Diseases, Disorders information

Low-Grade Squamous

Intraepithelial Lesion
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Analysis of the screening programs in British Columbia indicate that low-grade lesions in women younger than 34 years of age will regress spontaneously 84% of the time. For women older than 34 years, 40% of lesions will regress. Despite the fact that most low-grade lesions will regress spontaneously, some physicians are unwilling to manage these lesions expectantly. However, it is acceptable to repeat the Pap test in 4-6 months; if the result is abnormal, colposcopy may be performed at that time. When a woman has a colposcopically abnormal transformation zone and a low-grade squamous intraepithelial lesion is documented by biopsy, destruction of that abnormal transformation zone is acceptable. However, no treatment and monitoring by cytologic and colposcopic examination every 4-6 months are reasonable options. If a lesion persists for more than 1 year, treatment should be recommended at that time because of the diminished likelihood of spontaneous regression.

High-Grade Squamous

Intraepithelial Lesion
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Any woman with a cytologic specimen suggesting the presence of a high-grade lesion should undergo colposcopy and directed biopsy. No other management approach is currently acceptable. After confirmation of a high-grade lesion, therapy aimed at destruction or removal of the entire transformation zone should be performed. The modality of treatment is based on the location and size of the lesion, the skill of the operator, and the need for further diagnostic materials.

If a high-grade squamous lesion is reported during pregnancy, the patient should undergo colposcopy and repeat cytology. If the lesion is completely seen and there is no suggestion of invasive carcinoma on the colposcopic or cytologic evaluation, treatment can be delayed until after delivery of the fetus. Vaginal delivery can be anticipated. If the patient presents for colposcopy in the first or second trimester and a lesion is visible, a directed cervical biopsy to confirm the absence of invasion is indicated. Biopsy may be delayed until after delivery in patients in the third trimester with no evidence of invasion on colposcopy or cytology.
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