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Cytologic surveillance versus immediate colposcopy for women with a cervical smear diagnosis of low-grade squamous intraepithelial lesion in a poor setting in Nigeria

Authors Ajah LO, Chigbu CO, Onah HE, Iyoke CA, Lawani OL, Ezeonu PO

Received 10 July 2014

Accepted for publication 17 October 2014

Published 27 November 2014 Volume 2014:7 Pages 2169—2173


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Faris Farassati

LO Ajah,1,2 CO Chigbu,1 HE Onah,1 CA Iyoke,1 OL Lawani,2 PO Ezeonu2

1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria

Background: Ideally, all patients with abnormal Papanicolaou smear cytology results should undergo colposcopic examination of the cervix, but low-grade squamous intraepithelial lesions (LSILs) can also be followed up with further Papanicolaou smear surveillance. The aim of this study was to evaluate the outcome of cytologic surveillance versus immediate colposcopy in women with a cervical smear diagnosis of LSIL.
Methods: This was a prospective comparative study of 240 eligible consenting women consecutively grouped into cervical surveillance for 6 months versus immediate colposcopy at a ratio of 1:1. Free cervical smear cytology, colposcopy, and biopsy, as well as histology, were provided for all study participants.
Results: The regression, persistence, and progression rates with 6 months of cytologic surveillance of LSIL were 46.1%, 43.4%, and 3.9%, respectively. The difference between the proportions of women who had an eventual histologic diagnosis of cervical intraepithelial neoplasia 2+ in both groups was not statistically significant (4.9% versus 8.7%; P=0.68). The default rates among women on cytologic surveillance and immediate colposcopy were 37% and 12.5%, respectively (P=0.0002).
Conclusion: Although the progression rate of LSIL is low, a high persistence rate and higher default rate from cytologic surveillance highlight the need to consider immediate referral for colposcopy, where available, for all women with a Papanicolaou smear diagnosis of LSIL in this environment.

Keywords: cytologic surveillance, immediate colposcopy, low-grade squamous intraepithelial lesions, Enugu

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