HGSIL of the Cervix on Pap Smear: What it Means
Frederick R. Jelovsek MD, MS
\"I have had my first abnormal pap smear. It showed \"high grade epithelial lesions\". The ob/gyn said that the LEEP is the next step, after my colposcopy results are revealed. Does this mean that I have just cervical dysplasia, or is it really cervical cancer. I am scared, although I have a family background of various types of cancers on both sides of my family. \" Carol
The Pap smear is a screening tool and its classifications indicate to the doctor whether there is a risk of having cervical cancer. The classification system your doctor\'s Pap laboratory is using is called the Bethesda System. In this classification HGSIL, which stands for high grade squamous intraepithelial lesion, indicates changes in the cells of the cervix which may represent a moderate or severe dysplasia of the cervix.
The next step is to have a colposcopically directed biopsy of the cervix to see whether the changes on the cervix are the same as the Pap, worse than the Pap indicates (carcinoma in situ, or invasive cancer) or less severe (mild dysplasia, inflammation) than the Pap indicated. The biopsy result is the \"gold standard\", not the Pap result. Your further treatment and follow-up depend upon what the biopsy shows.
Does high grade epithelial lesion (HGSIL) on Pap smear mean I may have cancer?
A high grade squamous intraepithelial lesion on Pap smear does not indicate cancer. It usually indicates what is called moderate or severe dysplasia. However, since the Pap smear is a screening test, the actual changes on the cervix can be worse and actually be an invasive cervical cancer. This would be very uncommon and the chance of a Pap smear showing HGSIL and of there being an invasive cancer of the cervix already present would be less than 1%. In fact only about 1.5% of women with a HGSIL Pap smear will progress to having invasive cancer of the cervix within the next 24 months (1).
Since cervical dysplasia can progress to an invasive cervical cancer over time, it is very important to have it treated if your biopsy shows dysplasia is present. Treatment will remove or destroy the affected cells on the cervix and the hope is that when the body heals over that tissue, the new cells will not be affected by dysplasia. Destruction of those cells can be performed by loop electrical excision (LEEP, LLETZ). cryotherapy, cautery or laser excision or ablation. In general, any destructive procedure of dysplastic cervical cells is about 85% curative over the long run.