What Is High-Grade Cervical Dysplasia (HGSIL)?

Find out what this Pap smear result means

Pap smear tools
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In most cases, cervical cancer is a slow-progressing disease that often takes years to develop. Before any cancer develops, the cervix (the narrow neck of a woman's uterus) undergoes abnormal changes called cervical dysplasia. When caught at an early stage, cervical cancer is easier to treat and the survival rates are highest. This is why women undergo regular Pap smear exams to screen for any abnormal changes to the cervix.

When Pap smear results come back abnormal, there are several categories that describe why it was found to be abnormal:

  • ASCUS (atypical squamous cells of undetermined significance)
  • LGSIL (low-grade squamous intraepithelial lesion)
  • HGSIL (high-grade squamous intraepithelial lesion)
  • AGC (atypical glandular cells on a Pap smear)

Although untreated cervical dysplasia may lead to cervical cancer in some cases, having cervical dysplasia does not mean that a person has cancer or will ever develop the disease. It is commonly treated first with monitoring to see if it persists, and then with outpatient procedures in the doctor's office.

What Does an HGSIL Pap Smear Result Mean?

An HGSIL Pap smear result indicates that more defined changes in the size and shape of cervical cells have been detected, which—as mentioned above—indicates moderate-to-severe cervical dysplasia. HGSIL is not cervical cancer yet, but if it's left untreated and unmonitored, then it can lead to cervical cancer.

Confirming an HGSIL Result

If Pap smear results come back as HGSIL, a colposcopy exam is then done to confirm the findings. A colposcopy exam is an in-office procedure that allows a doctor to visually examine the cervix with a lighted instrument called a colposcope. During the exam, the colposcope remains outside of the vagina.

It acts like a microscope, allowing an in-depth view of the cervix. During the colposcopy, the doctor may also do a cervical biopsy, a procedure that removes small pieces of cervical tissue. The tissue samples are then sent to a lab for further examination. Think of a colposcopy as a more in-depth Pap smear. 

Types of Treatment

If cervical biopsy results confirm HGSIL, then treatment to remove abnormal cervical tissue is necessary in order to prevent the possibility of cervical cancer in the future. Possible treatments for HGSIL include:

  • Loop Electrosurgical Excision Procedure (LEEP): During a LEEP, an electric current is sent through a wire loop. The wire loops act as a knife, removing abnormal cervical cells.
  • Cryotherapy: Cryotherapy is a technique that's used to destroy abnormal tissue by freezing it. It is also called cryosurgery.
  • Conization: Also called a cone biopsy, conization removes a larger, cone-shaped sample of abnormal tissue.
  • Laser Therapy: During laser therapy, a tiny beam of light is used to destroy abnormal cells.

Follow-Up Care After Treatment

Following up after treatment for HGSIL is absolutely necessary. Cells can become abnormal, despite treatment, and may require further treatment.

Following up consists of regular Pap smears and colposcopy exams for an extended period of time. 

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