Squamous Cells•Low grade squamous intraepithelial lesion(LSIL)•encompassing: mild dysplasia/CIN1(cervical intraepithelial neoplasia)•High grade (HSIL)•encompassing: moderate and severe dysplasia, CIN 2,3•Squamous cell carcinoma
What are the different types of abnormal Pap test results?•Atypical squamous cells of undetermined significance (ASC-US)•changes in the cervical cells have been found, usually due to HPV. ASC-US is the most common abnormal Pap test result.•Low-grade squamous intraepithelial lesion (LSIL)•cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.•High-grade squamous intraepithelial lesion (HSIL)•more serious changes in the cervix than LSIL. It is more likely than LSIL to be associated with precancer and cancer.•Atypical squamous cells, cannot exclude HSIL (ASC-H)•changes in the cervical cells have been found that raise concern for the presence of HSIL.•Atypical glandular cells (AGC)•Glandular cells make up the thin layer of tissue that covers the inner canal of the cervix, and also are present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of precancer or cancer.
Managing Initial Abnormal Pap Test Results•Follow up care should be provided according to the ASCCP 2019 Guidelines : which have replaced the 2012 guidelines/algorithmsHighlights of Initial abnormal pap follow up are as below:•21-24 years of age are managed more conservatively than older Individuals because of potential harms of over treatment and low risk for cancer. In this age group cytology results with ASCUS or LSIL are usually repeated in 12 months verses colposcopy•For individuals with ASCUS cytology : cytology can be repeated in 12 months for individuals of all ages OR Reflex HPV testing can be performed to help triage results •For individuals with ASCUS /Negative HPV results a repeat HPV and pap tests in 3 years is recommended
Managing Initial Abnormal Pap Test Results (cont.)•For individuals with ASCUS positive HR HPV results : a colposcopy is advised only if they are 25 years of age or older•HPV 16 /18 Genotype testing is an option for women who have a negative pap test with Positive high risk HPV detected If the HPV genotype is positive for 16/18 a colposcopy is advisedIf the HPV genotype is negative for 16/18 a repeat Pap/ HPV (co-testing ) is advised in 12 months •LSIL pap in 25 years of age and older : management depends on HPV status / repeat pap in 12 months in HPV negative verses colposcopy if HPV positive •HSIL and AGUS regardless of age always needs referred for Colposcopy or depending on age may go directly to treatment
Management of Abnormal Pap Tests •Repeat testing•Colposcopy•LEEP•Conization•Cryosurgery•Laser Ablation•Hysterectomy
Treatment for Cervical Cancer•Staging•Surgery•Cryosurgery•Laser surgery•LEEP•Cold knife conization•Hysterectomy•Radiation•Chemotherapy