Management of the low grade squamous intraepithelial lesion Pap smear in a cross-sectional, observational cohort.
OBJECTIVE
To evaluate the practice of delaying colposcopy until repeat cytology demonstrates persistent low grade squamous intraepithelial lesion (LSIL).


METHODS
A retrospective cross-sectional analysis was performed on patients diagnosed with LSIL in a high-risk urban population. Primary outcomes were defined as regression, persistence, progression and lost to follow-up.


RESULTS
A total of 624 patients received an initial cytologic diagnosis of LSIL. Of these, 260 (42%) were lost to follow-up despite multiple contact attempts. Of the 364 patients available for full analysis, 168 (26%) regressed to negative cytology, 93 (15%) had persistent LSIL/cervical intraepithelial neoplasia (CIN) 1, and 103 (17%) progressed to high grade cervical intraepithelial neoplasia (HSIL)/CIN 2/3. Higher rates of LSIL regression were observed in teenagers (< or = 20) compared to women aged 21-30 or > 30 (51% vs. 43% vs. 45%), although this was not statistically significant (p = 0.29).


CONCLUSIONS
Delaying colposcopy to repeat cytology resulted in a significant loss to follow-up in a population at high risk for poor compliance. In women with LSIL over 20 years of age, immediate colposcopy is recommended when optimal patient compliance cannot be ensured. Only 25% of patients avoided eventual colposcopy by regression to normal cytology.
Yoost
Jennie L
JL
Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 639, Charleston, SC 29425, USA. yoost@musc.edu
Goetzl
Laura
L
Hoda
Rana
R
Soper
David E
DE
Barry
Audrey
A
D000328:Adult; D000367:Age Factors; D003127:Colposcopy / Q000379:methods*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000473:pathology*; D010349:Patient Compliance; D011247:Pregnancy; D011364:Professional Practice; D012189:Retrospective Studies; D014505:Urban Population; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000628:therapy* / Q000821:virology / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000517:prevention & control / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult