Low grade intraepithelial lesion (LSIL) is the second most common anomaly on cervical cytology. Despite the low risk of progression to carcinoma, 10-25% have a histological diagnosis of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). Therefore, the challenge these lesions present is to identify the patients at risk of developing premalignant or malignant lesions. Our aim was to evaluate demographic characteristics, colposcopic findings and clinical follow-up of patients with LSIL on cervix cytology.
Retrospective longitudinal study of the patients referred to our Cervical Pathology consultation during January-December 2014 (n=356). Colposcopic classification was performed according to 2011 IFCPC nomenclature and histologic classification was divided in three groups: No displasia, CIN 1 and CIN2+. Statistical analysis was performed using SPSS ® v.21.
LSIL was the indication for referral of 36% (n=128) of patients. The mean age at referral was 38,46±10,49 years, 14,1% (n=18) were post-menopausal, 64,6% (n=52) had >1 sexual partners, 20,3% (n=16) were smokers, 63,6% (n=70) were contraceptive pill users and 39,6% (n=40) were positive for high risk HPV. 96,4% (n=124) had a colposcopy done upon admission: 33,9% (n=42) were normal, 62,1% (n=77) had grade 1 findings and 3,9% (n=5) had grade 2 findings. Within those with grade 1 findings, biopsy revealed no displasia in 63,6% (n=49), CIN 1 in 27,2% (n=21) and CIN2+ in 9,1% (n=7). Within the group of grade 2 findings, one case presented no displasia, one case presented a CIN1 and 3 cases presented CIN2+. There was a significant association between grade 2 colposcopic findings and high grade histologic lesions (OR 13,714; IC 1,978-98,065). Regarding the therapeutic approach, CIN1 lesions underwent expectant management in 63,6% (n=14) and destructive therapy in 36,4% (n=8). All CIN2+ lesions were submitted to excisional therapy. During a 6-24 month follow-up period, there were no de novo high grade lesions. There was no case of cervical cancer in our sample.
In accordance with the literature, LSILs were more prevalent in premenopausal women, with a higher number of sexual partners and a high prevalence of high risk HPV. Despite traducing mostly low grade histologic lesions, CIN2+ was present in 12,3%. The presence of grade 2 colposcopic anomalies correlated with high grade histologic lesions, reinforcing the importance of colposcopy in the surveillance of these patients.