Cervical Dysplasia

If your pap test has a positive result, this does not necessarily mean you have cervical cancer. There are many different grades of abnormal cells found in your pap smear.  These are the most common terms used to describe abnormal Pap test results:

Atypical squamous cells of undetermined significance (ASCUS) – This is the most common abnormal Pap test result. “Squamous” refers to the type of cells that make up the tissue that covers the cervix. ASCUS means that changes in these cells have been found; this can be a sign of inflammation or human papillomavirus (HPV) infection, although it can indicate a pre-cancerous condition.

Squamous intraepithelial lesion (SIL) – This means that abnormal changes are seen in the cells and may be a sign of pre-cancer. SIL can be either low-grade (LSIL) or high-grade (HSIL).

• LSIL is very common, almost always indicates an HPV infection and usually clears without treatment (but may also indicate mild pre-cancerous changes)
• HSIL indicates more severe changes. Carcinoma in situ (CIS) is a severe form of HSIL and most likely to progress to cancer.

Atypical squamous cells, cannot exclude HSIL (ASC-H) – Testing has found changes in the cervical cells; these changes are not clearly HSIL but could be, and further testing is needed

Atypical glandular cells – This means that cell changes are seen that suggest pre-cancer of the upper part of the cervix or uterus

Cancer – Abnormal cells may have spread more deeply into the cervix or other tissue

Sometimes a Pap test will reveal:

• Endometrial (uterine) cells – These can be normal or abnormal based on when the pap was performed in relation to your menstrual cycle, but normal endometrial cells should not be present after menopause.
• Infections – Sometimes the pathologist reviewing the pap test will see bacteria, yeast or other signs of infection.

The follow up to an abnormal pap depends on both your age and the type of abnormality found. The two most common follow up procedures are a repeat pap test or a colposcopy.

A colposcopy is an in-office procedure that is used to help make a more precise diagnosis and to confirm the results of the pap test.  During this procedure, your doctor takes a closer look at your cervix and vagina using a special instrument called a colposcope.  The colposcope magnifies the area, helping to locate where the abnormal cells came from and possibly take small tissue samples (biopsies) for further evaluation.

If there’s concern about abnormal glandular cells or endometrial cells, your doctor may recommend an endometrial biopsy.

In the case of a diagnosis of severe pre-cancerous cells following a colposcopy, a LEEP procedure most likely will be recommended.  Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue in a woman’s lower genital tract. It is used as part of the diagnosis and treatment for abnormal or cancerous conditions. This procedure can be done in office or in the operating room based on the patient’s preference.