The Pap test is a procedure that collects cells from the cervix and vagina for examination under a microscope. Its main use is as a screening test for cervical cancer, which is linked to human papilloma virus (HPV). The treatment of an abnormal result depends on the specifics, with more severe abnormalities requiring more involved management.
Atypical Squamous Cells of Undetermined Significance (ASC-US)
An ASC-US result means that changes have been found in the cells examined, but their behavior is unknown. It could be of no significance, or it could be related to an HPV infection. Another possibility is a precancerous condition. Several options exist for followup, depending on resources and the level of concern. Typically the sample will be processed to test for the presence of HPV, and if this is confirmed the specific type will be determined. Certain types of HPV pose a greater risk for cervical cancer. Repeat Pap testing in 6 and 12 months may also be recommended. In certain cases, colposcopy may be elected. Colposcopy is a direct magnified examination of the cervix accompanied by special tests, and, at times, acquisition of a tissue sample, or biopsy. Further actions can be determined by the results of the biopsy.
Atypical Glandular Cells (AGC)
Abnormal glandular cells seen on a Pap smear result could indicate a cancer in the lining of the uterus. Further testing is recommended in the form of colposcopy, HPV testing and microscopic examination of cells taken from the endometrium, or uterine lining. Treatment will depend on the results of these tests, and could be quite involved if endometrial cancer is detected.
Low-Grade Squamous Intraepithelial Lesion (LSIL)
An LSIL pap test result usually leads to further testing in the form of colposcopy. Typically, no further treatment is necessary, and in fact, many of these abnormalities will resolve on their own with time, as noted in the American Congress of Obsetricians and Gynecologists pamphlet. However, if not, or if they progress, invasive treatment may be necessary to kill or remove the abnormal cells.
High-Grade Squamous Intraepithelial Lesion (HSIL)
An HSIL Pap finding is the most concerning and normally triggers immediate treatment. Colposcopy and biopsy is a common first step. In some cases a Loop electrosurgical excision procedure (LEEP) is performed. This procedure involves removal of the portion of the cervix containing the abnormal cells using an electric wire. This may also be accomplished with a cone biopsy, which is performed with a scalpel in an operating room. Other options for destroying the abnormal cells involve freezing or laser treatments.
References
- National Guideline Clearinghouse: Initial management of abnormal cervical cytology (Pap smear) and HPV testing
- American Congress of Obstetricians and Gynecologists: Understanding Abnormal Pap Test Results
- American Society for Colposcopy and Cervical Pathology: Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests
