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UNDERSTANDING PAP SMEAR RESULTS

A Pap smear collects cells from the cervix (the neck of the uterus). This is the area in which the majority of the cancers of the uterus develop. The clinician will remove cells from the surface and place them onto a glass slide for examination at the laboratory. All Pap smears are examined by either a cyto-technologist or a pathologist. About 95% of all Pap smears are found to be normal. The Pap test, as currently performed, has been largely responsible for reducing the annual death rate from cervical cancer by about 70%. A slight potential for error exists due to sampling or from technical misinterpretation by the laboratory, however, at this time there is no perfect test. Results from Pap smears taken at CSU Bakersfield generally take from seven to ten days following the examination to return to the Student Health Service. Patients will be called by the clinician if the results are abnormal. If the Pap smear results are normal patients will be notified by mail.

Terminology for Pap smear results can be confusing. The following classifications are used nationally to categorize findings and to determine appropriate treatment for abnormal Pap smears. The following classifications use both the terminology from the traditional Papanicolou classification and the Bethesda system introduced in 1988.

"Within Normal Limits/Negative/Class I" - Indicates that no abnormal cells have been detected. If you should experience any unusual symptoms, even after having a negative Pap smear, please consult your clinician.

"Cellular Inflammatory Alterations/Reactive or Reparative Changes" - These phrases indicate to the clinician that there is a minor change in the appearance of some of the cells present. These changes can occur for a wide variety of reasons. If the lab suspects the presence of an infectious organism, it will be indicated. There is no reason for serious concern. Your clinician may recommend treatment and/or a repeat smear in six months or so.

"Atypical Squamous or Glandular Cells of Undetermined Significance" (sometimes reported as Atypical or Class II) - This indicates that there are cells present that are slightly abnormal in appearance but do not necessarily represent a significant abnormality. Studies indicate that in more than 50% of such cases, the next Pap smear will be negative. These changes can result from inflammation or from the very earliest stages of an abnormal growth of cells. In some instances the pathologist will also further classify these changes to suggest that reactive change or pre-malignant change is favored. This is a very subjective distinction. Reactive changes are generally expected to heal without treatment. Pre-malignant changes are those that are expected to persist or progress to a low grade intraepithelial lesion. A repeat smear in three to six months is most often suggested.

"Low Grade Squamous Intraepithelial Lesion/Mild Dysplasia/CIN I/Class II or Class III" - These reports indicate a very early change in the cells that suggests a very early pre-cancerous lesion. Dysplasia is a technical term that means an abnormal development of tissue. Dysplasia is considered a pre-malignant condition. This type of condition may go away without treatment in up to 50% of patients. The simple act of taking the Pap smear may remove some very small growths. The cells may also suggest the presence of human papilloma virus, a virus that causes genital warts. This is a virus that some scientists believe may play a role in the development of cervical cancer. A colposcopic examination is usually recommended. A colposcope is an instrument that allows a clinician to inspect the cervix under high magnification. Very small abnormalities can then be seen. A biopsy to rule out a more serious process and to treat the lesion may also be performed. These are relatively minor procedures that are usually performed in the doctor’s office, and do not require hospitalization.

"High Grade Squamous Intraepithelial Lesion/Moderate or Severe Dysplasia/CIN II or CIN III or Class IV" - These reports indicate that the lab has detected cells which are suggestive of the presence of a pre-cancerous lesion that should be treated. Only a few of these lesions will disappear without treatment, and many will go on to become cancerous if not treated. These lesions tend to grow slowly and can take years to develop. Most clinicians will recommend a colposcopy and a biopsy. These lesions are often still quite small and are usually easily cured by removal of a small amount of tissue. Continued follow-up through Pap smears at regular intervals is vital.

"Carcinoma-in-situ" - This term simply means a cancerous lesion that is confined to the surface and has not spread into surrounding tissue or other areas. Your physician will discuss the best forms of treatment with you. There is a very high rate of cure of this type of lesion.

If cancer is detected your clinician will discuss the type and extent of the disease with you. Even in patients who have cancer, there is a high rate of complete cure. Prompt treatment and closely following your physician’s recommendations are vital.

Resources: A patient’s guide to understanding pap smear results, International Cancer Screening Laboratories, Inc. and Understanding Pap Test Reports: A Review, OB/GYN Nursing & Patient Counseling

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