Natural History of Low-Grade Squamous Intraepithelial Lesion

Background: Clinicians commonly perform colposcopy directed biopsies on patients with low grade squamous intraepithelial lesion (LSIL) on PAP cytology even when not consistent with clinical guidelines. Objective: We study the association of PAP cytology screening results with cervical intra-epithelia neoplasia (CIN) 2-3 high-grade dysplasia, as confirmed by colposcopy-directed biopsy. Methods: A retrospective study of 263 women with an abnormality on the PAP smear. Multinomial logistic regression was performed with predictors of PAP cytology screening results with the outcome variable of colposcopy-directed biopsy. Results: High grade squamous intraepithelial lesion (HSIL) had significantly increased relative risk for CIN 2-3 (RR: 9.85, 95% CI: 1.84, 52.79, p=0.008). LSIL was not significantly associated with CIN 2-3. In the comparisons of negative with CIN-1, both HSIL and LSIL were not significantly associated with a negative biopsy. Conclusion: HSIL is associated with cervical dysplasia of CIN 2-3 while LSIL is not associated with cervical dysplasia of CIN 2-3. We do not recommend routine biopsies in patients with LSIL cytologic abnormalities unless additional compelling factors exist.

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Primary acquired melanosis (PAM) without atypia/WHO low-grade conjunctival melanocytic intraepithelial lesion over areas of oculodermal melanocytosis

BMJ Case Reports ◽

10.1136/bcr-2020-236741 ◽

2020 ◽

Vol 13 (10) ◽

pp. e236741

Author(s):

Bashar M Bata ◽

Sachin M Salvi ◽

Hardeep Singh Mudhar

Keyword(s):

Bulbar Conjunctiva ◽

Low Grade ◽

Primary Acquired Melanosis ◽

Conjunctival Biopsy ◽

History Of ◽

Intraepithelial Lesion ◽

The Relationship ◽

Oculodermal Melanocytosis ◽

Substantia Propria ◽

New Onset

An elderly white man with a history of left oculodermal melanocytosis presented with new onset brown pigmentation of the left bulbar and inferior tarsal conjunctiva. The bulbar conjunctival pigmentation was at the level of the conjunctival epithelium and was overlying areas of typical slate-grey scleral pigmentation characteristic of oculodermal melanocytosis. Both areas of new pigmentation were biopsied. The bulbar conjunctiva revealed primary acquired melanosis (PAM) without atypia with increased melanin production and the tarsal conjunctival biopsy showed PAM without atypia sine pigmentio overlying areas of substantia propria spindle-shaped heavily pigmented melanocytes of oculodermal melanocytosis. The case report examines the relationship between the epithelial and substantia propria melanocytes and correlates the findings with what is known about this association from the dermatopathology literature.

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ASCCP Practice Guidelines Management Guidelines for the Follow-up of Cytology Read as Low Grade Squamous Intraepithelial Lesion

Journal of Lower Genital Tract Disease ◽

10.1046/j.1526-0976.2000.04205.x ◽

2000 ◽

Vol 4 (2) ◽

pp. 83-92 ◽

Cited By ~ 1

Author(s):

J. Thomas Cox ◽

L. Stewart Massad ◽

Neil Lonky ◽

Robert Tosh ◽

Alan Waxman ◽

...

Keyword(s):

Practice Guidelines ◽

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Management Guidelines ◽

Intraepithelial Lesion

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Clinical application of the 2011 IFCPC colposcope terminology

BMC Women s Health ◽

10.1186/s12905-021-01395-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bei Zhang ◽

Shuhui Hong ◽

Guihui Zhang ◽

Fengnian Rong

Keyword(s):

Diagnostic Accuracy ◽

Precancerous Lesions ◽

High Specificity ◽

Diagnostic Value ◽

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Diagnostic Significance ◽

Cervical Precancerous Lesions ◽

Intraepithelial Lesion ◽

Common Sign

Abstract Background Colposcopy offers an accurate way to the diagnose of cervical precancerous lesions. However, the diagnostic accuracy of colposcopy is unsatisfied. This study was to evaluate colposcopic accuracy according to the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology. Methods A retrospective cohort study was performed in 1,838 patients who underwent colposcopy in Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University from October 2013 to April 2018. Using conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated, and correlations between variables were analyzed. Results As an authoritative and widely used terminology for colposcopy diagnosis, the 2011 IFCPC terminology has certain clinical practicality and diagnostic accuracy. However, some signs such as mosaic, punctation, sharp border, inner border sign and ridge sign had high specificity but unsatisfactory sensitivity, which limited the diagnostic value. Therefore, we discussed the Lugol’s staining, a very common sign in colposcopy, and analyzed the diagnostic significance of bright yellow staining in low-grade squamous intraepithelial lesion (LSIL) and mustard yellow staining in high-grade squamous intraepithelial lesion (HSIL). The results showed that mustard yellow may be a valuable indicator in the diagnosis of HSIL. Conclusion The 2011 IFCPC colposcope terminology has standardized interpretations of the colposcopic findings and improved the accuracy of colposcopy diagnosis. The aceto-white epithelium still has important diagnostic value; however, the value of a few signs is needed to be discussed and new signs are expected to be discovered. Although the significance of Lugol’s staining was diminishing, mustard yellow might be a valuable indicator for the diagnosis of HSIL.

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