CONSERVATIVE TREATMENT OF LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS (LSIL) OF THE CERVIX

Objective: To assess the accuracy of the cervical smear and colposcopy in diagnosing low grade squamous intraepithelial lesions (LSIL), and the natural history of LSIL. Method: The cytological, colposcopic and histological findings of 145 patients with a smear diagnosis of LSIL w ere compared, and the final outcome studied. Results: The diagnosis of LSIL either by cytology alone or in combination with colposcopy was a ssociated with a rate of overdiagnosis of 11.7% and 6.9%, respectively , and a rate of underdiagnosis of 31.0% and 26.2%, respectively. Spont aneous regression of lesions occurred in 81.1% of patients with proven LSIL, with regression within 24 months in 4/5 of cases. Conclusions: The degree of dysplasia shown in the cervical smear correlated poorly with histology. All patients with cervical smear showing LSIL should h ave colposcopy and colposcopic-directed biopsy to exclude the presence of more advanced lesions. In the absence of some serious lesions, it is then acceptable to observe the patient for 24 months before adoptin g definite treatment, as spontaneous regression is common. (C) 1998 In ternational Federation of Gynecology and Obstetrics.