What an LSIL Pap Smear Result Means

Does a low-grade lesion suggest a cancer risk?

Pap smear

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A low-grade squamous intraepithelial lesion, commonly known as LSIL or LGSIL, is detected through a routine Pap smear and means that mild cervical dysplasia has been detected.

This means that cells on the cervix are showing changes that are mildly abnormal, meaning the cells could turn into cervical cancer years down the line. The fact that they are considered "low-grade" means that the process is likely to be gradual if it happens at all.

Cervical dysplasia is not cancer or even pre-cancer. The term is simply used to describe abnormalities in cervical cells that suggested an increased risk of cancer.

According to a retrospective study from Brigham and Women’s Hospital in Boston, of the 1,076 women diagnosed with LSIL, 93 (8.3 percent) went on to develop cervical intraepithelial neoplasia (CIN), a precancerous condition.

Cause

LSIL is almost always caused by the human papillomavirus (HPV), the primary risk factor for cervical cancer. HPV is easily transmitted through vaginal, anal, or oral sex. The good news is that the majority of people infected with HPV clear the virus spontaneously. For women whose immune systems are unable to clear the virus, cervical cancer may occur.

LSIL is only one of the possible interpretations of a Pap smear. If the cells are diagnosed as HGSIL (high-grade squamous intraepithelial lesion), it means that they have a greater likelihood of turning into cancer faster.

Detection

When women visit their OB/GYN doctors for checkups, they often receive a Pap smear, which is sometimes called a Pap test. A Pap smear is a procedure that tests for cervical cancer in women and takes just a few minutes. This procedure involves collecting cells from the cervix which is the lower, narrow end of the uterus that's at the top of the vagina.

During a Pap smear, a woman lies on an exam table and places her feet in stirrups. The doctor then inserts a medical instrument called a speculum (which is lubricated) into the vagina and using a brush or swab, gently swipes the surface of the cervix to obtain a collection of cells. These cells are then sent to a lab to be analyzed.

Screening Recommendations

In August 2018, the U.S. Preventive Services Task Force (USPSTF) issued updated recommendations for cervical cancer screening:

  • For women 21 to 29: every three years with a Pap smear alone
  • For women 30 to 65: every three years with a Pap smear, every five years with an HPV test, or every five years with a Pap smear and HPV test

If LSIL Is Diagnosed

If you receive a diagnosis of LSIL, it's important to follow up with your doctor, as her recommendations on how to manage the results will differ among women depending on their age, history of prior Pap smears, and results of an HPV test.

For example, if LSIL is found through a Pap smear, a repeat Pap smear in a year and/or an HPV test may be performed. An HPV test looks for the presence of certain strains of HPV associated with cervical cancer. Your doctor can usually obtain an HPV test on the same cells that were used on your initial Pap smear (the Pap smear that came back as "abnormal" because of LSIL). 

For other women who receive a diagnosis of LSIL, a colposcopy may be performed, like in women who tested positive on an HPV test or women who are between the ages of 25 and 29. 

A colposcopy is an in-office procedure that allows a doctor to examine the cervix more in-depth. When performing a colposcopy, your doctor will use a lighted microscope called a colposcope which magnifies the cervix, so it can be better visualized. 

During the colposcopy, the doctor may also do a cervical biopsy to remove small pieces of cervical tissue. Mild cramping may occur during a cervical biopsy; however, it is relatively painless. The tissue samples are then sent to a lab for further examination. 

Treatment

One of the most common ways to treat LSIL is to take a "watch and wait" approach. In the past, doctors took a more active approach to low-grade lesions, but retrospective research has shown that the practice did nothing to reduce the risk of cancer. In fact, it was more likely to cause harm by exposing a woman to treatments she didn't need.

Since low-grade dysplasia usually resolves on its own, medical treatment may not be needed. With that said, Pap smears and/or colposcopies may be performed at regular intervals to monitor the dysplasia and ensure it doesn't progress.

If the dysplasia progresses, treatment may be needed to remove the lesion, most of which can be performed as an in-office procedure. Among them:

  • Loop electrosurgical excision procedure (LEEP) is a technique in which an electric current is sent through a wire loop the cauterize and remove abnormal cells.
  • Cryotherapy is a technique used to destroy abnormal tissue through freezing.
  • Cone biopsy, also known as conization, involves the removal of a larger, cone-shaped sample of abnormal tissue.
  • Laser therapy uses a tiny beam of amplified light to destroy abnormal cells.

A Word From Verywell

The bottom line here is that the Pap smear result of LSIL is considered "abnormal" and requires further testing and possibly treatment. But the good news is that in most cases, it clears up on its own within two years.

Even so, regular check-ups with your doctor are critical to ensuring that any abnormal cells do not persist or progress. Remember, early detection is key to lowering your chances of developing cervical cancer. 

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