Pap smear results – What to expect, understanding abnormal findings and the importance of regular check-ups for cervical health.

Vaginal cytology is a screening test used to detect abnormal cells in the cervix, which may indicate the presence of cervical cancer or other cervical conditions. The results of a Pap smear are essential in determining the patient’s subsequent diagnosis and treatment plans. The information obtained from the test is usually presented in a structured format, including the presence or absence of abnormal cells, as well as other important details.

When Pap smear results are received, they are typically reported as one of the following:

1. Negative: A negative result indicates that no abnormal cells were seen and that the cervix appears healthy. This is the ideal outcome as it provides peace of mind that there is no immediate concern for cervical abnormalities or cancer.
2. Positive for abnormal cells: A positive result indicates the presence of abnormal cells, which can be classified as atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL). Further evaluation and follow-up are needed to determine the significance and possible treatment options based on the severity of the abnormalities.

Additionally, the results may indicate the presence of human papillomavirus (HPV), a sexually transmitted infection that is closely related to cervical cancer. It is important to note that not all abnormal Pap smear results indicate the presence of cervical cancer. Other tests, such as a colposcopy or biopsy, may be necessary to confirm the diagnosis and determine the appropriate course of action.

Understanding Pap Smear Results

1. Normal results: When Pap cytology results are “normal,” it means that no abnormal cells have been detected during the exam. This is a reassuring result, as it indicates that the cervix is healthy and the risk of developing cervical cancer is low. However, it is important to remember that a normal result does not guarantee complete protection against all types of cervical abnormalities or cancers. It is still necessary to undergo periodic check-ups, following the recommendations of your healthcare professional.

Note: A normal Pap smear result does not rule out the presence of sexually transmitted infections (STIs) or other conditions. It is essential to discuss any other symptoms or concerns with your healthcare professional, even if the cytology result is normal.

2. Abnormal results: If your Pap smear results show abnormalities, it does not necessarily mean that you have cervical cancer. Abnormal results indicate the presence of atypical cells, which may be precancerous or caused by other factors, such as inflammation or infection. The doctor will evaluate the abnormal cells and recommend additional tests or procedures based on the severity of the abnormalities.

1. ASC-US: Atypical squamous cells of undetermined significance (ASC-US) indicates a minor abnormality in which the cells appear slightly different than usual, but are not definitely precancerous. In these cases, your doctor may recommend additional tests, such as human papillomavirus (HPV) testing, or repeat Pap smears in a few months to monitor any changes.
2. LSIL: Low-grade squamous intraepithelial lesion (LSIL) indicates the presence of mild cellular changes that may be caused by HPV infection. Although most cases of LSIL resolve on their own, your doctor may recommend a follow-up Pap smear or colposcopy to examine the cervix more closely.
3. HSIL: High-grade squamous intraepithelial lesion (HSIL) indicates more significant cellular changes that are more likely to be precancerous. In these cases, the doctor may recommend a colposcopy and biopsy to further evaluate and potentially remove any abnormal cells.

What is a Pap Smear?

During a Pap smear, a healthcare professional will gently insert a speculum into the vagina to get a clear view of the cervix. Next, she will use a small brush or spatula to collect a sample of cells from your cervix. The sample is carefully placed on a glass slide or stored in a liquid medium for analysis in the laboratory. The collected cells are sent to a pathology laboratory, where they are examined by a qualified pathologist to determine if there are any abnormal or precancerous changes.

IMPORTANT NOTE: It is essential to go periodically to Pap smear reviews recommended by your healthcare professional. Detection and precocious treatment significantly improve successful chances in cases of cervical cancer or precancerous conditions. Be sure to consult with your Gynecologist or Primary Care Medicine the adequate review calendar to ensure effective monitoring of cervical health.

• The American College of Obstetricians and Gynecologists (welcoming) recommends that most women begin to have a Pa p-rgeoou tests at 21.
• If the initial results of the Pap smear are normal, it is usually enough with a routine review every three years.
• From the age of 30, women can choose to undergo a joint test, which includes a vaginal cytology and test to detect hig h-risk strains of the human papillomavirus (HPV).

The combination of periodic cytologies and HPV tests has significantly reduced the incidence and mortality of cervical cancer. It is important to note that, although vaginal cytology is an effective screening tool, not diagnose cancer. If an anomaly is detected, other tests, such as a colposcopy or a biopsy, may be necessary to obtain a definitive diagnosis.

The Importance of Regular Pap Smears

The benefits of periodic vaginal cytologies include:

1. Early abnormal cell detection: cytologies are mainly used to identify any abnormal change in cervical cells. These changes could be a sign of precancerous or cancer conditions, which would allow timely intervention and treatment.
2. Prevention of the propagation of the human papillomavirus (HPV): HPV is a frequent sexually transmitted infection that can cause cervical cancer. Periodic Pap smear can help identify the presence of HPV and allow health professionals to take appropriate measures to prevent their progression.
3. Tranquility: routine cytologies provide women tranquility about their cervical health. Thanks to periodic reviews, women can trust their general wel l-being and detect any possible problem early, when it is more treatable.

It is important to note that, although cytologies are incredibly effective in detecting cervical anomalies, they do not definitively diagnose cervical cancer. However, they constitute a fundamental initial screening tool, which allows health professionals to recommend other diagnostic tests if necessary.

“Periodic vaginal cytologies are a simple and effective way that women take control of their reproductive health and prevent the development of cervical cancer.”

