GYNECOLOGIC ONCOLOGY Frequency of cervical intraepithelial neoplasia grade II or worse in women with a persistent low-grade squamous intraepithelial lesion seen by Papanicolaou smears P. R. B. Nogara • L. A. R. Manfroni • M. E. L. Consolaro Received: 19 July 2012 / Accepted: 25 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Purpose We investigated the frequency of cervical intraepithelial neoplasia (CIN) grade II or worse in low- income Brazilian women with persistent low-grade squa- mous intraepithelial lesions (LSIL). Methods A retrospective review of medical records was performed for all patients who underwent a loop electro- surgical excision procedure (LEEP) with ‘‘see and treat’’ strategy for persistent LSIL seen on Papanicolaou (Pap) smears (persisting [ 12 months in at least two consecutive tests, over a 50-month period. We assessed the colposcopy and histopathology results at the time of the procedure and at follow-up, using Pap and histopathology. Results Of 106 women, 48 (45.3 %) had no dysplasia by histopathology, 18 (17.0 %) had CIN I, 29 (27.4 %) had CIN II and 10 (9.4 %) had CIN III. Among the patients with CIN, 38 (66.7 %) performed the follow-up. Of these, only 4 (10.5 %) were classified as follow-up (?), all had CIN I. Women with initial CIN I had 16.7 % (n = 2) recurrences; those with initial CIN II had 5.9 % (n = 1); and those with initial CIN III had 11.1 % (n = 1) (p [ 0.05). Conclusions A very high proportion of the women with persistent LSIL had CIN II/III on post-LEEP histopathol- ogy. Recurrence rates were equal to than those that origi- nally caused the patients to be subjected to LEEP (LSIL). The benefits of the ‘‘see and treat’’ protocol by LEEP for persistent LSIL outweigh the risk of overtreatment, prin- cipally in low-resource settings where poor patient com- pliance is expected, as in Brazil. Keywords LSIL Á Persistent Á Cytology Á CIN II/III Á Cervical cancer prevention Introduction Cervical cancer is the second most common cancer in women worldwide, and in 2008 was the third leading cause of death in all women [1, 2]. The highest rates of cervical carcinoma are observed in underdeveloped or developing countries, including Brazil, where an incidence of 17,540 new cases of cervical cancer was estimated for 2012 [3]. Squamous cell carcinoma (SCC) of the uterine cervix is the most common type of cervical cancer, and is a slowly evolving disease with preinvasive stages that, if diagnosed early, can allow intervention in the natural course of its pathology. Although, Human Papillomavirus (HPV) test- ing is accepted as an effective mode of cervical screening, cytology is still the mainstay of screening at the present time in underdeveloped countries, including Brazil [4, 5]. The cytology or Papanicolaou (Pap) smear is used to detect preinvasive squamous intraepithelial lesions (SIL) and invasive lesions, and is the method of choice for screening for this type of cancer [6–8]. However, to our knowledge, few cytology services in Brazil and other countries assess the prevalence of more-severe preinvasive lesions, such as P. R. B. Nogara Á M. E. L. Consolaro Clinical Cytology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringa ´, Maringa ´, Parana ´, Brazil L. A. R. Manfroni Division of Gynecology, Sixth Region of Public Health of Parana ´ (CISVALI) Hospital, Unia ˜o da Vito ´ria, Parana ´, Brazil M. E. L. Consolaro (&) Departamento de Ana ´lises Clı ´nicas e Biomedicina—DAB, Universidade Estadual de Maringa ´, Av: Colombo, 5790, Maringa ´, Parana ´ 87020-900, Brazil e-mail: melconsolaro@yahoo.com.br; melconsolaro@gmail.com 123 Arch Gynecol Obstet DOI 10.1007/s00404-013-2872-2