title: Cytologic surveillance versus immediate colposcopy for women with a cervical smear diagnosis of low-grade squamous intraepithelial lesion in a poor setting in Nigeria.
abstract: BACKGROUND
  Ideally, all patients with abnormal Papanicolaou smear cytology results should undergo colposcopic examination of the cervix, but low-grade squamous intraepithelial lesions (LSILs) can also be followed up with further Papanicolaou smear surveillance. The aim of this study was to evaluate the outcome of cytologic surveillance versus immediate colposcopy in women with a cervical smear diagnosis of LSIL.
  
  
  METHODS
  This was a prospective comparative study of 240 eligible consenting women consecutively grouped into cervical surveillance for 6 months versus immediate colposcopy at a ratio of 1:1. Free cervical smear cytology, colposcopy, and biopsy, as well as histology, were provided for all study participants.
  
  
  RESULTS
  The regression, persistence, and progression rates with 6 months of cytologic surveillance of LSIL were 46.1%, 43.4%, and 3.9%, respectively. The difference between the proportions of women who had an eventual histologic diagnosis of cervical intraepithelial neoplasia 2+ in both groups was not statistically significant (4.9% versus 8.7%; P=0.68). The default rates among women on cytologic surveillance and immediate colposcopy were 37% and 12.5%, respectively (P=0.0002).
  
  
  CONCLUSIONS
  Although the progression rate of LSIL is low, a high persistence rate and higher default rate from cytologic surveillance highlight the need to consider immediate referral for colposcopy, where available, for all women with a Papanicolaou smear diagnosis of LSIL in this environment.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria ; Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Lo
authors.initials: L
authors.lastname: Ajah
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Co
authors.initials: C
authors.lastname: Chigbu
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: He
authors.initials: H
authors.lastname: Onah
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Ca
authors.initials: C
authors.lastname: Iyoke
authors.affiliation: Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Ol
authors.initials: O
authors.lastname: Lawani
authors.affiliation: Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Po
authors.initials: P
authors.lastname: Ezeonu
keywords: Enugu; cytologic surveillance; immediate colposcopy; low-grade squamous intraepithelial lesions