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  • Writer's pictureGynecology Pelvic Surgery

Diagnosis and Management of Abnormal PAP Test

What encompasses an abnormal PAP test?

Abnormal PAP test, also known as a PAP smear or cervical cytology, is a screening test used to detect changes in the cells of the cervix, which is the lower aspect of the uterus. The test involves collecting a sample of cells from the cervix during a pelvic exam , which are then examined under a microscope to look for any abnormalities.

The purpose of the PAP test is to detect early sign of cervical cancer or pre-cancer changes in the cervical cells. Most abnormal results do not indicate the presence of cancer but they may suggest the presence of abnormal or potentially pre-cancerous cells that require further investigation, treatment, and/or monitoring.

There are different levels of abnormalities in PAP test results which are categorized based on changes seen in the cells by the pathologist.

Depending on the findings and the level of abnormalities, further tests may be indicated that include colposcopy, and cervical biopsy to assess the severity of the abnormality. Once the diagnosis is determined, further management options are recommended.

How is abnormal PAP test diagnosed?

Once the cells are obtained from the cervix by the Physician, they are subjected to evaluation by a pathologist who will determine the status of the cells including the level of abnormality. The following categories of cells are known currently when evaluating by the pathologist:

  1. Atypical squamous cells of undetermined significance (ASC -US)

  2. Low grade squamous intraepithelial lesions (LGSIL)

  3. High grade lesion cannot rule out high grade (ASC-H)

  4. High grade squamous intraepithelial lesions (HGSIL)

  5. Atypical Glandular Cells

What are the Management Options ?

Depending on the Pap test results and the identified abnormalities, additional tests may be recommended. These may include

  • Colposcopy, which is a more detailed examination of the cervix using a special magnifying device, or an HPV (human papillomavirus) test, unless it was performed before, to check for the presence of high-risk HPV types.

  • Endocervical curettage (ECC)

  • Cervical Biopsy.

Usually ECC and cervical biopsy may be performed during a colposcopy. During ECC and cervical biopsy, a small sample of tissue is removed from the cervix for further examination under a microscope by the pathologist. This helps to determine the extent and severity of the abnormality and whether any precancerous or cancerous changes are present.

How is diagnosis and treatment conducted?

Based on the results of the Pap test, additional tests, and any biopsy findings, the healthcare provider will make a diagnosis and develop a treatment plan, if necessary. Treatment options may include:

  • observation,

  • further monitoring, or

  • procedures to remove abnormal or precancerous cells.

It's essential to follow up with the healthcare provider promptly after receiving an abnormal Pap test result to ensure timely and appropriate evaluation and management of any detected abnormalities. Hence, regular cervical cancer screening is vital for early detection and prevention of consequences of the abnormality.


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