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Low Grade Squamous Intraepithelial Lesion
Aka: Low Grade Squamous Intraepithelial Lesion, LSIL, LGSIL, CIN 1
- See Also
- Cervix Anatomy
- Colposcopy
- Colposcopy Findings
- Colposcopy Protocol
- Cervical Intraepithelial Neoplasia Procedures
- Cervical Dysplasia
- Atypical Squamous Cells of Undetermined Significance (ASCUS)
- High Grade Squamous Intraepithelial Lesion (HSIL)
- Atypical Glandular Cells of Undetermined Significance (AGUS Pap Smear)
- Human Papillomavirus (HPV)
- Cervical Cancer
- Precautions
- LEEP or other destructive measure is no longer recommended for LGSIL
- Refer if inadequate Colposcopy
- Adequate Colposcopy requires visualization of SCJ
- Colposcopy adequate if SCJ fully visualized and
- Lesion not identified and ECC completed or
- Lesion responsible for abnormal pap was found
- Consider trial of intravaginal Estrogen in post-menopausal women
- Use if signs of atrophy and no contraindication
- Repeat Cervical Cytology one week after Estrogen course completed
- Evaluation: Age 21 to 24 years old with LSIL or ASC-US (2014 Guidelines)
- Option 1: Reflex HPV Testing (ASC-US Pap Smear only)
- HPV negative
- Return to routine screening
- HPV positive
- Go to option 2
- Option 2: Repeat Cervical Cytology in 12 months (preferred)
- Cytology ASC-H, AGC, HSIL
- Colposcopy
- Cytology Negative, ASC-US or LSIL
- Repeat cytology in 12 months
- Colposcopy if cytology ASC-US or worse
- Routine screening after 2 negative cytology results
- Evaluation: Age over 25 years with LSIL (2014 Guidelines)
- LSIL and HPV negative (age >30 years old)
- Option 1: Repeat co-testing (cytology and HPV) in 1 year (preferred)
- Colposcopy if cytology ASC-US or worse, or HPV positive
- Repeat co-testing in 3 years if cytology and HPV negative
- Option 2: Colposcopy (see below)
- Colposcopy for LSIL with positive or unknown HPV (or negative and elects Colposcopy)
- Endocervical sampling
- Preferred in non-pregnant patients with no lesion identified or inadequate Colposcopy
- Optional with an adequate Colposcopy and lesion identified
- Interpretation
- No CIN 2 or 3
- See CIN 1 as below
- CIN 2 or 3
- See CIN 2 or CIN 3
- Evaluation: LSIL in pregnancy (2014 Guidelines)
- Option 1: Delay Colposcopy until 6 weeks postpartum
- Option 2: Colposcopy (preferred)
- No CIN 2 or 3
- Postpartum follow-up
- CIN 2 or 3 (or suspected CIN 2/3 or cancer)
- See CIN 2 or CIN 3
- Evaluation: CIN 1 on Colposcopy (2014 Guidelines)
- Prior Lesser abnormalities (ASC-US, LSIL, HPV 16, 18 or persistent HPV)
- Age under 25 and repeat cytology in 12 months positive for ASC-H or HSIL
- Colposcopy
- Age under 25 and repeat cytology in 12 months negative for ASC-H or HSIL
- Repeat cytology in 12 months
- Colposcopy if positive (ASC-US or worse)
- Routine screening if negative
- Age over 25 and HPV negative and Cervical Cytology negative at 12 months
- Repeat cytology (and HPV if age >30 years old) in 3 years
- Colposcopy if ASC-US or HPV positive
- Routine screening with Cervical Cytology (and HPV if age >30) if cytology negative
- Age over 25 and HPV positive or Cervical Cytology positive (ASC-US or worse)
- Colposcopy with No CIN
- Colposcopy with CIN 1 that persists at least 2 years
- Excision (esp. if colpo inadequate, ECC positive or prior treatment) OR
- Ablation
- Colposcopy with CIN 2, 3
- See CIN 2 or CIN 3
- Prior ASC-H or HSIL
- Age under 25 years old
- Manage as per HSIL protocol after a non-CIN 2, 3 Colposcopy
- Age 25 years old and older
- Option 1: Revise diagnosis and treat based on re-review of cytology, biopsy, Colposcopy
- Option 2: Diagnostic excisional procedure (if not pregnant or age <25 years old)
- Option 3: Repeat HPV and cytology in 12 and 24 months (only if adequate colpo with negative ECC)
- Diagnostic excisional procedure if HSIL on cytology
- Colposcopy if HPV positive or cytology positive for ASC-US, ASC-H, LSIL
- Repeat cytology (and HPV if age >30) in 3 years if HPV and Cervical Cytology negative
- Resources
- (2014) ASCCP Guidelines
- http://www.asccp.org/Guidelines-2/Management-Guidelines-2
- (2019) ASCCP Guidelines
- https://www.asccp.org/management-guidelines
- References
- Apgar (2009) Am Fam Physician 80(2): 147-55 [PubMed]
- Apgar (2004) Am Fam Physician 70:1905-16 [PubMed]
- Nyirjesy (1998) Obstet Gynecol 92:601-7 [PubMed]
- Wright (2002) J Low Genit Tract Dis 6:127-43 [PubMed]