Clinical significance of low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion as a squamous abnormality category in cervical cytopathology / 肿瘤

ABSTRACT

Objective: To examine the histological outcomes and the predictive value of clinical risks in women with liquid-based Papanicolaou tests (PTs) interpreted as "low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion" (LSIL-H) in comparison with the 2001 Bethesda System (TBS 2001) cytologic categories of low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and atypical squamous cells, cannot rule out a high grade lesion (ASC-H). Methods: The PTs which diagnosed as squamous cell abnormalities, including atypical squamous cells of undetermined significance (ASC-US), LSIL, ASC-H and HSIL, were reviewed by two pathologists who were blinded to the histology results. The diagnose of histology was used as gold standard, and the prevalence of high-risk human papillomavirus (HR-HPV) was examined. Results: Of 49 000 PTs, 88 (0.17%) were rediagnosed as LSIL-H. Before rediagnosed as LSIL-H, these 88 cases were diagnosed as ASC-US (19.32%, 17/88), LSIL (43.18%, 38/88), ASC-H (34.09%, 30/88) and HSIL (3.41%, 3/88). Women who diagnosed as LSIL-H had a higher incidence of cervical intraepithelial neoplasia 2 (CIN-2) /-3 or more severe lesion (CIN-3+) than that in women who diagnosed as LSIL ( P<0.01), but the incidences in these two groups were both lower than that in women who diagnosed as HSIL ( P<0.01). The difference of CIN-2/-3 incidence between LSIL-H and ASC-H was not significant. Conclusion: The similarity of histologic follow-up results between LSIL-H and ASC-H suggested that the similar management decisions should be made for women who were diagnosed as LSIL-H or ASC-H.