Cervical cytology: Evaluation of low-grade squamous intraepithelial lesions (LSIL)
- Annekathryn Goodman, MD
Annekathryn Goodman, MD
- Associate Professor
- Harvard Medical School
- 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 addition of human papillomavirus (HPV) testing to cervical cancer screening strategies has improved detection of cervical neoplasia and allowed further risk stratification.
Cervical cytology findings may be described as atypical squamous cells (ASC), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), atypical glandular cells (AGC), or invasive cervical cancer.
Evaluation of women with cervical cytology with LSIL 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" and "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing" and "Cervical and vaginal cytology: Interpretation of results (Pap test report)" and "Cervical cytology: Evaluation of atypical squamous cells (ASC-US and ASC-H)" and "Cervical cytology: Evaluation of high-grade squamous intraepithelial lesions (HSIL)" and "Cervical cytology: Evaluation of atypical and malignant glandular cells" and "Cervical intraepithelial neoplasia: Management of low-grade and high-grade lesions".)
Cervical cancer screening co-testing is testing with both cervical cytology (Pap test) and testing for high-risk human papillomavirus (HPV) types (ie, types that are associated with cervical cancer) (table 1). In this discussion, HPV testing refers only to testing for high-risk HPV types, and this testing should be performed using an assay approved by the US Food and Drug Administration or one that is associated with peer-reviewed publications.
Regarding cervical histology, in 2012, the Lower Anogenital Squamous Terminology (LAST) project of the College of American Pathology and American Society for Colposcopy and Cervical Pathology (ASCCP) published changes in the terminology used to describe HPV-associated squamous lesions of the anogenital tract (figure 1) [2,3]. This is described in detail separately. (See "Cervical cytology: Evaluation of atypical squamous cells (ASC-US and ASC-H)", section on 'Terminology'.)
- 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.
- Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 2+ and CIN 3+ among women with HPV-positive and HPV-negative LSIL Pap results. J Low Genit Tract Dis 2013; 17:S43.
- 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.
- 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.
- Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol 2016; 128:e111.
- http://www.asccp.org/ (Accessed on March 22, 2012).
- Lawson H. American Society for Colposcopy and Cervical Pathology, 2013, personal communication.
- Wright TC Jr, Massad LS, Dunton CJ, et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. J Low Genit Tract Dis 2007; 11:223.
- ASCUS-LSIL Traige Study (ALTS) Group. A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol 2003; 188:1393.
- 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.
- Castle PE, Schiffman M, Wheeler CM, Solomon D. Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol 2009; 113:18.
- Moscicki AB, Schiffman M, Burchell A, et al. Updating the natural history of human papillomavirus and anogenital cancers. Vaccine 2012; 30 Suppl 5:F24.
- Economos K, Perez Veridiano N, Delke I, et al. Abnormal cervical cytology in pregnancy: a 17-year experience. Obstet Gynecol 1993; 81:915.
- 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.
- Peyton CL, Gravitt PE, Hunt WC, et al. Determinants of genital human papillomavirus detection in a US population. J Infect Dis 2001; 183:1554.
- Sherman ME, Schiffman M, Cox JT, Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study Group. Effects of age and human papilloma viral load on colposcopy triage: data from the randomized Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS). J Natl Cancer Inst 2002; 94:102.
- Evans MF, Adamson CS, Papillo JL, et al. Distribution of human papillomavirus types in ThinPrep Papanicolaou tests classified according to the Bethesda 2001 terminology and correlations with patient age and biopsy outcomes. Cancer 2006; 106:1054.
- Benard VB, Watson M, Castle PE, Saraiya M. Cervical carcinoma rates among young females in the United States. Obstet Gynecol 2012; 120:1117.
- RISK OF PREMALIGNANT OR MALIGNANT DISEASE
- RATIONALE FOR EVALUATION STRATEGIES
- Women ages 25 and older
- - Role of HPV testing
- Ages 30 and older
- Ages 25 to 29
- Women ages 21 to 24
- SPECIAL POPULATIONS
- Pregnant women
- Postmenopausal women
- Adolescents inadvertently screened
- Immunocompromised women
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS