Gynecology Book

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Low Grade Squamous Intraepithelial Lesion

Aka: Low Grade Squamous Intraepithelial Lesion, LSIL, LGSIL, CIN 1
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  1. Precautions
    1. LEEP or other destructive measure is no longer recommended for LGSIL
  2. Evaluation: LSIL identified on Pap Smear
    1. Notes
      1. Colposcopy is needed in all LSIL cases except for age 20 years and younger (see Step 2a)
    2. 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
    3. Step 2a: Interpret Pap Smear 1 in adolescents 20 years and younger
      1. Repeat Pap Smear in 12 months
        1. Pap Smear 2 - HSIL or higher: Colposcopy
        2. Pap Smear 2 - LSIL, ASCUS or Normal: Repeat Pap Smear in 12 months
          1. Pap Smear 3 - ASCUS or higher: Colposcopy
          2. Pap Smear 3 - Normal: Return to annual Pap Smears
    4. Step 2b: Interpret Colposcopy in women 20 to 50 years
      1. CIN 2-3 or Cancer: Follow guidelines
      2. No CIN 2-3 or Cancer
        1. Pap Smear at 6 and 12 months or HPV at 12 months
          1. Negative: Return to routine screening
          2. Positive for HPV or ASCUSPap Smear or higher: Colposcopy
    5. Step 2c: Interpret Colposcopy in postmenopausal women
      1. Background
        1. Assumes low risk women with negative prior paps
      2. Option 1: HPV DNA Testing in 12 months
        1. HPV Positive for high risk type: Colposcopy
        2. HPV Negative for high risk type: Pap in 12 months
      3. Option 2: Repeat Pap Smear in 4 to 6 months
        1. Positive: Colposcopy
        2. Negative: Repeat in 4-6 months
          1. Routine surveillance if second pap is negative
      4. Option 3: Trial of intravaginal Estrogen
        1. Use if signs of atrophy and no contraindication
        2. Repeat Pap Smear one week after Estrogen done
        3. Follow Option 2 for Pap Smear interpretation
  3. References
    1. Apgar (2009) Am Fam Physician 80(2): 147-55
    2. Apgar (2004) Am Fam Physician 70:1905-16
    3. Nyirjesy (1998) Obstet Gynecol 92:601-7
    4. Wright (2002) J Low Genit Tract Dis 6:127-43

Low-Grade Squamous Intraepithelial Lesion (C1302773)

Definition (NCI) A precancerous neoplastic process characterized by the presence of mild dysplastic cytological changes which are usually present in the lower part of the squamous epithelium. Representative examples include the low grade esophageal squamous intraepithelial neoplasia, low grade cervical squamous intraepithelial neoplasia, low grade vaginal intraepithelial neoplasia, and low grade vulvar intraepithelial neoplasia.
Definition (NCI) A condition in which the cells of the uterine cervix are slightly abnormal. Low-grade squamous intraepithelial lesion is not cancer.
Concepts Neoplastic Process (T191)
SnomedCT 112662005, 400002005
Spanish lesión intraepitelial escamosa de bajo potencial maligno (anomalía morfológica), lesión intraepitelial escamosa de bajo potencial maligno, Lesión intraepitelial escamosa de bajo grado, LSIL, lesión intraepitelial escamosa de escasa malignidad (anomalía morfológica), lesión pavimentosa intraepitelial de escasa malignidad, neoplasia intraepitelial escamosa grado 1, neoplasia intraepitelial escamosa grado 1 (anomalía morfológica), neoplasia escamosa intraepitelial grado 1, neoplasia intraepitelial escamosa grado I, neoplasia escamosa intraepitelial grado 1 (anomalía morfológica), lesión intraepitelial escamosa de escasa malignidad, lesión intraepitelial escamosa de bajo grado, lesión pavimentosa intraepitelial de bajo potencial maligno
Dutch LSIL, laaggradige squameuze intra-epitheliale laesie
French Lésion épidermoïde intra-épithéliale de faible grade, Lésion épidermoïde intra-épithéliale de faible grade (LSIL)
German Low grade squamous intraepithelial lesion, LSIL
Italian Lesione intraepiteliale squamosa di basso grado, Lesioni intraepiteliali squamose di basso grado (LSIL)
Portuguese LSIL, Lesão intra-epitelial por células escamosas de baixo grau
Japanese 軽度扁平上皮内病変, ＬＳＩＬ, LSIL, ｹｲﾄﾞﾍﾝﾍﾟｲｼﾞｮｳﾋﾅｲﾋﾞｮｳﾍﾝ
Czech Šupinatá intraepitelová léze nízkého stupně, LSIL
Hungarian Enyhe fokú intraepithelialis squamosus laesio, Low grade squamous intraepithelialis laesio
English Low-grade squamous intraepithelial lesion, LSIL, Low grade SIL, Low-grade squamous intraepithelial lesion (morphologic abnormality), Squamous intraepithelial neoplasia grade 1 (morphologic abnormality), Squamous intraepithelial neoplasia grade 1, Low-Grade Squamous Intraepithelial Lesion, Grade 1 Squamous Intraepithelial Neoplasia, Grade I Squamous Intraepithelial Neoplasia, Low Grade Squamous Intraepithelial Neoplasia, Low grade squamous intraepithelial lesion, low-grade squamous intraepithelial lesion, LGSIL
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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