10. Management of histologically confirmed high-grade squamous abnormalities

Introduction

According to the two-tiered nomenclature for cervical histology recommended by the Lower Anogenital Squamous Terminology (LAST) standardization project[1] and adopted by the Royal College of Pathologists of Australasia, non-invasive human papillomavirus (HPV)-associated squamous lesions are classified as:

• LSIL: low-grade squamous intraepithelial lesion
• HSIL: high-grade squamous intraepithelial lesion

HSIL can be further subcategorised, according to the grade of cervical intraepithelial neoplasia (CIN), as HSIL (CIN2) and HSIL (CIN3).

HSIL of the cervix is characterised histologically by mitotic figures in epithelial cells undergoing cell division, nuclear abnormalities including enlarged nuclei and irregular nuclear membranes, and little to no cytoplasmic differentiation in the middle third and upper third of the epithelium.

Invasive squamous cell carcinoma is categorised as:

• SISCCA: superficially invasive squamous cell carcinoma (previously termed microinvasive carcinoma)
• SCC: squamous cell carcinoma

See also Chapter 3. Terminology.

See:

• Diagnosis of HSIL
• Treatment of HSIL
• Test of Cure after treatment for HSIL (CIN2/3)
• Discussion: Management of histologically confirmed high-grade squamous abnormalities

Author(s):

• A/Professor Lyndal Anderson — Co-author
• A/Professor Selvan Pather — Co-author
• Professor Gordon Wright — Co-author
• Professor Ian Hammond — Co-author
• Professor Marion Saville — Co-author
• Cancer Council Australia Cervical Cancer Screening Guidelines Working Party — Co-author

References

1. Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J Low Genit Tract Dis 2012 Jul;16(3):205-42 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22820980.

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