Immediate Loop Electrode Excisional Procedure for High-Grade Cervical Cytology: One Size Fits All?

W e have read with great interest the article authored by McGregor et al., concerning immediate loop excision in young women with high-grade squamous intraepithelial lesion (HSIL) Pap test results. Rather than criticize the authors' article, it sparked upon us some thoughts that deserve consideration when developing management guidelines in the future. Although this approach is obviously a good one in settings such as the one described, with low patient compliance leading to significant loss to follow-up, this may not be generalized to other populations. The lower anogenital squamous terminology lumps cervical intraepithelial neoplasia (CIN) 2 and CIN 3/carcinoma in situ into HSIL, which is logical in biological terms, except for youngerwomen (<30years). In our practice, women with a histological diagnosis of CIN 2, who are younger than 30 years and considered compliant, are offered expectant management. Currently, all cases are triagedwith p16,meaning that those who test negative are not considered to have