CASE N°40 – Management of women with Low-grade squamous intraepithelial lesion

Clinical History:

Age: 22

Sex: female

gynecological examination: nothing to report

Image:

cytological speciemen: Pap Test

composit_21_08_14 lsil

Cytological Report:

Low-grade squamous intraepithelial lesion (L-SIL)

Discussions:

original articles

C Scheungraber, N Kleekamp, and A Schneider Br J Cancer. Mar 8, 2004; 90(5): 975–978.
Published online Mar 2, 2004

… Management of women with the cytologic diagnosis of low-grade SIL varies considerably according to the availability of medical resources and socio-economic status of women.

Immediate colposcopy after cytologic diagnosis of low-grade SIL is costly and may cause unnecessary stress on patients and the health system in countries where colposcopy is not a routine part of the gynaecologic examination. However, delay of histopathologic confirmation by 6 months or longer  may lead to underdiagnosis and worsening of prognosis.

In health-care systems where high-risk HPV testing is available, triaging in high-risk HPV-positive and high-risk HPV-negative lesions is performed. However, for clinical practice, no clear guidelines have been established as to testing of smears or biopsies and choice of HPV test. Tests that include only a certain amount of pooled high-risk HPVs and that show crossreaction between high- and low-risk types are clinically not useful due to low specificity.

There is a need to coordinate the diversing algorithms for the management of patients with low-grade SIL in order to avoid overtreatment: The majority of women with diagnosis of low-grade SIL are young and still desire conception. Standard treatment is still invasive, either using excisional or ablative procedures, which are associated with a peri- and postoperative morbidity rate of up to 10%. The data presented in this enquiry should therefore serve as a basis to start a discussion of a coordinated effort to improve the quality and result of the management of this highly prevalent diagnosis in order to improve women’s health.

References:

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