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Abnormal Pap Smears

The Pap smear is a screening test for cancer of the cervix. It was originally developed by Dr. George Papanicolaou in the 1930's to detect cancer of the cervix before it could be seen with the naked eye, in much the same way a mammogram is able to detect breast cancers that are too small to be felt. Since that time, our understanding of how to interpret pap smears has allowed us to detect abnormalities of the cervix before a cancer even develops. Thus, today the pap smear is used not only to detect very early cancer, but more often to prevent a cancer from even developing.

Cancer of the cervix develops when cells on the surface of the cervix begin to divide uncontrollably. This eventually produces a large growth, or tumor, which can be seen with the naked eye. However, cancers rarely develop suddenly. In most cases, it takes several years for a group of normal cells to turn into a cancer. During this time period the normal cells undergo changes in which they become progressively more and more abnormal before finally turning into a cancer. This process is known as dysplasia. A pap smear not only detects cancer, but can detect dysplasia as well. Cells that are only minimally abnormal are said to have mild dysplasia. If left untreated, over time mild dysplasia may become more abnormal and form moderate dysplasia, then eventually severe dysplasia. If severe dysplasia is left untreated, it may go on to form cancer of the cervix.

Credit: UIC Ob/Gyn

Abnormal Pap Smears - Does an abnormal Pap smear mean I have cancer of the cervix?

Not necessarily. While an abnormal Pap smear may be a sign of cancer, many different changes on your cervix can cause an abnormal Pap smear. Pap smears can be abnormal if the cervix is inflamed or irritated. This can be caused by an infection of the cervix, douching, menopausal changes, or irritation. The cervix may also be going through some changes called dysplasia. Dysplasia means the cells on the Pap smear look abnormal under the microscope. Dysplasia isn't the same thing as cancer but may lead to cancer if it is not treated.

Credit: LSUMC Family Medicine

Abnormal Pap Smears - Readings

The two methods commonly used today are the Bethesda System and the CIN Grading System.

The Bethesda System was developed by the CDC and NIH in order to have a comprehensive and standardized method of classifying Pap smear results. It uses the term squamous intraepithelial lesion (SIL) to describe abnormal changes in the cells on the surface of the cervix. Squamous refers to thin, flat cells that lie on the outer surface of the cervix. An intraepithelial lesion occurs when normal cells on the cervical surface are replaced by a layer of abnormal cells, and these changes are classified as high grade or low grade.

Abnormal Pap Smears - Bethesda System

  •     ASCUS (atypical squamous cells of undetermined significance) - Borderline, some abnormal cells
  •     LGSIL (low-grade squamous intraepithelial lesions) - Mild dysplasia and cellular changes associated with HPV
  •      HGSIL (high-grade squamous intraepithelial lesions)- Moderate to severe dysplasia, precancerous lesions, and carcinoma in-situ (preinvasive cancer that involves only the surface cells)
Squamous cell carcinoma
Cervical intraepithelial neoplasia (CIN) refers to new abnormal cell growth. Intraepithelial refers to the surface layers of the cells. The CIN System grades the degree of cell abnormality numerically, CIN I is the lowest and CIN III is the highest.

CIN Grading System

  • Atypia - correlates with ASCUS
  • CIN I - mild dysplasia and correlates with LGSIL
  • CIN II - moderate dysplasia and correlates with HGSIL
  • CIN III - severe dysplasia and correlates with HGSIL
  • Carcinoma in-situ
  • Cervical cancer

Abnormal Pap Smears - ThinPrep Pap Smear

The only method approved to replace the conventional Pap smear is the ThinPrep Pap Smear. Unlike rescreening technologies that reevaluate cell samples a technician has classified as abnormal, the ThinPrep Pap changes the way cell samples are placed on a slide and prepared for analysis.

After collecting cells in the usual way, the healthcare provider using the ThinPrep Pap Test

  • rinses the entire collection device into a vial of preserving solution
  • sends the vial to a laboratory for microscopic analysis

Abnormal Pap Smears - At the laboratory

  • the ThinPrep 2000 processor purifies the cell sample by reducing the amount of blood, pus, yeast, bacteria, mucus, inflammation, and other material it contains
  • deposits a thin, even layer of processed cells onto a slide that a cytotechnologist will analyze

Abnormal Pap Smears - Studies indicate that the ThinPrep Pap Test can

  • detect 65 percent more low-grade and more severe abnormalities in the general population
  • detect six percent more abnormalities in women with cervical cancer risk factors
  • reduce the number of inadequate cell samples by more than 50 percent

Abnormal Pap Smears - Cervical cancer experts are debating whether the ThinPrep Pap Test

  • is likely to have a significant impact on cervical cancer prevention
  • is the best way to improve cervical cancer screening technology
Credit: Your Medicine Source

Abnormal Pap Smears - Alternative Names

Papanicolaou test

Abnormal Pap Smears - Common Misspellings

Papsmear, Pep Smear, Pap Smeer, Pap Smeir, Pap Smier



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ASCUS cells alone should not necessitate a LEEP procedure or cryotherapy.