<prompt> Patient diagnosed as squamous cell intraepithelial lesion which of the following has the highest risk for progression to carcinomaLow grade squamous intraepithelial neoplasiaHigh grade squamous intraepithelial neoplasiaSquamous intraepithelial neoplasia associated with HPV 16Squamous intraepithelial neoplasia associated with HIV  <response>: High grade squamous intraepithelial neoplasia Ref C.G.O.T. 9the p 895, 8961 Cervical lesions are characterized Histologically -- using the CIN nomenclature and Cytologically -4 using the Bethesda system Now the Pap smears are repoed using the Bethesda system which has advocated a standardized repoing system for cytological repos. EPITHELIAL CELL ABNORMALITIES Squamous cell Atypical squamous cell - Of undetermined significance ASC-US - Cannot exclude HSIL ASC-H Low grade squamous intraepithelial lesion LSIL - encompassing HPVmild dysplasiaCIN High grade squamous intraepithelial lesion HSIL - encompassing moderate and severe dysplasia - CIN 2 and CIN 3CIS Squamous cell carcinoma Glandular cell Atypical AGC - endocervical cells - endometrial cells - glandular cells not otherwise specified NOS Atypical, our neoplastic - endocervical cells - glandular cell NOS Endocervical adenocarcinoma in situ AIS Adenocarcinoma - endocervical - endometrial - extrauterine - not otherwise specified NOS Cervical Cytology Screening American College of Obstetricians and Gynecologists Guideline Initial screening Age 21 or 3 y after vaginal sex Interval Every year Every 2-3 y after age 30 with 3 consecutive normals Discontinue No upper limit of age Comparison of Cytology Classification Systems in simplified form Bathesda CIN Dysplasia Limit of histologic changes LSIL CIN 1. Mild Basal 13rd of sq. epithelium CIN 2 Moderate Basal 12 to 23rd HS1L CIN3 Severe Whole thickness except one or two superficial layers CIS Whole thickness 