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).

STUDY

DESIGN

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).

CONCLUSION

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.