Gynecology Book

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Low Grade Squamous Intraepithelial LesionAka: LSIL, LGSIL, CIN 1

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  1. Evaluation of LSIL 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
    2. Step 2a: Interpret Colposcopy in young women
      1. CIN or Cancer: Follow guidelines
      2. No CIN or Cancer
        1. Pap Smear at 6-12 months or HPV at 12 months
          1. Negative: Return to routine screening
          2. Positive for HPV or ASCUS or higher: Colposcopy
    3. Step 2b: 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
    4. Step 2c: Interpret Colposcopy in adolescents
      1. Option 1: Colposcopy
      2. Option 2: Repeat Pap Smear in 3-6 months
        1. Abnormal: Colposcopy
        2. Normal: Repeat pap in 6 months
          1. Routine surveillance if pap normal
      3. Option 3: Send liquid pap on for HPV DNA Test
        1. Based on Vira-Pap (Human Papilloma Virus Test)
          1. Colposcopy if positive for high risk HPV
          2. (2003) Am J Obstet Gynecol 188:1383
        2. HPV negative for high risk: Pap Smear in 1 year
        3. HPV positive for high risk: Colposcopy
  2. References
    1. Apgar (2004) Am Fam Physician 70:1905
    2. Nyirjesy (1998) Obstet Gynecol 92:601
    3. Wright (2002) J Low Genit Tract Dis 6:127

Low-Grade Squamous Intraepithelial Lesion (C1302773)

ConceptsNeoplastic Process (T191)
EnglishGrade 1 Squamous Intraepithelial Neoplasia, Grade I Squamous Intraepithelial Neoplasia, LGSIL, Low grade SIL, Low Grade Squamous Intraepithelial Neoplasia, LSIL, Squamous intraepithelial neoplasia grade 1
Spanishlesión intraepitelial escamosa de bajo grado, lesión intraepitelial escamosa de bajo potencial maligno, lesión intraepitelial escamosa de escasa malignidad, lesión pavimentosa intraepitelial de bajo potencial maligno, lesión pavimentosa intraepitelial de escasa malignidad, lesion intraepitelial escamosa de bajo grado, lesion intraepitelial escamosa de bajo potencial maligno, lesion intraepitelial escamosa de escasa malignidad, lesion pavimentosa intraepitelial de bajo potencial maligno, lesion pavimentosa intraepitelial de escasa malignidad, neoplasia escamosa intraepitelial grado 1
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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