Bethesda 2001 Pap Smear Report

Interpretation Result

Negative for intraepithelial lesion or malignancy

Infection (Trichomonas vaginalis, Candida spp., shift in flora suggestive of bacterial vaginosis, Actinomyces spp., cellular changes consistent with Herpes simplex virus)

Other Non-neoplastic Findings:

Reactive cellular changes associated with inflammation (includes typical repair) radiation, intrauterine contraceptive device (IUD) Glandular cells status post-hysterectomy Atrophy

Other

Endometrial cells (in a woman >40 years of age)

Epithelial Cell Abnormalities Squamous Cell

Atypical squamous cells

-of undetermined significance (ASC-US) -cannot exclude HSIL (ASC-H) Low-grade squamous intraepithelial lesion (LSIL)

encompassing: HPV/mild dysplasia/CIN 1 High-grade squamous intraepithelial lesion (HSIL) encompassing: moderate and severe dysplasia, CIS/CIN 2 and CIN 3 with features suspicious for invasion (if invasion is suspected) Squamous cell carcinoma Glandular Cell Atypical

-Endocervical cells (not otherwise specified or specify in comments)

-Glandular cell (not otherwise specified or specify in comments)

-Endometrial cells (not otherwise specified or specify in comments)

-Glandular cells (not otherwise specified or specify in comments) Atypical

-Endocervical cells, favor neoplastic -Glandular cells, favor neoplastic Endocervical adenocarcinoma in situ Adenocarcinoma (endocervical, endometrial, extrauterine, not otherwise specified (not otherwise specified)

Other Malignant Neoplasms (specify)

Management of the Abnormal Papanicolaou Smear

Result

Action

Specimen adequacy

Satisfactory for evaluation

Routine follow-up

Unsatisfactory for evaluation

Repeat smear

No endocervical cells

Follow-up in one year for low-risk women with a previously normal smear; repeat in 4-6 months for high-risk women

Atypical cells

Atypical squamous cells of undetermined significance (ASC-US)

HPV testing with referral to colposcopy if positive for high-risk HPV type; if negative for high-risk HPV type, then repeat cytology in 12 months

Special circumstances

Postmenopausal women with atrophic epitheliium may be treated with topical estrogen followed by repeat cervical cytology one week after completing treatment

ASC-H

Immediate referral to colposcopy

Atypical glandular cells (AGS)

Immediate referral to colposcopy with sampling of the endocervical canal. Women over age 35 and any woman with unexplained vaginal bleeding should also have an endometrial biopsy

Intraepithelial neoplasia

High grade

Immediate referral for colposcopy

Low grade

Immediate referral for colposcopy, except adolescents and postmenopausal women

Endometrial cells

Endometrial biopsy in selected cases

Other malignant cells

Referral to a gynecologic oncologist

II. Atypical squamous cells (ASC) is divided into ASC-US, which are qualified as "of undetermined significance," and ASC-H, in which a high-grade squamous intraepithelial lesion (HSIL) cannot be excluded.

A. ASC requires further evaluation, but it does not require treatment. This cytologic diagnosis is common and frequently associated with spontaneously resolving, self-limited disease. The risk of invasive cancer is low, 0.1 to 0.2 percent. However, 5 to 17 percent of patients with ASC and 24 to 94 percent of those with ASC-H will have CIN II or III at biopsy; therefore, further investigation is necessary to determine if underlying high-grade dysplasia is present.

B. Evaluation of ASC-US. Reflex HPV testing is the preferred approach. Reflex testing refers to concurrent collection of cytology and HPV samples with actual testing for HPV only if indicated by cytology results. If liquid-based cytology is used, reflex HPV testing can be performed on the same specimen.

1. Women with a positive test for high- (including intermediate) risk type HPV DNA are evaluated by colposcopy. The sensitivity of this approach for detection of CIN II/III is 83 to 100 percent.

2. Women who test negative for high-risk HPV DNA can be followed with a repeat cervical cytology in 12 months.

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