Management of Low-Grade Squamous Intraepithelial Lesion (LSIL)

Initial Management

The National Comprehensive Cancer Network recommends that during colposcopy, the cervix should be examined with a long focal-length microscope (10x-16x magnification) after application of 3-5% acetic acid solution to identify abnormal areas requiring biopsy 1
The National Comprehensive Cancer Network suggests that colposcopically directed biopsies should be performed on any suspicious areas to rule out invasive disease and determine the extent of preinvasive disease 1
If the entire squamocolumnar junction is visualized (adequate colposcopy), the National Comprehensive Cancer Network states that endocervical curettage is not required 1

The National Comprehensive Cancer Network recommends that CIN 1 should not be treated immediately unless persistent for 2 years 2
The National Comprehensive Cancer Network suggests that if follow-up tests are negative, return to routine screening 2
The National Comprehensive Cancer Network states that if follow-up shows persistent abnormalities, repeat colposcopy 2

The National Comprehensive Cancer Network recommends that for CIN 2, observation may be considered, especially in younger women 2
The National Comprehensive Cancer Network suggests that for CIN 3, treatment with excisional procedure is recommended 2
The National Comprehensive Cancer Network states that treatment options include loop electrosurgical excision procedure (LEEP), cold-knife conization, or in some cases, ablative procedures (laser ablation or cryotherapy) 1

The National Comprehensive Cancer Network recommends that for HIV-infected women or immunocompromised patients, more frequent screening and follow-up is recommended due to increased risk of progression and recurrence 1
The National Comprehensive Cancer Network suggests that for pregnant women with LSIL, colposcopy is preferred but can be deferred until 6 weeks postpartum; treatment of CIN 1 is not recommended during pregnancy 2

The National Comprehensive Cancer Network recommends that for persistent LSIL (>2 years), treatment options include excisional procedures (LEEP, cold-knife conization) or ablative procedures (laser ablation, cryotherapy) 1, 2

The American College of Obstetricians and Gynecologists recommends colposcopy for women with atypical squamous cells, atypical glandular cells, low-grade or high-grade squamous intraepithelial lesion, or squamous carcinoma noted by Pap testing 3
For women aged ≥21 years with ASC-US, the Centers for Disease Control and Prevention recommends three management options: HPV DNA testing, immediate colposcopy, or repeat cytology at 6 and 12 months, with colposcopy prompted by any result showing ASC-US or worse 4
The Centers for Disease Control and Prevention recommends immediate colposcopy for women aged ≥21 years with LSIL 4
For women with HSIL or ASC-H, the American Society for Colposcopy and Cervical Pathology recommends immediate colposcopy due to high risk of underlying high-grade cervical intraepithelial neoplasia (CIN 2,3) 5

The Infectious Diseases Society of America recommends HIV-infected women to have cervical Pap smear upon initiation of care, repeated at 6 months, and if results are normal, annually thereafter, with any abnormal results prompting colposcopy and directed biopsy 3

The American Society for Colposcopy and Cervical Pathology recommends follow-up after colposcopy to include either repeat cytology at 6 and 12 months or HPV testing at 12 months for women with negative colposcopy results for ASC-H 5
The Centers for Disease Control and Prevention recommends surveillance to continue for at least 25 years after treatment for high-grade precancer, with initial post-treatment testing including HPV test or cotest at 6, 18, and 30 months 6
The Centers for Disease Control and Prevention recommends expedited treatment as an alternative to colposcopy for non-pregnant patients aged ≥25 years with HSIL cytology and positive HPV 16 6