From the Guidelines
The management of Low-grade Squamous Intraepithelial Lesion (LSIL) according to the American College of Obstetricians and Gynecologists (ACOG) guidelines involves referral to colposcopy for women who subsequently test positive for HPV DNA or who are found to have ASC-US or greater on their repeat cytologic tests. The approach to managing LSIL is based on the patient's age and HPV status, with consideration for the potential for overtreatment and the need for careful follow-up. For women with LSIL, the following steps are recommended:
- Cytological testing at 6 and 12 months is acceptable 1
- Referral to colposcopy is recommended for women who subsequently test positive for HPV DNA or who are found to have ASC-US or greater on their repeat cytologic tests 1
- If the HPV DNA test is negative or if 2 consecutive repeat cytologic tests are negative for intraepithelial lesion or malignancy, return to routine cytologic screening is recommended 1 It's also important to note that the routine use of diagnostic excisional procedures such as the loop electrosurgical excision procedure is unacceptable for women with an initial ASC-US in the absence of histologically diagnosed CIN 2,3 1. In terms of specific management strategies, the guidelines recommend:
- For women aged ≥21 years with a Pap test report of ASC-US, three options are available for follow-up management: 1) prompt colposcopy, 2) repeat Pap tests at 6 and 12 months, and 3) a high-risk HR HPV DNA test 1
- If indicated, high-risk HPV testing can be performed by 1) collecting a specimen for Pap test and HPV DNA on the same swab, 2) using a supplied swab at the time of the Pap test, if conventional cytology is used, 3) reflex testing (if liquid-based cytology is used and enough residual material is available in the cytology test vial), or 4) scheduling a separate follow-up appointment when the Pap test report results are known 1
- If the high-risk HPV DNA test is negative, a repeat Pap test should be performed at 12 months. If the test is positive, the patient should be referred immediately for colposcopy, and if indicated, directed cervical biopsy 1. Overall, the management of LSIL requires a careful and individualized approach, taking into account the patient's age, HPV status, and other clinical factors.
From the Research
Management of Low-grade Squamous Intraepithelial Lesion (LSIL)
According to the American College of Obstetricians and Gynecologists (ACOG) guidelines, the management of LSIL is as follows:
- For women aged 21-24 years with LSIL, repeat cytology is recommended 12 months after HPV-positive results 2
- For women with LSIL, colposcopy is recommended as the initial management strategy, as there is no useful triage strategy identified 3
- In women with biopsy diagnosis of cervical LSIL, a high rate of regression is observed, and in most cases, the regression occurs in the first year of follow-up 4
- For postmenopausal women with LSIL on cytology and a negative HRHPV test, the risk of HSIL (CIN 2-3) on colposcopic biopsy is minimal, and repeat cytology after 12 months is recommended 5
Factors Influencing Management
The following factors influence the management of LSIL:
- Age: Women under 25 years have a higher prevalence of ≥CIN2 lesions compared to older women 2
- HPV status: HPV-positive women with LSIL have a higher risk of ≥CIN2 lesions compared to HPV-negative women 2, 3
- Cytology results: Women with ASC-H or HSIL on referral cytology have a higher risk of persistence or progression of LSIL 4
- Tobacco use: Tobacco users have a higher risk of persistence or progression of LSIL 4
Follow-up and Surveillance
The following follow-up and surveillance strategies are recommended: