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Is the HSIL subclassification cytologically real and clinically justified?
Valerija Milicić-Juhas1, Marija Pajtler
1Department of Clinical Cytology, Osijek University Hospital Center, Osijek, Croatia. valerija.mj@gmail.com
Collegium Antropologicum
|August 12, 2010
Summary
The Croatian modification of the Bethesda classification for high-grade squamous intraepithelial lesions (HSIL) is clinically justified. Subclassifying HSIL into moderate and severe dysplasia improves diagnostic accuracy and guides treatment decisions for cervical intraepithelial neoplasia (CIN).
Area of Science:
- Gynecologic Oncology
- Cytopathology
- Cervical Cancer Screening
Background:
- The Bethesda System is a standard for reporting cervical cytology.
- Distinguishing between cervical intraepithelial lesion grade 2 (CIN2) and grade 3 (CIN3) within high-grade squamous intraepithelial lesions (HSIL) is crucial for patient management.
- The Croatian modification of the Bethesda classification warrants evaluation for its clinical utility.
Purpose of the Study:
- To assess the cytological and clinical justification of subclassifying HSIL into moderate dysplasia (CIN2) and severe dysplasia (CIN3) in Croatia.
- To determine if this subclassification impacts diagnostic accuracy and therapeutic decisions.
- To evaluate the long-term application and validity of this modification.
Main Methods:
- Retrospective analysis of 3110 vaginal-cervical-endocervical (VCE) smears from 1993-2005.
- Cytological and colposcopic monitoring for 57.1% of patients; pathohistological examination for 42.9%.
- Statistical analysis of spontaneous regression rates, lesion progression, and positive predictive values for cytological diagnoses against histological CIN3+.
Main Results:
- Spontaneous regression was observed in 66.3% of cases, with mild dysplasia regressing more often than moderate and severe dysplasia.
- Moderate dysplasia progressed to severe dysplasia in 34.1% of cases, significantly more than mild dysplasia (12.7%).
- Positive predictive values for mild, moderate, and severe dysplasia significantly increased towards CIN3+, supporting their distinct diagnostic categories. Moderate dysplasia showed different biological behavior and histological findings compared to severe dysplasia.
Conclusions:
- The cytological subclassification of HSIL into moderate and severe dysplasia is cytologically possible and clinically justified.
- Moderate dysplasia can be considered an individual diagnostic category, as it differs significantly in biological behavior and histological outcomes from severe dysplasia.
- This subclassification aids in appropriate diagnostic and therapeutic procedures, potentially avoiding overtreatment for some cases.
