Women in a region with high incidence of cervical cancer warrant immediate colposcopy for low-grade squamous intraepithelial lesion on cervical cytology

Abstract

The objective of this study was to determine the prevalence of high-grade histologic diagnoses in women who had low-grade squamous intraepithelial lesion (LSIL) on Pap smear in an area with high incidence of cervical cancer. We conducted a retrospective study of 220 women with LSIL cytology undergoing colposcopic examination in Chiang Mai University Hospital between January 1999 and July 2004. The histologic diagnoses, obtained from colposcopically directed biopsy or electrical loop excision after initial colposcopy, showed that 80 (36.4%) women had histologically confirmed high-grade lesions and 11 (5%) women had microinvasive (9) and frankly invasive (2) carcinomas. Overall, 41.5% of women with LSIL on Pap smear had significant underlying lesions, requiring appropriate treatment. In conclusion, in the region with high incidence of cervical cancer, women with LSIL cytology are at increased risk of having underlying high-grade lesions and invasive cancer. Immediate referral for colposcopy is warranted.

High‐grade histologic lesions in women with low‐grade squamous intraepithelial lesion cytology from a region of Thailand with a high incidence of cervical cancer

“…Our previous retrospective study [3] revealed a unique finding of a high prevalence of high-grade disease (41.5%) in women whose smear test revealed LSIL. However, because of a limitation in the study design, a uniform management protocol could not be conducted.…”

Clinical significance of atypical glandular cells on Pap smears: Experience from a region with a high incidence of cervical cancer

“…1 Unique findings from previous studies from Chiang Mai, were a high incidence of cervical cancer region (age standardized incidence rate of 29.4 per 100 000) and high incidences invasive lesion noted across all grade of squamous cell abnormalities on Pap smears. [2][3][4][5] Thus, a high prevalence of significant lesions in women with ACG smears is also anticipated and a study evaluating this hypothesis is relevant. Accordingly, this retrospective study was undertaken to evaluate the underlying histopathology of women with AGC cytology by TBS 2001 criteria.…”

Underlying pathology of women with “atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion” smears, in a region with a high incidence of cervical cancer

“…Despite a growing body of literature illustrating the underlying cervical histopathology of women with ASC‐H after the implementation of the 2001 Bethesda system, almost all of these studies mainly investigated in populations with a low incidence of invasive cervical cancer 7–14 . There are several reports which demonstrated that the distribution of underlying cervical lesions in women with abnormal cervical cytology in the regions with a high incidence of cervical cancer is quite different from those reported among low incidence populations, irrespective of the severity of cervical cytology 15–19 . Additionally, in some of these studies, the histological diagnoses have not been carried out in all women and then the final diagnoses are made on colposcopic findings only.…”