Watch and wait for adolescent LSIL regression

OB/GYN News, Sept 15, 2002 by Michele G. Sullivan

BALTIMORE -- Watchful observation by cytology, rather than colposcopy, may be the most appropriate way to manage low-grade squamous intraepithelial lesions in adolescent women because the overwhelming majority of these lesions clear in 36-40 months.

Low-grade squamous intraepithelial lesions (LSIL), the most common manifestation of human papillomavirus (HPV) infection, persist or progress to high-grade lesions or cancer in 20%-30% of adults, Dr. Anna-Barbara Moscicki said at the annual meeting of the Pediatric Academic Societies. However, teens show a much higher regression rate, indicating that colposcopy may not be necessary for this age group.

The 10-year follow-up study of 187 patients aged 13-22 years with LSIL indicated that 95% showed LSIL regression by 36 months after diagnosis; only 3% progressed to high-grade squamous intraepithelial lesions (HSIL). The women were examined every 4 months, and regression was defined as three consecutive negative Pap smears, said Dr. Moscicki of the University of California, San Francisco.

No associations were found between regression time and sexual behavior, type of contraceptive use, years of sexual activity, number of sexual partners, or substance abuse.

The only associations found were the type and numbers of HPV infecting the patient. Patients with HPV 16-like infections (the HPV 30s, HPV 52, and HPV 58) showed a delayed regression time, as did patients infected with multiple types of HPV.

However, it's important to note that although the regression time was delayed, by 40 months the clearance rates were similar to the rates of patients with non-HPV 16-like infections and single HPV infections, Dr. Moscicki said at the meeting sponsored by the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

There was no difference in regression times between lesions designated cervical intraepithelial neoplasia 1 (CIN 1) or condyloma. There also was no difference in regression time between patients whose lesions were histologically confirmed and those who had normal biopsies.