1. Pap Smear (Cytology) Results Classification
- Normal
- Atypical squamous cells of undetermined significance (ASC-US). ASC-US is the most common abnormal Pap test result.
- Low-grade squamous intraepithelial lesion (LSIL)
- High-grade squamous intraepithelial lesion (HSIL)
- Atypical squamous cells, cannot exclude HSIL (ASC-H)
- Atypical glandular cells (AGC).
What is the difference between SIL and CIN?
ASCUS – 1) If high grade, ASC-H, then do a colposcopy. 2) Test HPV and if it is 16 and 18, do a colposcopy. If it’s another HPV, can watch. 3) If it’s from inflammation, then you can watch.
**Note that anything above ASCUS needs a colposcopy.
Unsatisfactory cytology means there were not enough cells per HPF (high power field) for them to tell. You get this if the patient is on their period, has an infection, and in postmenopausal women because of atrophy. If this is the case, treat the infection or repeat when not having a period. For postmenopausal women, treat with Premarin cream (twice per week — check to confirm) for six weeks and then repeat the pap smear.
2. Biopsy Results Classification
- CIN 1
- CIN 2
- CIN 3
- Carcinoma in Situ
- Invasive Cancer
If HPV is positive, separate them by genotype. If HPV 16 and 18, do a colposcopy. If other types, my can watch.
Adenocarcinoma comes from columnar cells. It is more aggressive.
AIS = Adenocarcinoma in situ.
Algorithm for handling abnormal pap smear results:
Pap Smear Results: ASCCP Management Guidelines.
References
http://www.aafp.org/patient-care/clinical-recommendations/all/cw-pap-smears.html
https://www.acog.org/Patients/FAQs/Abnormal-Cervical-Cancer-Screening-Test-Results#difference
http://www.medscape.com/viewarticle/718158_5