Management of low-grade squamous intraepithelial lesions of the uterine cervix

Abstract

Strategies of management for low-grade squamous intraepithelial lesion (SIL) vary even on a national level. We evaluated the diversity of management algorithms. This should serve as a source to find a common basis for the management of low-grade SIL. A total of 38 representatives and specialists for colposcopy and cervical pathology were contacted to provide national guidelines, recommendations or consensus for the management of patients diagnosed with the cytologic diagnosis of low-grade SIL. In all, 23 addressees (60%) responded. The algorithms provided varied considerably. Three variants of algorithms could be defined. Variant 1 was proposed in 14 countries and recommended colposcopy immediately after cytologic diagnosis of low-grade SIL or at the same time the smear is taken. If available, HPV testing was recommended as a triage option in some countries. Variant 2 is used in three countries and colposcopy is only performed after a repeated abnormal cytologic result within a 6-month interval or after an optional test positive for high-risk HPV. Variant 3, as proposed in six countries, takes into account the socio-economic status of the patient: In patients with poor compliance, 'see and treat' management is recommended; in patients where compliance can be assured, follow-up is carried out by cytology and colposcopy. Global policy of management of patients with low-grade SIL can be summarised in three algorithms. Quality standards and outcome parameters must be defined in order to improve the management of women with low-grade SIL.

Figure 1

Algorithm 1: colposcopy immediately following cytologic diagnosis of low-grade SIL or in each check-up as a routine examination described for Austria (Girardi et al, 2001), Germany, Greece, Hong Kong (Ngam et al, 1999), Hungary, Israel, Italy, Poland, Portugal, Russia, Spain, Sweden (Stockholm area), USA (Wright et al, 2002), Yugoslavia (Kesic, 2002). This is not the algorithm of the American Society of Colposcopy and Cervical Pathology (ASCCP), which can be viewed at www.asccp.org.

Figure 2

Algorithm 2: repeat cytology following cytologic diagnosis of low-grade SIL described for Croatia (Ljubojeviæ et al, 2002), England (Duncan, 1997), New Zealand.

Figure 3

Algorithm 3: management of patients with the cytologic diagnosis of low-grade SIL according to socio-economic status described for Argentina, Chile, India, Paraguay, Philippines, Slovakia.

Figure 4

World map: Black: countries following algorithm 1; hatched: Sweden Stockholm area following algorithm 1, other parts following algorithm 2. Grey: countries following algorithm 2. Chequered: countries following algorithm 3.