Abnormal Pap Test Result: Low-Grade Squamous Intraepithelial Lesion and High-Grade Squamous Intraepithelial Lesion

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Last modified 06/06/2015

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Chapter 98 Abnormal Pap Test Result: Low-Grade Squamous Intraepithelial Lesion and High-Grade Squamous Intraepithelial Lesion

INTRODUCTION

Description: Low-grade squamous intraepithelial lesions (LGSIL) encompass changes associated with human papillomavirus (HPV), mild dysplasia, and cervical intraepithelial neoplasia (CIN) I. High-grade squamous intraepithelial lesions (HGSIL) include CIN II and III and carcinoma in situ (CIS).
Prevalence: Less than 5% of Pap tests for low-grade and 2% for high-grade abnormalities.
Predominant Age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: HPV appears to be responsible for the development of cervical dysplasia. Although as many as 70% of invasive cervical cancers have HPV serotypes 16 or 18 present, these types may be detected in patients with LGSIL as well. Normal patients have HPV prevalence rates that vary from 10% to 50%, depending on the study technique and population evaluated.
Risk Factors: Exposure to HPV and other sexually transmitted disease; smoking is associated with a higher risk.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Asymptomatic

DIAGNOSTIC APPROACH

Differential Diagnosis

• LGSIL—inflammatory change (cervicitis)
• Cervical carcinoma
• HGSIL—cervical CIS
• Invasive cervical carcinoma

Associated Conditions: HPV infection, vaginitis, cervicitis, cervical dysplasia, carcinoma in situ, invasive carcinoma of the cervix, endocervical adenocarcinoma.

Workup and Evaluation

Laboratory: No evaluation indicated.
Imaging: No imaging indicated.
Special Tests: High prevalence, a poor correlation with later risk, and the cost of screening have resulted in the general recommendation that routine HPV screening or serotyping not be carried out.
Diagnostic Procedures:

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