Gynecology Book

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Low Grade Squamous Intraepithelial LesionAka: 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 ASCUS Pap 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
    2. Apgar (2004) Am Fam Physician 70:1905
    3. Nyirjesy (1998) Obstet Gynecol 92:601
    4. 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, Low-Grade Squamous Intraepithelial Lesion, LSIL, Squamous intraepithelial neoplasia grade 1
Spanishlesion 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
Parent ConceptsSquamous intraepithelial lesion (C0333873), Mild epithelial dysplasia (C0334058), Precancerous Conditions (C0032927), Squamous intraepithelial neoplasia - category (C1302751)
SourcesMTH, NCI, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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