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Low‐grade squamous intraepithelial lesion, cannot rule out high‐grade lesion: Diagnosis, histological outcomes and human papillomavirus results
Author(s) -
Segura Sheila E.,
RamosRivera Gloria,
Hakima Laleh,
Suhrland Mark,
Khader Samer
Publication year - 2019
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12629
Subject(s) - medicine , squamous intraepithelial lesion , papanicolaou stain , papanicolaou test , gynecology , cervix , human papillomavirus , cytology , histopathology , cervical intraepithelial neoplasia , pathology , cancer , cervical cancer
Background The 2014 Bethesda System for Reporting Cervical Cytology classifies squamous intraepithelial lesions ( SIL s) of cervix into two main categories: low‐grade SIL ( LSIL ) and high‐grade SIL ( HSIL ). In some clinical practices, the LSIL cannot rule out high‐grade lesion ( LROH ) interpretive category is used in cases with LSIL and findings that may raise the possibility of HSIL . Our purpose is to assess follow‐up histopathology and high‐risk human papillomavirus (hr HPV ) results in patients with LROH , in comparison with LSIL , atypical squamous cells, cannot rule out HSIL ( ASC ‐H), and HSIL in our institution. Design Cervical Papanicolaou tests with LROH , LSIL , ASC ‐H and HSIL interpretation, surgical follow‐up, and hr HPV status were retrieved from the computer database from May 2014 to December 2016. Results Of 109 963 total Papanicolaou tests, LROH comprised 0.3%, LSIL 3.1%, ASC ‐H 0.2% and HSIL 0.4%. Only 3272 cases with surgical diagnoses were included in the study. The most common histological outcome for ASC ‐H was cervical intraepithelial neoplasia ( CIN) 2/3 (32.6%); LSIL was CIN 1 (45.7%); LROH was CIN 1 (46.7%) and HSIL was CIN 2/3 (64.4%). For LROH and LSIL , 31.1% and 7.5% respectively, had CIN 2/3. Approximately 79% of cases were hr HPV positive. Of LROH cases with surgical follow‐up, 86.9% tested hr HPV positive, accounting for the second most common positive group after HSIL (92.6%). Conclusion In our study cohort, LROH interpretation is associated with a higher number of CIN 2 or higher lesions on follow‐up compared to patients with LSIL ( P < 0.0001), and is associated with a significant percentage of positive other hr HPV , supporting LROH as a useful diagnostic category that triggers appropriate follow‐up in affected women.