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Low-grade squamous intraepithelial lesions: cytologic predictors of biopsy confirmation
Insights
The number of diagnostic cells in a low-grade squamous intraepithelial lesion (LSIL) Pap smear predicts biopsy confirmation. This finding supports combining condylomatous atypia and cervical intraepithelial neoplasia 1 into the LSIL category.
Area of Science:
- Gynecologic Pathology
- Cervical Cancer Screening
Background:
- Low-grade squamous intraepithelial lesion (LSIL) is a common finding in cervical cytology.
- Predicting biopsy confirmation from LSIL Pap smears is crucial for patient management.
Purpose of the Study:
- To evaluate features within LSIL Pap smears that predict subsequent biopsy confirmation.
- To assess the diagnostic value of cell quantity in LSIL smears.
Main Methods:
- Analysis of 107 cervical smears initially diagnosed with LSIL.
- Correlation of smear findings (cell number, specific atypia types) with histological biopsy results.
- Comparison of biopsy confirmation rates based on repeat smear findings.
Main Results:
- Biopsy confirmation rates increased significantly with the number of LSIL cells present (29% for few, 60% for intermediate, 82% for many).
- Smears showing condylomatous atypia (CA) or cervical intraepithelial neoplasia 1 (CIN 1) individually or combined had variable confirmation rates (47-63%).
- Repeat smears showing SIL at colposcopy had a higher biopsy confirmation rate (65%) than normal or ASCUS smears (15%).
Conclusions:
- The quantity of diagnostic cells in an LSIL Pap smear is a significant predictor of biopsy confirmation.
- The findings support the Bethesda System's classification of combining CA and CIN 1 under the LSIL category.
Abstract:
One hundred and seven smears demonstrating a low-grade squamous intraepithelial lesion (LSIL) were analyzed for features predicting subsequent biopsy confirmation. Twelve (29%) of 41 smears showing few LSIL cells were biopsy confirmed compared to 33 (60%) of 55 containing an intermediate number of LSIL cells and 9 (82%) of 11 displaying many LSIL cells (P < 0.002). Thirty-seven (47%) of 78 smears showing mainly condylomatous atypia (CA), 7 (54%) of 13 revealing predominantly cervical intraepithelial neoplasia 1 (CIN 1), and 10 (63%) of 16 displaying both CA and CIN 1 were histologically confirmed (N.S.). Biopsy confirmation was obtained in 35 (65%) of 54 women whose repeat smears obtained at colposcopy demonstrated SIL compared to four (15%) of 26 patients whose repeat smears were normal or contained atypical squamous cells of undetermined significance (P < 0.001). These results suggest that the number of diagnostic cells in an LSIL smear predicts biopsy confirmation and affirm the validity of combining CA and CIN 1 under the category of LSIL in the Bethesda System.
