The impact of LSIL‐H terminology on patient follow‐up patterns

Abstract

The Papanicolaou (Pap) test category of "low grade squamous intraepithelial lesion, cannot exclude high grade squamous intraepithelial lesion" (LSIL-H) is not recognized by The Bethesda System but is commonly used. It is essentially an amalgamation of the official LSIL and ASC-H categories. Since these two categories have similar follow-up algorithms, the clinical utility of the combined LSIL-H category is unclear. We have therefore studied follow-up patterns for these three entities in our laboratory to determine the real-world impact of each in our patient population. We searched our pathology database over an 18-month period to find Pap tests (predominantly ThinPrep) interpreted as LSIL-H (137), LSIL (2,189), and ASC-H (101). Like other studies, we found that the discovery rate of high grade dysplasia in biopsies after LSIL-H (31.9%) was similar to ASC-H (35.3%) and was higher than LSIL (7.6%; P < 0.0001). In women with no previous history of dysplasia, the frequency of biopsy follow-up after the initial Pap test was significantly higher for LSIL-H (68.3%) than for LSIL (49.6%; P = 0.0038) and similar to ASC-H (62.3%). We also found that women with an initial negative biopsy or a biopsy positive for low grade dysplasia were more likely to undergo an additional biopsy if the initial Pap test was LSIL-H (36.2%) than if it was LSIL (18.2%; P = 0.0023). ASC-H (26.9%) had an intermediate rate. In our patient population, the use of the terminology LSIL-H is associated with follow-up biopsy patterns much more similar to ASC-H than to LSIL.

Bethesda 2014 Implementation and Human Papillomavirus Primary Screening: Practices of Laboratories Participating in the College of American Pathologists PAP Education Program

“…Previous papers cite that the histologic follow-up rate of high-grade lesions is intermediate between LSIL and HSIL and that fewer are associated with high-risk HPV types. [15][16][17][18] In some studies, 20 ASC-H and LSIL-H appear to have similar rates of high-grade lesions on follow-up, but others show LSIL-H to be followed by more high-grade lesions 15 or more often associated with high-risk HPV than ASC-H. 18 Thrall et al 20 also comment that the rate of initial biopsy follow-up for women with LSIL-H is similar to that for ASC-H, but that women with LSIL-H and initial negative biopsy are more likely to undergo a second biopsy than women with ASC-H. Many laboratories either are unaware of the TBS 2014 final recommendations or choose to use LSIL-H, perhaps because of pathologist preference or concerns that patients may not receive sufficient follow-up by clinicians.…”

Significance of bizarre cells in cervical screening liquid‐based cytology: A prospective study of 15 cases

“…The current third edition of the Bethesda system places bizarre cells, as we described them above, implicitly into the LSIL category . There are some authors who are in favour of use of the LSIL‐H category; however, such suggestions have not reached a consensus yet . We suppose it is conceivable that, from a practical point of view, the term LSIL‐H could be used with a certain degree of convenience in cases of BCD when no HSIL cells are found in a smear.…”

Low‐grade squamous intraepithelial lesion, cannot rule out high‐grade lesion: Diagnosis, histological outcomes and human papillomavirus results

“…Several reported studies have indicated that patients with LROH/LSIL‐H appeared to have an intermediate risk of harbouring or developing high‐grade squamous lesions on biopsy and a different HPV prevalence compared with LSIL and ASC‐H, ranging from 22.8% to 59% of cases . Because of the increased incidence of high‐grade lesions found on histology, comparable to patients with HSIL, it has been proposed that these patients may require a clinical management similar to HSIL diagnosis …”