by Marcelle Pick, OB/GYN NP
Women’s health testing: a guide for you
When a laboratory technician looks at the section of cells that was taken from your cervix during your Pap test, they will be searching for indications of specific changes that occur within the cells (cervical dysplasia). These reveal a variety of discrete tiny characteristic changes which the cytologist will then be able to classify according to the Bethesda system. Each category within the Bethesda system (e.g. ASCUS) designates a level of risk. Your healthcare provider will plan their management strategy for your particular case on a standard of care which is directed by that category.
If you ever receive a call informing you that your Pap results are anything other than normal, you will want to know what that means. Women to Women have put some great information together to help explain some of the terminology to make it easier to understand. We hope by giving you information it will help you understand to any suggestions or recommendations your healthcare practitioner may provide. What follows here is a summary of terms and abbreviations which are commonly used to categorize Pap test results.
Normal Pap smear
A normal Pap smear result means that no cell lesions or malignancy have been found. It is important for you to note that although Pap smears are an excellent screening tool, they are not perfect. False negatives do happen on occasion. This is why it’s important to get regular exams. Some changes that can show up on a Pap test that is otherwise normal, include reactive cellular changes, cellular atrophy, and endometrial cells present.
ASCUS is fairly common, but it is not a normal Pap test. This result indicates “atypical cells of undetermined significance.” This is considered to be a very mild irregular reading. Completing HPV testing is the current standard of care for follow-up. If your result is ASCUS and negative for high-risk HPV strains, then repeat Pap testing is normally ordered more frequently for a while in order to watch your immune response, in the hope that you will be able to resolve any of the abnormal cells. If your result is ASCUS and positive for high-risk HPV strains, you will need to have a colposcopy for a diagnosis that is correct.
LGSIL, the next grade of cellular abnormality, indicates a “low–grade squamous intraepithelial lesion.” This low–grade result is seen as an indication that a higher-grade HPV viral strain is probably causing the cell abnormalities. This leads directly to colposcopic evaluation in most cases as the standard of care. It is suspected that at least 60 to 70% of all females carry the viral strain of HPV. This statistic will change as the younger generation that have had the vaccine get older. Young healthy women are likely to clear this without a serious problem, about 60% of them do, but we tend to watch them closely throughout the process. Understanding however, when an older woman’s Pap test is found with this result, it may more worrisome, and she will definitely require closer monitoring after the initial colposcopy.
HGSIL indicates a “high–grade intraepithelial lesion.” This concerns us more, because the HPV virus in this case is more than likely causing moderate to severe changes in the cervix. Colposcopic biopsy is definitely needed to find out what is really there. The biopsy will be sent to a pathologist so they can provide a truer diagnosis. This information will then provide the practitioner with the information they need to develop a plan.
AGUS represents “atypical glandular cells of undetermined significance.” Atypical cells can stem from either the cervix or the uterus. Glandular lesions are harder to detect on a simple colposcopy, so a colposcopy and or endometrial biopsy may be needed for a definite diagnosis. It’s not yet clear if HPV testing is of any help with this category. AGUS is a fairly new classification, so treatment protocol with this continues to develop. See the ASCCP guidelines for more information.
Endometrial cells present
A result showing “endometrial cells present” is concerning especially for post-menopausal women. It can represent endometrial cells that have built up within the uterus, slowly leaking down to the uterus and then noted on the Pap. The overgrowth can come about as the result of higher-grade atypical cells in a location outside the cervix, the uterus being the most likely origin. Endometrial biopsy follows as the next step to provide a more definite diagnosis and to help plan management strategy. If a Pap test shows endometrial cells are present in a pre-menopausal woman, it is often due to simply having had the Pap completed toward the end of your period. Your practitioner will take the date of your last menstrual period into account when determining your need for follow up.
Remember, if you are told your Pap test results are abnormal, or if you’ve been told you have HPV, it doesn’t mean you will get genital warts later. It certainly doesn’t always mean your partner has been unfaithful, although it can be a possibility. Only in very rare cases does it mean you have cancer. These days we know so much more about the changes and what they mean, so we can observe closely if needed and treat correctly. Following your practitioner’s recommendations is vitally important.
It’s also crucial to take good care of yourself, in every area of your life. Eat well and balance your diet with nutritious whole foods which are good for you. Find ways to put away some of your stress and strain and fully relax, even if it’s only for ten or fifteen minutes a day. Rest well. See if you can work even a little exercise into your week. It doesn’t take much to feel so much better. You’re worth it! Seeing how often, when women change their diet, add nutrients, and change their lifestyle that their Paps return to normal, reminds us all that you have more control than your realize when it comes to abnormal Pap results.
For further information, read our full article on abnormal Pap Smears and HPV, including excellent steps to protecting your reproductive health.