Normal Pap Smear Results

When interpreting the results of a vaginal cytology, health professionals usually use a standardized notification system known as Bethesda system. This system classifies the results of cytology into several categories based on the presence of abnormal cells and the probability of cervical cancer. A normal result of cytology is usually classified in the “negative category for intraepithelial lesion or malignancy”, commonly abbreviated as NILM.

Normal results of vaginal cytology:

1. Negative for intraepithelial lesion or malignancy (NILM): This result indicates that abnormal cells or precancerous changes in the sample were not found. It is the most common and desired result of vaginal cytology.
2. Satisfactory for evaluation: This means that the sample obtained during the Pap smear was sufficient for evaluation and no more tests are required.
3. Presence of endocervical cells: the presence of endocervical cells in the sample indicates that the healthcare professional was able to collect cells from the upper cervix, which improves the accuracy of cytology.

Abnormal Pap Smear Results

There are several types of abnormal results of vaginal cytology, classified according to the observed cell changes. These classifications include atypical squamous cells of indeterminate meaning (ASC-US), atypical glandular cells (AGC), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (hsil) and squamous cell carcinoma. Each classification represents a different level of cellular abnormalities, with LSIL and HSIL indicating higher levels of precancerous changes.

Important information:

1. The abnormal results of vaginal cytology do not necessarily indicate cancer.
2. More evaluations and diagnostic tests are required to determine the cause and severity of the anomaly.
3. The most common causes of abnormal results in vaginal cytology include infections, inflammation and hormonal changes.

A common cause of abnormal cytology results is the presence of infections, such as human papillomavirus (HPV). HPV is a sexually transmitted infection that can cause cellular changes in the cervix. Other infections, such as fungal or bacterial infections, can also contribute to abnormal cytology results. Inflammation of the cervix, known as cervicitis, can also cause abnormal cellular changes and is usually caused by infection or irritation.

It is important to note that abnormal cytology results require further evaluation. The doctor may recommend additional tests, such as colposcopy or biopsy, to determine the cause and severity of the abnormality. These tests can provide more detailed information about the status of the cervix and help guide further treatment, if necessary.

Types of Abnormalities Detected

1. Atypical squamous cells of undetermined significance (ASC-US)

• ASC-US is one of the most common types of abnormalities detected on cytology.
• It indicates the presence of squamous cells that appear slightly abnormal but show no clear signs of precancerous changes.
• This result usually requires more tests or additional cytology to monitor any changes.

Note: ASC-US is considered a low-grade abnormality and in many cases the cells can return to normal without any treatment. Regular follow-up and repeat testing is essential to monitor any progression or regression of the abnormality.

2. Atypical squamous cells, not exclusive of high-grade squamous intraepithelial lesion (ASC-H)

• ASC-H is another abnormality that is usually detected during a Pap smear.
• It suggests the presence of squamous cells that appear significantly abnormal, raising concerns about the possibility of high-grade intraepithelial lesions.
• When ASC-H is identified, other diagnostic procedures, such as colposcopy, may be recommended to evaluate the cervix more closely.

Note: ASC-H is considered a high-grade abnormality and may indicate an increased risk of precancerous or cancerous changes. Prompt follow-up and appropriate treatment are crucial to ensure early detection and appropriate treatment if necessary.

Further Evaluation and Treatment Options

One of the first steps in the subsequent evaluation is a colposcopy, which allows a detailed examination of the cervix, vagina, and vulva. This procedure involves the use of a special magnifying instrument called a colposcope, which helps the healthcare professional visually inspect the affected areas in more detail. During colposcopy, a small amount of tissue may also be collected for later analysis through a biopsy.

Evaluation and Treatment Options:

• Colposcopy: Colposcopy is a recommended follow-up procedure for abnormal vaginal cytology results. This process allows healthcare professionals to examine the cervix with a magnifying lens for a more detailed evaluation of any abnormalities detected during cytology.
• Biopsy: In some cases, during colposcopy, a healthcare professional may take a small sample of tissue from the cervix for laboratory testing. This procedure, known as a biopsy, helps confirm the presence of any abnormal cells and determine the appropriate treatment plan.
• Loop electrosurgical excision procedure (LEEP): If biopsy results indicate the presence of precancerous or cancerous cells, a loop electrosurgical excision procedure (LEEP) may be recommended. This procedure involves using a fine wire loop that emits an electrical current to remove affected tissue from the cervix.

It is important to note that each case is unique, and the recommended evaluation and treatment options may vary based on the specific abnormality identified during cytology. Close communication with a healthcare professional is crucial to determining the most appropriate course of action.

Recurring Abnormal Pap Smear Results: What to Do?

In the event of recurrent abnormal results from vaginal cytology, it is important to consult a health professional who can guide and evaluate the situation. A gynecologist or health care professional specializing in women’s reproductive health will be able to evaluate the specific details of the cytology results, take into account the person’s medical history, and offer personalized recommendations. It is essential to address these abnormal results promptly to ensure early detection and appropriate treatment of any potential underlying conditions.

Key steps to keep in mind when dealing with recurrent abnormal Pap smear results:

1. Search for professional guidance: concerns an appointment with a healthcare professional with experience in female reproductive health to comment on the results of your cytology and receive personalized advice. You can explain the implications of anomalies and recommend other tests or treatment options.
2. Soma to follo w-up tests: Depending on the scope of the anomaly, the doctor can suggest additional tests, such as a colposcopy or a biopsy. These tests help to better evaluate abnormal cells and determine the necessary course.
3. Fulfill the recommended screening intervals: even with abnormal results, it is important not to skip or delay future cytologies. Periodic reviews are crucial to control any change and detect possible problems on time.

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Author of the article

Dr.Greenblatt M.

Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont