Low Grade Squamous Intraepithelial Lesion

Aka: Low Grade Squamous Intraepithelial Lesion, LSIL, LGSIL, CIN 1

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II. Precautions

  1. LEEP or other destructive measure is no longer recommended for LGSIL
  2. Refer if inadequate 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. Consider trial of intravaginal Estrogen in post-menopausal women
    1. Use if signs of atrophy and no contraindication
    2. Repeat Cervical Cytology one week after Estrogen course completed

III. Evaluation: Age 21 to 24 years old with LSIL or ASC-US (2014 Guidelines)

  1. Option 1: Reflex HPV Testing (ASC-US Pap Smear only)
    1. HPV negative
      1. Return to routine screening
    2. HPV positive
      1. Go to option 2
  2. Option 2: Repeat Cervical Cytology in 12 months (preferred)
    1. Cytology ASC-H, AGC, HSIL
      1. Colposcopy
    2. Cytology Negative, ASC-US or LSIL
      1. Repeat cytology in 12 months
        1. Colposcopy if cytology ASC-US or worse
        2. Routine screening after 2 negative cytology results

IV. Evaluation: Age over 25 years with LSIL (2014 Guidelines)

  1. LSIL and HPV negative (age >30 years old)
    1. Option 1: Repeat co-testing (cytology and HPV) in 1 year (preferred)
      1. Colposcopy if cytology ASC-US or worse, or HPV positive
      2. Repeat co-testing in 3 years if cytology and HPV negative
    2. Option 2: Colposcopy (see below)
  2. Colposcopy for LSIL with positive or unknown HPV (or negative and elects Colposcopy)
    1. Endocervical sampling
      1. Preferred in non-pregnant patients with no lesion identified or inadequate Colposcopy
      2. Optional with an adequate Colposcopy and lesion identified
    2. Interpretation
      1. No CIN 2 or 3
        1. See CIN 1 as below
      2. CIN 2 or 3
        1. See CIN 2 or CIN 3

V. Evaluation: LSIL in pregnancy (2014 Guidelines)

  1. Option 1: Delay Colposcopy until 6 weeks postpartum
  2. Option 2: Colposcopy (preferred)
    1. No CIN 2 or 3
      1. Postpartum follow-up
    2. CIN 2 or 3 (or suspected CIN 2/3 or cancer)
      1. See CIN 2 or CIN 3

VI. Evaluation: CIN 1 on Colposcopy (2014 Guidelines)

  1. Prior Lesser abnormalities (ASC-US, LSIL, HPV 16, 18 or persistent HPV)
    1. Age under 25 and repeat cytology in 12 months positive for ASC-H or HSIL
      1. Colposcopy
    2. Age under 25 and repeat cytology in 12 months negative for ASC-H or HSIL
      1. Repeat cytology in 12 months
        1. Colposcopy if positive (ASC-US or worse)
        2. Routine screening if negative
    3. Age over 25 and HPV negative and Cervical Cytology negative at 12 months
      1. Repeat cytology (and HPV if age >30 years old) in 3 years
        1. Colposcopy if ASC-US or HPV positive
        2. Routine screening with Cervical Cytology (and HPV if age >30) if cytology negative
    4. Age over 25 and HPV positive or Cervical Cytology positive (ASC-US or worse)
      1. Colposcopy with No CIN
      2. Colposcopy with CIN 1 that persists at least 2 years
        1. Excision (esp. if colpo inadequate, ECC positive or prior treatment) OR
        2. Ablation
      3. Colposcopy with CIN 2, 3
        1. See CIN 2 or CIN 3
  2. Prior ASC-H or HSIL
    1. Age under 25 years old
      1. Manage as per HSIL protocol after a non-CIN 2, 3 Colposcopy
    2. Age 25 years old and older
      1. Option 1: Revise diagnosis and treat based on re-review of cytology, biopsy, Colposcopy
      2. Option 2: Diagnostic excisional procedure (if not pregnant or age <25 years old)
      3. Option 3: Repeat HPV and cytology in 12 and 24 months (only if adequate colpo with negative ECC)
        1. Diagnostic excisional procedure if HSIL on cytology
        2. Colposcopy if HPV positive or cytology positive for ASC-US, ASC-H, LSIL
        3. Repeat cytology (and HPV if age >30) in 3 years if HPV and Cervical Cytology negative

VII. Resources

  1. (2014) ASCCP Guidelines
    1. http://www.asccp.org/Guidelines-2/Management-Guidelines-2
  2. (2019) ASCCP Guidelines
    1. https://www.asccp.org/management-guidelines

VIII. References

  1. Apgar (2009) Am Fam Physician 80(2): 147-55 [PubMed]
  2. Apgar (2004) Am Fam Physician 70:1905-16 [PubMed]
  3. Nyirjesy (1998) Obstet Gynecol 92:601-7 [PubMed]
  4. Wright (2002) J Low Genit Tract Dis 6:127-43 [PubMed]

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Related Studies

Ontology: Low Grade Squamous Intraepithelial Neoplasia (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_NCI-GLOSS) 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)
MSH D065310
SnomedCT 400002005, 450595003, 112662005
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, neoplasia intraepitelial escamosa de bajo grado (anomalía morfológica), neoplasia intraepitelial escamosa de bajo grado, 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 Squamous intraepithelial neoplasia, grade I, Squamous intraepithelial neoplasia, low grade (morphologic abnormality), Squamous intraepithelial neoplasia, low grade, Low Grade Squamous Intraepithelial Neoplasia, Low-Grade Squamous Intraepithelial Lesions, Low Grade Squamous Intraepithelial Lesions, LSIL, Low Grade Squamous Intraepithelial Lesions, LSIL, Low-Grade Squamous Intraepithelial Lesions, 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, Grade 1 Squamous Intraepithelial Neoplasia, Grade I Squamous Intraepithelial Neoplasia, Low-Grade Squamous Intraepithelial Lesion, Low grade squamous intraepithelial lesion, low-grade squamous intraepithelial lesion, LGSIL
Derived from the NIH UMLS (Unified Medical Language System)

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