Gynecology Book

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High Grade Squamous Intraepithelial LesionAka: HSIL, HGSIL, CIN 2, CIN 3

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  1. Evaluation of HSIL identified on Pap Smear
    1. Step 1: Colposcopy
      1. Adequate Colposcopy requires visualization of SCJ
      2. Colposcopy adequate if SCJ fully visualized and
        1. Lesion not identified and ECC completed or
        2. Lesion responsible for abnormal pap was found
      3. Refer if inadequate Colposcopy
        1. Review diagnostics
        2. Consider LEEP
    2. Step 2a: Interpret Colposcopy in nonpregnant women
      1. Biopsy confirmed CIN 2 or 3: Manage per guidelines
        1. See Colposcopy Protocol
      2. Biopsy with CIN I or no CIN
        1. Reevaluate diagnostic results
        2. Consider LEEP
    3. Step 2b: Interpret Colposcopy in pregnant women
      1. Delay LEEP until after pregnancy
        1. Low risk of progression in pregnancy
        2. Lesions often regress in postpartum period
        3. Yost (1999) Obstet Gynecol 93:359
      2. Exception: Suspected invasive disease
  2. Follow-up after excision or ablation of HGSIL
    1. Option 1: Pap Smear +/- Colposcopy
      1. Repeat every 4-6 months for 3 total
      2. Negative for ASCUS or greater: Annual Pap Smears
      3. Positive for ASCUS or greater: Colposcopy
    2. Option 2: HPV DNA >6 months after procedure
      1. Negative for high risk HPV: Annual Pap Smears
      2. Positive for high risk HPV: Colposcopy
  3. References
    1. Apgar (2004) Am Fam Physician 70:1905
    2. Wright (2002) J Low Genit Tract Dis 6:127

High-grade squamous intraepithelial lesion (C0333875)

ConceptsNeoplastic Process (T191)
EnglishHigh grade SIL, High Grade Squamous Intraepithelial Neoplasia, High-grade squamous intraepithelial lesion, high-grade squamous intraepithelial neoplasia, HSIL
Spanishlesion intraepitelial escamosa de alto grado, lesion intraepitelial escamosa de alto potencial maligno, lesion intraepitelial escamosa de gran malignidad, lesion intraepitelial pavimentosa de alto potencial maligno, lesion intraepitelial pavimentosa de gran malignidad
Parent ConceptsSquamous intraepithelial lesion (C0333873), High Grade Intraepithelial Neoplasia (C1334015), unclassified/other cancer (C0279522)
SourcesNCI, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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