[1087] Does the LSIL-H Designation in Pap Tests Impact Patient Management?

SK Galfione, DA Smith, MJ Thrall. The Methodist Hospital, Houston, TX

Background: There has been some controversy regarding the use of the interpretive category Low Grade Squamous Intraepithelial Lesion (LSIL) cannot exclude High Grade Squamous Intraepithelial Lesion (LSIL-H) in Papanicolaou (Pap) tests. Since ASCCP guidelines recommend biopsy for all LSIL (except in adolescents and menopausal women), the clinical significance of this category is unclear. LSIL-H is not currently endorsed by the Bethesda System and is only currently used in some laboratories. This study aims to determine whether the designation of LSIL-H changes the gynecologic management of patients.
Design: We identified all LSIL and LSIL-H Pap tests in women with no prior abnormal Pap tests or cervical biopsies from 5/1/2007 to 10/31/2008. The total Pap test volume for this period was 67,223 (80% ThinPrep and 20% SurePath), of which 4.3% were LSIL. Biopsy and Pap test follow-up was compiled from 5/1/2007 to 9/30/09.
Results:

Table 1: All Women

	total	biopsy as first follow-up	pap as first follow-up	CIN 2-3
LSIL-H	66	44 (66.7%)	7 (10.6%)	15
LSIL	1249	618 (49.5%)	208 (16.7%)	47

Table 2: Women Age 21-Menapause

	total	biopsy as first follow-up	Pap as first follow-up	CIN 2-3
LSIL-H	51	34 (66.7%)	5 (9.8%)	11
LSIL	854	470 (55.0%)	133 (15.6%)	36

Women with LSIL-H were significantly more likely to get a follow-up biopsy than women with LSIL (p=0.0094). They also had a much higher incidence of high grade dysplasia found (p<0.001).
Conclusions: The LSIL-H category helps to identify a subset of patients at greater risk of high grade dysplasia. Gynecologists at our institution are more likely to aggressively follow up a patient with LSIL-H, resulting in more biopsies.
Category: Gynecologic & Obstetrics

Tuesday, March 23, 2010 9:30 AM

Poster Session III # 173, Tuesday Morning