High grade squamous intraepithelial lesion

High grade squamous intraepithelial lesion or HSIL or HGSIL is the medical term for a Pap test result suggesting moderate or severe cervical intraepithelial neoplasia of the squamous epithelium of the cervix, which could lead to cervical cancer.

HGSIL does not mean that cancer is present. Of all women with HGSIL results, 2% [Massad LS; Collins YC; Meyer PM. "Biopsy correlates of abnormal cervical cytology classified using the Bethesda system." Gynecologic Oncology. 2001 Sep;82(3):516-22.] or less [Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. "Natural history of cervical squamous intraepithelial lesions: a meta-analysis." Obstetric Gynecology. 1998 Oct;92(4 Pt 2):727-35.] have invasive cervical cancer at that time, however about 20% would progress to having invasive cervical cancer without treatment. [McIndoe WA; McLean MR; Jones RW; Mullins PR. "The invasive potential of carcinoma in situ of the cervix." Obstetric Gynecology. 1984 Oct;64(4):451-8.] To combat this progression, HGSIL is usually followed by an immediate colposcopy with biopsy to sample or remove the dysplastic tissue. This tissue is sent for pathology testing to assign a histologic classification that is more definitive than a Pap smear result (which is a cytologic finding). HGSIL generally corresponds to the histological classification of CIN 2 or 3.

HGSIL treatment involves the removal or destruction of the affected cells, usually by LEEP. Other methods include cryotherapy, cautery, or laser ablation, but none are performed on pregnant women for fear of disrupting the pregnancy. [Wright TC Jr; Massad LS; Dunton CJ; Spitzer M; Wilkinson EJ; Solomon D. "2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests." American Journal of Obstetric Gynecology. 2007 Oct;197(4):346-55.] Any of these procedures is 85% likely to cure the problem.


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