Objectives Biopsy proven newly diagnosed Low-grade Squamous Intraepithelial lesions(LGSIL), are considered reversible lesions and as such are usually treated conservatively with follow-up or ablation. In this study we aimed to evaluate the outcome of women with LGSIL who underwent surgical conization, and assess risk factors for higher risk disease.

Methods We performed a retrospective study of all patients who underwent surgical conization for LGSIL disease, in one university affiliated medical center (2012–2017). Study group was defined as patients who had their histological classification upgraded, and control group as patients who were either downgraded or diagnosis remained. Demographics, histological outcome and indications were compared between groups.

Results Overall, 111 patients met inclusion criteria of whom 44(39%) were histologically upgraded, 1 patient was found to have Adenocarcinoma of the cervix. Upgraded women were younger (34y vs 44y, p<0.001), and of lower parity(1.2 vs 2.4, p<0.001). There was no difference between groups as to BMI and smoking. The histologically upgraded women had higher rates of antecedent LSIL Pap smear (35% vs 15%, p<0.001), and higher rate of post-coital bleeding (PCB) as indication for conization (50% vs 23%, p=0.02). Using a logistic regression model adjusting for age, indication and possible confounders, increased age was found to be a protective factor (aOR=0.9 95% CI 0.84 – 0.97), while PCB was a predicting factor for upgrading (aOR=1.1 95% CI 1.003 - 1.195).

Conclusions Contrary to common practice, in this study, younger women with a biopsy diagnosis of LSIL, should be evaluated for high risk disease especially if they report PCB.