10. Outcomes following cytological prediction of possible LSIL

Abstract

Background Under the 1994 management guidelines for screen-detected cervical abnormalities, women with nonspecific minor changes were directed to annual cytology until smears returned to normal. The new 2006 guidelines recommend the same management strategy for possible low-grade squamous intraepithelial lesions (LSIL) as for definite LSIL – those with persistent ‘possible LSIL’ or worse at the 12 month repeat to be referred for colposcopy and immediate colposcopy or repeat smear at 6 months for women aged over 30 years and without a history of negative cytology in the preceding 36 months. Over-referral for colposcopy is of concern in terms of costs and patient anxiety. Aims To examine the outcome for women with cytological prediction of possible LSIL during 2006–2008 and determine if any differences in outcome exist between age groups 30 years old. Methods All cases diagnosed at VCS over the period January 2006 to December 2008 for which the index smear was ‘possible LSIL’ and the results of follow-up cervical histology available were collated according to age group at time of index smear. The groups were statistically compared regarding the diagnostic frequency of dysplasia on follow-up cervical biopsy. Results A total of 4054 patients diagnosed with ‘possible LSIL’ had follow-up histology results available. Of the 1771 women aged 30 years, biopsy was negative in 1646 (72.1%), a result significantly higher than the Conclusions Women aged 430 years are significantly more likely to have only benign changes on biopsy following an index smear of ‘possible LSIL’. The critical application of diagnostic criteria in this age group is important to avoid potentially unnecessary colposcopy. HPV testing may have a triage application in this setting.