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.
|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|
|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|