From the Guidelines
For a 23-year-old patient with squamous cells showing Low-Grade Squamous Intraepithelial Lesion (LGSIL) on Pap smear, the recommended follow-up is repeat cytology (Pap smear) in 12 months. This approach is based on the most recent guidelines from the Journal of the National Comprehensive Cancer Network, which recommends conservative management for women aged 21 to 24 years with LGSIL 1. The guidelines suggest that cotesting is not recommended for cervical cancer screening in women aged 21 to 29 years, but reflex HPV testing may be considered for management of abnormal tests in certain circumstances. However, for a 23-year-old patient with LGSIL, repeat cytology is the preferred initial management strategy.
According to the guidelines, most low-grade lesions will spontaneously regress without intervention in young women, and HPV testing is not recommended as the initial management strategy in this age group since HPV infections are common and often transient in women under 25 1. If the repeat Pap at 12 months shows persistent LGSIL or any abnormality, referral for colposcopy would then be appropriate. During this follow-up period, the patient should be counseled about smoking cessation if applicable, as smoking can impair immune response to HPV. The patient should also be advised to continue routine healthcare visits and to report any abnormal vaginal bleeding or discharge. This conservative management approach balances the need to monitor for potential progression while avoiding unnecessary procedures in a young patient where spontaneous regression is likely.
The American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Multisociety Guidelines Group, as well as the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force (USPSTF) all agree on the recommended age at the start of screening (21 y), the age at which screening can be discontinued if the history of negative screening is adequate (>65 y), and the recommended interval between tests 1. However, the most recent and highest quality study, which is the 2014 guideline from the Journal of the National Comprehensive Cancer Network, should be prioritized in this case 1.
From the Research
Follow-up Recommendations for 23-year-old Patient with Squamous, LGSIL on PAP
- The patient's condition, LGSIL on PAP, indicates a low-grade squamous intraepithelial lesion, which is a precancerous condition that can potentially progress to more severe lesions if left untreated 2.
- According to the study published in the European journal of gynaecological oncology 2, women with LGSIL and normal colposcopic findings do not require immediate therapeutic measures.
- The study suggests that these patients can be followed up with a new control smear 12 months after the initial one, as the lesion persisted in 37% and 39% of the patients in the two study groups at the end of the first year 2.
- Additionally, the study found that regression or persistence of the LGSIL was revealed in 63% and 61% of the women in the two study groups, respectively, at the end of the study 2.
- It is also noted that aggravation of the lesions occurred after 16.5 and 15 months, respectively, in the two study groups, highlighting the importance of regular follow-up 2.
- Based on these findings, the follow-up recommendations for the 23-year-old patient with squamous, LGSIL on PAP may include:
- A new control smear 12 months after the initial one
- Regular follow-up to monitor for any changes or progression of the lesion
- Consideration of colposcopy and potential therapeutic measures if the lesion persists or worsens over time 2