Analysis of follow-up outcomes in patients with cervical histologic low-grade squamous intraepithelial lesion preceded by serious cytology and repeated diagnosis for at least 2 years

Background: Treatment protocol for patients with cervical histologic low-grade squamous intraepithelial lesion (LSIL) such as that preceded by serious cytology and repeated diagnosis for at least 2 years is unclear. Objective: This study investigates the follow-up results of patients with cervical histologic LSIL and aims to provide evidence support for treatment and follow-up strategy. Design: A retrospective observational study design was used. Methods: The retrospective study included 4263 patients with cervical histologic LSIL diagnosed between August 2014 and February 2021. The follow-up period ended in August 2023. Results: During the followed-up of 6–101 months, 3246 (76.1%), 628 (14.7%), and 389 (9.1%) of the 4263 patients had lesion regression, persistence, and progression. Multiple gravidities, high-risk human papillomavirus (HPV) positive, HPV 16 positive, and cytologic examination (⩾atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)) were independent risk factors for histologic LSIL progression. The annual cumulative cervical intraepithelial neoplasia (CIN)3+ rate of patients with histologic LSIL preceded by cytologic ASC-H and gravidity >2 was 6.3% (1-year), 22.4% (2-year), 28.2% (3-year), 28.2% (4-year), and 28.2% (5-year). The cumulative CIN2+ and CIN3+ rates in patients with histologic LSIL under risk factors and repeated diagnosis for at least 2 years were significantly higher than patients preceded by cytologic negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and LSIL. Conclusion: Cervical histologic LSIL had a high natural regression rate and a low progression rate. Multiple gravidities, high-risk HPV positivity, HPV 16 positivity, and cytological examination ⩾ASC-H were risk factors for histologic LSIL progression. For patients with histologic LSIL preceded by cytologic ASC-H, stratified management based on the number of gravidities might be an option.