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Should LSIL-H be a distinct cytology category?
A study on the frequency and distribution of 40 human papillomavirus genotypes in 808 women
Article first published online: 30 MAY 2012
Copyright © 2012 American Cancer Society
Volume 120, Issue 6, pages 373–379, 25 December 2012
How to Cite
Zhou, H., Schwartz, M. R., Coffey, D., Smith, D., Mody, D. R. and Ge, Y. (2012), Should LSIL-H be a distinct cytology category?. Cancer Cytopathology, 120: 373–379. doi: 10.1002/cncy.21210
- Issue published online: 14 DEC 2012
- Article first published online: 30 MAY 2012
- Manuscript Accepted: 23 APR 2012
- Manuscript Received: 14 APR 2012
- human papillomavirus (HPV);
- HPV genotypes;
- Papanicolaou test;
- Bethesda System for gynecologic cervical cytology reporting;
- low-grade squamous intraepithelial lesion;
- cannot exclude high-grade squamous intraepithelial lesion (LSIL-H)
The 2001 Bethesda System for gynecologic cervical cytology reporting classifies squamous intraepithelial lesions into low-grade (LSIL) and high-grade (HSIL) lesions. An intermediate term, “low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H),” has been used in a small percentage of LSIL cases. To the authors' knowledge, little is known regarding the human papillomavirus (HPV) status in patients with LSIL-H.
A total of 808 SurePath specimens obtained between December 2009 and April 2011 were tested for 40 HPV genotypes using DNA microarray, followed by a confirmatory DNA sequencing assay.
The infection rate for high-risk HPV in women with LSIL-H (92%) was strikingly close to that for women with HSIL (91%), which was higher than that for those with LSIL (74%); atypical squamous cells, cannot rule out high-grade lesion (ASC-H) (78%); or LSIL and ASC-H combined (74%). HPV type 16, the most common carcinogenic HPV genotype, was detected in 36% of women with LSIL-H, which was significantly higher than that in women with LSIL and ASC-H combined (13.8%), but less than that in women with HSIL (44.6%). Patients with LSIL-H and HSIL had similar infection rates for low-risk/intermediate-risk HPV genotypes, which were lower than those in LSIL or LSIL and ASC-H combined.
Women found to have LSIL-H on a Papanicolaou test appear to have a unique HPV distribution pattern that clearly differs from LSIL and is comparable to that for HSIL, suggesting an increased risk of high-grade lesions over that of women with LSIL. Recognizing LSIL-H as an independent diagnostic category may help in the early identification of the high-risk subgroup that may require a management algorithm comparable to that for patients with HSIL. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.