Patient diagnosed as squamous cell intraepithelial lesion which of the following has the highest risk for progression to carcinoma :
Ans. is b i.e. High grade squamous intraepithelial neoplasia There are various nomenclatures / classification systems for repoing of Pap smear. The one which is classically used is by WHO, which uses the terms CIN-I, CIN-II and CIN-III (as discussed in chapter on CIN). Another system is devised Bethesda. It classifies cytological abnormalities of premalignant leisons into three categories : Atypical squmous cells of undetermined signifcance (ASCUS). Low grade squamous intraepithelial lesion. High grade squamous intraepithelial lesion. Atypical Squamous Cells of Undetermined Significance : The most common cytologic abnormality is atypical squamous cells of undetermined significance (ASC-US). which indicates cells that are suggestive of, but do not fulfill the criteria for, SIL. The risk of progression to CIN-II or CIN-III approximates only 5% and cancer is found in only 1 to 2 per thousands instances. The evaluation of ASC-US should not be overly aggressive, paicularly in adolescents who are at low risk of cervical cancer. (American College of Obstetricians and Gynaecologists, 2006a: Moscicki, 2005). There are three options for evaluation of ASC-US - HPV DNA testing. Colposcopy. or Repeat cytologies at 6 and 12 months, with referral to colposcopy if either of these is abnormal. Low-Grade Squamous Intraepiethelial Lesion : This cytology result indicates the likely presence of HPV infection or low-grade neoplasia. Low-grade SIL encompasses the cytologic features of HPV infection and CIN-I and carries a 15 to 30 percent risk of progression to CIN-II or CIN-Ill. Therefore, colposocpy is indicated for most. High-Grade Squamous Intraepiethelial Lesion and Glandular Abnormalities : High grade SIL, should all be evaluated by prompt colposcopic evaluation. High-grade SIL cytology encompasses features of CIN-II and CIN-III and carries a high risk of underlying histologic CIN-II or CIN-Ill (at least 70%). or invasive cancer (1 to 2%). Alternative management of HSIL cytology in women age 21 years and older includes immediate diagnostic loop excision because colposcopy may miss a high-grade lesion and most HSIL cytologies evenatually result in excision for diagnosis or treatment.
Low grade squamous intraepithelial neoplasia
High grade squamous intraepithelial neoplasia
Squamous intraepithelial associated with HPV 16
Squamous intraepithelial neoplasia associated with HIV