From the Guidelines
For patients with LSIL, colposcopy is recommended as the initial management strategy, especially in adults older than 30 years, as it allows for a more accurate assessment of the lesion. LSIL, or Low-grade Squamous Intraepithelial Lesion, is a mild abnormality found on Pap smear results that indicates possible early changes to cervical cells caused by human papillomavirus (HPV) infection 1. In adolescent patients, LSIL often regresses spontaneously; therefore, repeat cervical cytology is an effective triage strategy. However, in adults, the approach differs, and colposcopy is preferred due to the lack of a useful triage strategy, as evidenced by the ALTS trial 1.
- Key points to consider in managing LSIL include:
- The distinction between cytologic LSIL and histologic CIN I, as well as between cytologic HSIL and histologic CIN II, III 1.
- The recommendation against HPV DNA testing in women with ASC-H, LSIL, or HSIL cytology 1.
- The importance of continued regular screenings as recommended by the healthcare provider to monitor for any changes in the lesion.
- It's also important to note that while LSIL represents a relatively low risk for progression to cervical cancer, proper follow-up is essential to monitor for any changes, and HPV vaccination is recommended for prevention in eligible individuals who haven't been vaccinated, though it won't treat existing infections.
From the Research
Definition and Diagnosis of LSIL
- LSIL stands for Low-grade Squamous Intraepithelial Lesion, which is a condition characterized by abnormal cell growth on the surface of the cervix 2.
- The diagnosis of LSIL is typically made through a combination of cervical smear, colposcopy, and histological examination 2, 3.
- The accuracy of cervical smear and colposcopy in diagnosing LSIL can be limited, with rates of overdiagnosis and underdiagnosis ranging from 6.9% to 31.0% 2.
Natural History and Management of LSIL
- Studies have shown that spontaneous regression of LSIL occurs in approximately 81.1% of patients, with most cases regressing within 24 months 2.
- The management of LSIL typically involves colposcopy and colposcopic-directed biopsy to exclude the presence of more advanced lesions 2, 3.
- In some cases, immediate colposcopy may be recommended, particularly in women over 20 years of age or those with high-risk HPV types 4, 5.
Role of HPV Testing in LSIL Management
- High-risk HPV (HR-HPV) testing may be useful in triaging women with LSIL, particularly those over 30 years of age 5.
- Studies have shown that HR-HPV positive rates are lower in older women with LSIL, and that HR-HPV testing may help identify those at higher risk of developing high-grade cervical lesions 5, 6.
- The use of p16/Ki-67 dual staining test, either alone or combined with HR-HPV genotyping, may also be a useful tool for triage for colposcopy of HPV-positive patients with LSIL 6.
Treatment and Follow-up
- The treatment of LSIL typically involves loop electrosurgical excision procedure (LEEP) conization, which is an established method for removing abnormal cells from the cervix 3.
- Follow-up care after treatment for LSIL typically involves repeat cervical smears and HPV testing to monitor for recurrence or progression of the disease 3, 5.