Cervical dysplasia in adolescents.
BACKGROUND
Although the incidence of cervical dysplasia in adolescents is increasing, a paucity of data exists regarding the outcomes of adolescents with Pap test abnormalities. We determined the natural history and outcome of adolescents with low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL).


METHODS
A review of all women aged 18 years or younger with a cytologic diagnosis of LSIL or HSIL between 1997 and 2003 was performed. Follow-up cytologic and histologic samples were evaluated. The most significant abnormality was recorded for each patient. Rates of regression, persistence, and progression were calculated.


RESULTS
A total of 646 adolescents were identified. Follow-up was available for 477 teenagers with LSIL and for 55 with HSIL. Among adolescents with LSIL, 146 (35%) had negative follow-up. Low-grade abnormalities (atypical squamous cells of undetermined significance, LSIL, and cervical intraepithelial neoplasia grade 1) were seen in 199 (47%), whereas high-grade abnormalities were documented in 77 (18%). After 36 months, 62% had regressed, whereas 31% had progressive dysplasia. For the HSIL cohort, negative follow-up was documented in 12 (21.8%) adolescents, and 15 (27.3%) had low-grade abnormalities, whereas more than one half (50.9%) were found to have a high-grade abnormality. At 36 months, 31% of HSIL subjects had progressed to cervical intraepithelial neoplasia 3.


CONCLUSIONS
Adolescents with LSIL and HSIL cytology are at significant risk for progression to high-grade cervical abnormalities. The rate of development of high-grade cervical abnormalities in adolescents is similar to adults. Adolescents with cytologic abnormalities mandate close follow-up.


METHODS
II-3.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. wrightj@msnotes.wustl.edu
Jason D
JD
Wright
Rosa M
RM
Davila
Karen R
KR
Pinto
Diane F
DF
Merritt
Randall K
RK
Gibb
Janet S
JS
Rader
David G
DG
Mutch
Feng
F
Gao
Matthew A
MA
Powell
D000293:Adolescent; D000367:Age Factors; D001707:Biopsy, Needle; D002648:Child; D015331:Cohort Studies; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D011230:Precancerous Conditions / Q000473:pathology*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D014626:Vaginal Smears