Management of patients with mildly dysplastic cervical smears

The management of patients with mild dysplasia on cervical smears remains controversial. Recent studies have shown that many harbor high grade squamous intraepithelial lesions (HSIL) and human papillomavirus (HPV) and warrant further evaluation rather than follow-up. This prospective study dealt with the evaluation of patients with mild dysplastic smears using colposcopy and directed biopsies with view to identifying HSIL/HPV and treating them. Among 100 cases studied, 61% revealed HSIL/HPV; of them, 10% had high grades. Hence, patients with mildly dysplastic lesions should be evaluated further and managed with histopathologic examination of the biopsy specimen. This protocol may be cost effective for evaluating women with mildly dysplastic smears in a referral center, though it may not be so when compared to a policy of treating the infection, repeating the smears and performing colposcopy and biopsy on all those with persistent abnormality.