanicolaou test in routine screening programs has greatly reduced cancer incidence and mortality, the test has limited accuracy not likely to improve with enhanced collection and screening procedures (1). Specifically, the inability to distinguish high-grade CIN with the potential to progress to invasive cancer from pathologically insignificant or regressing dysplasia contributes to overtreatment (2), whereas false-negative results are not eliminated.…”