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STD GENITAL WARTS: HOW PAP SMEAR RESULTS ARE REPORTED
Pap smear results are reported in four ways, known as the class system, the CIN (cervical intraepithelial neoplasia) system, the descriptive system, and the Bethesda system. Which system is used depends on the laboratory to which the specimen was sent. The results are reported as follows:
1. Class I
CIN system: normal
Descriptive system: no abnormal cells seen, or negative
Bethesda system: within normal limits
A follow-up Pap smear is recommended in one year.
2. Class II
CIN system: normal, with a description given of any findings that may be unusual
Descriptive system: atypical cells, as seen with cervicitis and other infections
Bethesda system: infection, reactive or reparative changes seen, or atypical cells of unknown significance (ASCUS)
Although this is still a “negative” Pap smear in terms of cancer screening, either infection or “atypical” cells may be seen, and these may or may not be precancerous. Any infection must be identified and treated and a follow-up Pap smear performed, usually in three to six months. If no infection is present, another Pap smear in three to six months is still indicated. In addition to infection, some other causes of these changes may include atrophy (thinning) of the tissues as seen postmenopause and the presence of an intrauterine device. If the abnormalities persist or progress on the follow-up smear, then a colposcopic examination of the cervix is in order.
3. Class III
CIN system: CIN I-III
Descriptive system: dysplasia (mild to severe)
Bethesda system: squamous intraepithelial lesion (low- to high-grade squamous intraepithelial lesion [SIL])
This category encompasses a wide range of possible Pap smear results. In general, the lower the grade or number, the lower the need for concern, although close follow-up is recommended for all women whose Pap results fall into this category. About two-thirds of the lower-grade lesions resolve without treatment.
For the lower-grade lesions (CIN I, mild dysplasia, or low-grade SIL), a follow-up Pap smear should be performed in three to six months, or a colposcopy could be done at the start. If a total of three follow-up Pap smears at six-month intervals come back as normal, then a schedule of yearly Pap smears can be resumed. A colposcopy and a biopsy of suspicious lesions are recommended if the changes do not resolve on their own or if the changes progress to a higher-grade lesion.
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