Abnormal pap smear

Published on 10/03/2015 by admin

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Chapter 1 ABNORMAL PAP SMEAR (ABNORMAL CERVICAL CYTOLOGIC FINDINGS)

Cervical cytology screening has significantly decreased rates of mortality from cervical cancer; however, 400 women die each year in the United States from cervical cancer, mostly as a result of inadequate screening.

Cervical cytology results are classified according to the Bethesda 2001 system (Box 1-1), which describes the categories of epithelial cell abnormalities. Histologic diagnoses of abnormalities are reported as cervical intraepithelial neoplasia (CIN) grades 1-3.

Box 1-1. The 2001 Bethesda System Categorizing of Epithelial Cell Abnormalities

Glandular Cell

• Atypical glandular cells (AGC)

• Atypical glandular cells, favor neoplastic

• Endocervical adenocarcinoma in situ

• Adenocarcinoma

Modified from Solomon D, Davey D, Kurman R, et al: The 2001 Bethesda System: terminology for reporting results of cervical cytology. Forum Group Members; Bethesda 2001 Workshop. JAMA 2002;287:2114-2119. Copyright © 2002, American Medical Association. All rights reserved.

The glandular cell abnormalities are reported under the following categories: atypical glandular cells (AGC), subcategorized as endocervical, endometrial, or glandular not otherwise specified; AGC, favor neoplastic; endocervical adenocarcinoma in situ; and adenocarcinoma. Also noted are the presence of organisms, including Trichomonas vaginalis and fungal organisms morphologically consistent with Candida species; shift in flora suggestive of bacterial vaginosis; the presence of bacteria morphologically consistent with Actinomyces species; and cellular changes consistent with herpes simplex virus. Other findings that are noted include reactive cellular changes associated with inflammation, radiation, presence of intrauterine device, glandular cell status post hysterectomy, and atrophy.

In 2003, the U.S. Preventive Services Task Force recommended that all women be screened for cervical cancer with a cervical cytologic work-up beginning at age 21 or 3 years after sexual activity begins, whichever occurs first. Screening then should be performed at least every 3 years. Women who are older than 65 years need not undergo routine screening for cervical cancer if they have had appropriate screening and normal Pap smear results in the past. In addition, women who have had a total hysterectomy for a benign reason should not undergo screening for cervical cancer.

Most cases of cervical cancer are associated with infection with high-risk types of human papillomavirus (HPV) which are types 16, 18, 31, 33, 45, 51, 52, 56, 58, 5, 68, 73, and 82. HPV testing is used as an adjunct to the cervical cytologic work-up in women aged 30 years and older, as well as in cases of atypical squamous cells of undetermined significance (ASC-US) to determine whether a colposcopy should be performed.

Other risk factors for cervical cancer include cigarette smoking, immunocompromised status (e.g., human immunodeficiency virus [HIV] infection), early age at onset of sexual activity, multiple sexual partners, and sexual activity with male partners at high risk for sexually transmitted diseases.