Patient diagnosed as squamous cell intraepithelial lesion which of the following has the highest risk for progression to carcinoma
High grade squamous intraepithelial neoplasia [Ref C.G.O.T. 9th/e p 895, 8961 Cervical lesions are characterized Histologically --> using the CIN nomenclature and Cytologically -4 using the Bethesda system Now the Pap smears are repoed using the Bethesda system which has advocated a standardized repoing system for cytological repos. EPITHELIAL CELL ABNORMALITIES Squamous cell Atypical squamous cell - Of undetermined significance (ASC-US) - Cannot exclude HSIL (ASC-H) Low grade squamous intraepithelial lesion (LSIL) - encompassing HPV/mild dysplasia/CIN High grade squamous intraepithelial lesion (HSIL) - encompassing moderate and severe dysplasia - CIN 2 and CIN 3/CIS Squamous cell carcinoma Glandular cell Atypical (AGC) - endocervical cells - endometrial cells - glandular cells not otherwise specified (NOS) Atypical, our neoplastic - endocervical cells - glandular cell NOS Endocervical adenocarcinoma in situ (AIS) Adenocarcinoma - endocervical - endometrial - extrauterine - not otherwise specified (NOS) Cervical Cytology Screening (American College of Obstetricians and Gynecologists Guideline) Initial screening Age 21 or 3 y after vaginal sex Interval Every year Every 2-3 y after age 30 with 3 consecutive normals Discontinue No upper limit of age Comparison of Cytology Classification Systems (in simplified form) Bathesda CIN Dysplasia Limit of histologic changes *LSIL CIN 1. Mild Basal 1/3rd of sq. epithelium CIN 2 Moderate Basal 1/2 to 2/3rd HS1L CIN3 Severe Whole thickness except one or two superficial layers CIS Whole thickness