Abnormal Pap Smears

A Pap smear is an examination under the microscope of cells scraped from the tip of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. The Pap smear is done as part of a gynecological exam.

Procedure

You will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina and open it slightly to see inside the vaginal canal.

The health care provider will take a sample of cells from the outside and just inside the opening of the cervix (cervical canal) by gently scraping the outside of the cervix with a wooden or plastic spatula, then inserting a small brush that looks like a pipe cleaner into the canal. The cells are placed on a glass slide, or put in a bottle containing a preservative, and then sent to the lab for examination.

The Pap smear can detect cancerous or precancerous conditions of the cervix. Most invasive cancers of the cervix can be detected early if women have Pap tests and pelvic examinations.

When a Pap smear shows abnormalities, further testing or follow-up is needed. The next step depends on the results of the Pap smear, your previous history of Pap smears, and risk factors you may have for cervical cancer.

Further Testing May Include:

Colposcopy-directed biopsy

An HPV test to check for the presence of the HPV virus types most likely to cause cancer


Result Classifications

The current system divides the abnormal results into these main areas:

  • ASCUS or AGUS (atypical cells of uncertain significance): These changes may be due to infection with HPV but may also mean there are precancerous changes present.
  • LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia): This means precancer changes are likely to be present; the risk of cancer is greater if the result is HSIL.
  • Carcinoma in situ (CIS): This usually means the abnormal changes are likely to progress to cancer.
  • Atypical squamous cells (ASC–H): This means abnormal changes have been found and may be HSIL.
  • Atypical glandular cells (AGC): Cell changes are seen that suggest precancer of the upper part of the cervical canal or inside the uterus.
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