Cervical cytology: Evaluation of high-grade squamous intraepithelial lesions (HSIL)
- Annekathryn Goodman, MD
Annekathryn Goodman, MD
- Obstetrics, Gynecology, Reproductive Biology
- Harvard Medical School
- Division of Gynecologic Oncology
- Massachusetts General Hospital
- MGH Global Disaster Response
- Warner K Huh, MD
Warner K Huh, MD
- Margaret Cameron Spain Chair in Obstetrics/Gynecology
- Professor, Division of Gynecologic Oncology
- Senior Scientist, UAB Comprehensive Cancer Center
Cervical cytology became the standard screening test for cancer of the uterine cervix and premalignant cervical lesions with the introduction of the Papanicolaou (Pap) smear in 1941 . The incorporation of human papillomavirus testing to cervical cancer screening strategies has improved detection of cervical neoplasia and allowed further risk stratification.
Cervical cytology findings may be reported as atypical squamous cells (ASC), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), or atypical glandular cells (AGC).
Evaluation of women with cervical cytology with HSIL is reviewed here. Cervical cancer screening strategies and techniques, interpretation of cervical cytology results, follow-up of other abnormal cytology results, and management of cervical neoplasia are discussed separately:
●(See "Screening for cervical cancer".)
- Papanicolaou GN, Traut HF. The diagnostic value of vaginal smears in carcinoma of the uterus. Am J Obstet Gynecol 1941; 42:193.
- Waxman AG, Chelmow D, Darragh TM, et al. Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix. Obstet Gynecol 2012; 120:1465.
- Darragh TM, Colgan TJ, Thomas Cox J, et al. The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol 2013; 32:76.
- Katki HA, Schiffman M, Castle PE, et al. Benchmarking CIN 3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and management guidelines. J Low Genit Tract Dis 2013; 17:S28.
- Jones BA, Davey DD. Quality management in gynecologic cytology using interlaboratory comparison. Arch Pathol Lab Med 2000; 124:672.
- Alvarez RD, Wright TC, Optical Detection Group. Effective cervical neoplasia detection with a novel optical detection system: a randomized trial. Gynecol Oncol 2007; 104:281.
- Dunn TS, Burke M, Shwayder J. A "see and treat" management for high-grade squamous intraepithelial lesion pap smears. J Low Genit Tract Dis 2003; 7:104.
- Massad LS, Collins YC, Meyer PM. Biopsy correlates of abnormal cervical cytology classified using the Bethesda system. Gynecol Oncol 2001; 82:516.
- McIndoe WA, McLean MR, Jones RW, Mullins PR. The invasive potential of carcinoma in situ of the cervix. Obstet Gynecol 1984; 64:451.
- Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 3+ and cervical cancer among women with HPV-positive and HPV-negative high-grade Pap results. J Low Genit Tract Dis 2013; 17:S50.
- Söderlund-Strand A, Kjellberg L, Dillner J. Human papillomavirus type-specific persistence and recurrence after treatment for cervical dysplasia. J Med Virol 2014; 86:634.
- Katki HA, Schiffman M, Castle PE, et al. Five-year risk of CIN 3+ to guide the management of women aged 21 to 24 years. J Low Genit Tract Dis 2013; 17:S64.
- Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol 2016; 128:e111.
- Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17:S1.
- http://www.asccp.org/ (Accessed on March 22, 2012).
- Girardi F, Reich O, Tamussino K, Pickel H. Burghardt's Colposcopy and Cervical Pathology: Textbook and Atlas, 4th, Thieme, Stuttgart 2014.
- Economos K, Perez Veridiano N, Delke I, et al. Abnormal cervical cytology in pregnancy: a 17-year experience. Obstet Gynecol 1993; 81:915.
- Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013; 121:829.
- www.ASCCP.org (Accessed on April 11, 2012).
- Yost NP, Santoso JT, McIntire DD, Iliya FA. Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol 1999; 93:359.
- Paraskevaidis E, Koliopoulos G, Kalantaridou S, et al. Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum. Eur J Obstet Gynecol Reprod Biol 2002; 104:67.
- Ahdoot D, Van Nostrand KM, Nguyen NJ, et al. The effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period. Am J Obstet Gynecol 1998; 178:1116.
- Kaplan KJ, Dainty LA, Dolinsky B, et al. Prognosis and recurrence risk for patients with cervical squamous intraepithelial lesions diagnosed during pregnancy. Cancer 2004; 102:228.
- Benard VB, Watson M, Castle PE, Saraiya M. Cervical carcinoma rates among young females in the United States. Obstet Gynecol 2012; 120:1117.
- Winer RL, Lee SK, Hughes JP, et al. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol 2003; 157:218.
- Moscicki AB, Hills N, Shiboski S, et al. Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females. JAMA 2001; 285:2995.
- RISK OF PREMALIGNANT OR MALIGNANT DISEASE
- RATIONALE FOR EVALUATION STRATEGIES
- Women ages 25 and older
- Women ages 21 to 24
- SPECIAL POPULATIONS
- Pregnant women
- Postmenopausal women
- Adolescents inadvertently screened
- Immunocompromised women
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS