Abnormal Pap Smear
What is a normal pap smear result?
NILM - Negative for intraepithelial lesion or malignancy
What is an abnormal pap smear result?
In short, anything that’s not NILM. Listed below are possible abnormal results for the pap smear, meaning, for the cells of the cervix.
ASCUS - Atypical squamous cells of undetermined significance. This means slightly abnormal cells. This change can happen from HPV, or other infections like yeast, gonorrhea or chlamydia. It can also occur due to menopause
LSIL - low grade squamous intraepithelial lesion. This means the cells are showing some changes, but there is a lower risk of progressing to cancer
HSIL - high grade squamous intraepithelial lesion. This means the cells are showing significant change, and there is a higher risk of progression to cancer
ASC-H: Atypical squamous cells, cannot rule out high grade. This means that the cells are abnormal, but don’t quite meet the criteria for high grade. However, the changes are enough to have concern it could be high grade
AGC: Ayptical glandular cells. There are glands in the cervix and in the uterus. This means the glandular cells are abnormal
Cancer: Squamous cell carcinoma is the most common type of cervical cancer. Adenocarcinoma is the other type
Often, a test for HPV will also be performed.
HPV+ is considered an abnormal result, despite the high prevalence of HPV. Most labs only test for “high risk HPV,” meaning the strains of HPV that are most likely to cause cervical cancer. The most cancerous strain is HPV16, followed by HPV18. Other strains can still lead to cancer, but these two are the most worrisome.
What should I do if my pap smear is abnormal?
It depends.
As mentioned in Pap Smears 101, I recommend you keep track of your prior pap smear results. Using your current result in addition to previous results determines what is the best next step. One possibility is observation. Observation means the pap smear will be repeated in a sooner interval than if it had been normal, such as in 1 year or in 3 years, instead of 5 years.
The other possibility is that you made need a colposcopy.
Your doctor should let you know which course of action is recommended, based on your personal history and current result.
What is a colposcopy?
A colposcopy is a procedure to take a closer look at the cervix after an abnormal pap smear. As a patient, it feels very similar to a pap smear, in that you are in the same position and have the speculum placed. The doctor then looks through a device called a colposcope, which is kind of like a cross between a microscope and binoculars. The doctor will then place acetic acid (vinegar) on the cervix. The vinegar will highlight any abnormal cells. This shows us where to take biopsies, if needed.
What do the biopsy results mean?
If there are pre-cancerous changes in the cervix, it will be called cervical intraepithelial neoplasia, or CIN.
CIN is rated on a scale of 1, 2 or 3.
CIN-3 is the most worrisome, and should be treated with an excisional procedure to prevent the development of cancer. CIN-1 can typically be observed, meaning monitored with another pap smear next year. CIN-2 treatment plan depends on the patient age and plans for pregnancy, so it should be discussed with your doctor.
