Abnormal PAP Results Inflammation, ASC-US & ASC-H LSIL, HSIL
By Dr. Shehrebanu Merchant
What is a Pap test?
The Pap test or Pap smear checks for abnormal cells of the cervix. It is used as a screening test for cervical cancer.
What does my abnormal result mean?
Inflammation, ASC-US & ASC-H:
Squamous cells make up the outer-most layer of the cervix and vagina. Glandular cells are the cells from inside of the cervix. These are the cells that are collected for a Pap smear test.
Atypical squamous cells (ASC) is the term used to describe squamous cells that are not normal in appearance, but are not distinctly pre-cancerous. This term is further subdivided into two categories: undetermined significance (ASC-US) and cannot rule out a high-grade lesion (ASC-H).
Squamous cells may also appear normal in character, but have some evidence of irritation and be classified as Inflammation.
What does my abnormal result mean?
Inflammation, ASC-US & ASC-H:
Squamous cells make up the outer-most layer of the cervix and vagina. Glandular cells are the cells from inside of the cervix. These are the cells that are collected for a Pap smear test.
Atypical squamous cells (ASC) is the term used to describe squamous cells that are not normal in appearance, but are not distinctly pre-cancerous. This term is further subdivided into two categories: undetermined significance (ASC-US) and cannot rule out a high-grade lesion (ASC-H).
Squamous cells may also appear normal in character, but have some evidence of irritation and be classified as Inflammation.
LSIL & HSIL:
Squamous cells make up the outer-most layer of the cervix and vagina. Glandular cells are the cells from inside of the cervix. These are the cells that are collected for a PAP smear test. When there is a change noted in these cells, the PAP smear may come back with a label of Low-Grade Squamous Lesion (LSIL). LSIL is usually due to a mild cellular change.
When a moderate or severe change in the squamous cells of the cervix is seen on the PAP smear, it may be labeled as High-Grade Squamous Intraepithelial Lesion (HSIL). Women with HSIL have a higher risk of developing cancer if this abnormality is not treated. The good news is that if the precancerous lesion is removed or destroyed, cervical cancer can usually be prevented.
What are my treatment options?
Inflammation, ASC-US & ASC-H:
For a Pap result of Inflammation, a repeat Pap test is recommended in 12 months to ensure that no further changes have taken place.
In women older than 21 years old, with a Pap result of ASC-US there are several treatment options, depending on whether high risk human Papillomavirus (HR-HPV) was also detected. These include:
- If you have ASC-US without HR-HPV, you can repeat the Pap smear in 6-12 months. If this Pap is normal, then you can return to routine screening.
- 2. If you have ASC-US with HR-HPV you are at an increased risk for developing cervical cancer, and it is recommended that you have a colposcopy done to evaluate your cervix. The American Society Colposcopy and Cervical Pathology (ASCCP) guidelines recommend immediate colposcopic evaluation.
ASC-H is more likely than ASC-US to be caused by a pre-cancerous lesion and a colposcopy should be done.
LSIL & HSIL:
Women with Low-Grade Squamous Lesion (LSIL) on their PAP require further testing. We recommend a colposcopy and cervical biopsy be done for these women because 12-16% of women with LSIL have a pre-cancerous lesion.
As with LSIL, patients with HSIL on their PAP results also require further evaluation with a colposcopy and cervical biopsy. Further treatment options will be discussed with the biopsy results.
What about my partner?
Many times, cervical changes are due to the Human Papillomavirus (HPV). To decrease your chances of becoming infected with HPV, you should use condoms with sexual intercourse. This will help to decrease your risk of getting HPV, as well as spreading HPV.
Dr. Merchant is a board-certified obstetrician and gynecologist who has been practicing in the Northwest suburbs of Chicago for the last 27 years.
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