Management of

Abnormal Pap Smears

Presented by: Kelly Thibert, OMS-III September 2014
Edited by: Dr. Frank Cirisano, MD
Pap Smear
A pap smear checks the cervix (lower part of the
uterus/womb) for abnormal cell changes
Cell samples are taken from the cervix using a blunt spatula
(A) and cytobrush (B)
Cells are placed into a liquid-based medium which is then
used to prepare a slide to be viewed under a microscope
Screening Test Pap Smear
large population testing withhigh sensitivity (ability to
correctly identify patients with abnormal cervical cells)
identifies the true positive patients patients who test
positive and who actually have abnormal cervical cells
willalso identify many false positive patients patients who
test positive but who do NOT have abnormal cervical cells
GOAL : assist in identifying patientswho will need a biopsy
Guidelines - Pap Smears
All women should begin cervical cancer screening 3 years after
they begin having vaginal intercourse, but no later than age 21
Women 21 - 29 should have a Pap test every 3 years (they should
not be tested for HPV unless it is needed after an abnormal Pap
test result)
Women 30 - 65 should have both a Pap test and an HPV test every
5 years (this is preferred, but it is also OK to have a Pap test alone
every 3 years)
Women over age 65 who have had regular screenings with normal
results should not be screened for cervical cancer. Women who
have been diagnosed with cervical pre-cancer should continue to
be screened
Women who have had their uterus and cervix removed in a
hysterectomy and have no history of cervical cancer or pre-cancer
should not be screened
Guideline update Pap Smears
The American Cancer Society no longer recommends that
women get a Pap test every year, because it generally takes
much longer than that, 10 to 20 years, for cervical cancer to
develop and overly frequent screening could lead to
procedures that are not needed
The Abnormal Pap Smear
ASC-US: Atypical squamous cells of undetermined
significance cells somewhat abnormal in appearance
ASC-H: Atypical squamous cells cannot exclude high-grade
squamous intraepithelial lesion cells appear abnormal,
but not enough to be classified as HSIL
LSIL: Low-grade squamous intraepithelial lesion mild/CIN1
changes seen in cells
HSIL: High-grade squamous intraepithelial lesion
moderate/severe/CIN2,3 changes seen in cells
Diagnostic Testing
Small population testing withhigh specificity (ability to
correctly identify patients without abnormal cervical cells)
Identify the true positive patients , whileeliminating the
false positive patients fromscreening
GOAL: assist in finding a true diagnosis requiring treatment
Colposcopy
Abnormal cervical
cells may be
visualized by the
physician, aiding in a
making a diagnosis.
If abnormal tissue is
seen, a biopsy may
also be performed.
This involves
removing small
samples of tissue
from any abnormal
areas in or around
the cervix.
Transformation Zone
Where the two different types of epithelial cells (squamous
and columnar) of the vagina meet one another
This is where cells are most likely to become abnormal
Ablation and Biopsy/Excision
Ablation: destruction of abnormal cervical cells via laser
Biopsy/Excision: removal of abnormal cervical cells via laser
or electrically charged loop
Hysterectomy
Surgery options
Open (abdominal) hysterectomy: hospital
recovery time 3-5 days, total recovery time ~6
weeks
Robotic hysterectomy: hospital recovery time 4-
24 hours, total recovery time ~3 weeks
Cervical Cancer Trends
How you can reduce your risk of
cervical cancer
Get regular Pap tests
Get an HPV vaccine(if you are 26 or younger)
Be monogamous
Use condoms
References
Bate's Guide to Physical Examination and History Taking. 8th ed. Philadelphia: Lippincott Williams
& Wilkins, 2003. Print.
"Gynecologic Cancers." Centers for Disease Control. Centers for Disease Control, 7 Mar. 2014. Web.
11 Sept. 2014. <http://www.cdc.gov/cancer/cervical/basic_info/screening.htm>.
Gynecologic Pathology and Cytopathology. Women's Health and Education Center, 19 Sept. 2012.
Web. 11 Sept. 2014. <http://www.womenshealthsection.com/content/gynpc/gynpc008.php3>.
Simon, Stacy. "New Screening Guidelines for Cervical Cancer." American Cancer Society.
American Cancer Society, 14 Mar. 2012. Web. 11 Sept. 2014. <http://www.cancer.
org/cancer/news/news/new-screening-guidelines-for-cervical-cancer>.
UCSF Department of Medicine. UCSF Department of Medicine, 2014. Web. 11 Sept. 2014. <http:
//id.medicine.ucsf.edu/analcancerinfo/diagnosis/screening.html>.
US Preventive Services Task Force. US Preventive Services Task Force, Mar. 2012. Web. 11 Sept.
2014. <http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancersum.
htm>.
Women'sHealth.gov. U.S. Department of Health and Human Services, 23 Oct. 2013. Web. 11 Sept.
2014. <http://www.womenshealth.gov/publications/our-publications/fact-sheet/pap-test.
html>.