What do endocervical cells present mean on a Pap smear. How are squamous metaplastic cells interpreted in Pap test results. When should you be concerned about atypical cells on a Pap smear. What further tests might be needed after an abnormal Pap result.

Decoding Pap Smear Results: Endocervical and Squamous Metaplastic Cells

Pap smears are crucial screening tools for cervical health, but the terminology used in results can be confusing. Two common phrases you might encounter are “endocervical cells present” and “squamous metaplastic cells present.” Understanding these terms can help alleviate concerns and provide insight into your cervical health.

What are Endocervical Cells?

Endocervical cells are mucus-producing glandular cells located in the inner cervix (endocervix). When your Pap smear results indicate “endocervical cells present,” it simply means that cells from this area were collected during the test. This is a normal finding and doesn’t indicate any abnormality or cause for concern.

Significance of Squamous Metaplastic Cells

Squamous metaplastic cells are flat, thin cells found in various tissues throughout the body, including the outer surface of the cervix (ectocervix). The presence of these cells in a Pap smear typically indicates normal cellular growth and repair processes. It’s important to note that while most cervical cancers are squamous cell carcinomas, the presence of squamous metaplastic cells alone does not indicate cancer.

Understanding Atypical Squamous Cells (ASC-US) in Pap Results

Sometimes, Pap smear results may show atypical squamous cells of undetermined significance (ASC-US). This finding warrants attention but isn’t necessarily cause for alarm. ASC-US indicates that irregular cells were found, but their cause couldn’t be determined definitively.

Potential Causes of ASC-US

• Human Papillomavirus (HPV) infection
• Inflammatory changes in the cervix
• Noncancerous cervical changes

If ASC-US is detected, your healthcare provider may recommend additional testing, such as an HPV test, to determine the underlying cause and appropriate next steps.

Squamous Intraepithelial Lesions (SIL): What You Need to Know

Squamous intraepithelial lesions (SIL) are another finding that may appear on Pap smear results. These lesions are categorized as either low-grade (LSIL) or high-grade (HSIL), indicating the potential risk of developing into cervical cancer.

Low-Grade vs. High-Grade SIL

LSIL suggests a lower risk of cancer development, while HSIL indicates a higher risk. In cases of HSIL, your doctor may recommend a colposcopy for further examination and potentially a biopsy of any suspicious areas.

Colposcopy: A Closer Look at Cervical Abnormalities

A colposcopy is a diagnostic procedure that allows for detailed examination of the cervix. During this procedure, a healthcare provider uses a colposcope, which is essentially a microscope with a bright light, to magnify and closely inspect the cervical tissue.

What Happens During a Colposcopy?

1. The cervix is visualized using the colposcope
2. A vinegar solution may be applied to highlight any abnormal areas
3. Biopsies of suspicious tissue may be taken for further analysis
4. Results are typically available within a week or two

Endocervical Cells and Cancer: Separating Fact from Fear

The presence of endocervical cells in a Pap smear is generally not a cause for concern. However, in rare cases, cancer cells may be detected in the endocervix. If this occurs, your Pap smear results may indicate a form of carcinoma, such as adenocarcinoma or squamous cell carcinoma.

Types of Cervical Cancer

• Squamous cell carcinoma: Originates in the flat, thin cells of the ectocervix
• Adenocarcinoma: Develops from the glandular cells of the endocervix

Is the presence of endocervical cells always indicative of cancer? No, endocervical cells are typically a normal finding in Pap smear results. Their presence simply confirms that the sample included cells from the inner cervix, which is important for a comprehensive evaluation.

Decoding Common Phrases in Pap Smear Results

Understanding the terminology used in Pap smear results can help you have more informed discussions with your healthcare provider. Here’s a breakdown of some common phrases you might encounter:

Normal Results

• Endocervical cells present: Cells from the inner cervix were sampled and appear normal
• Squamous metaplastic cells present: Changes in cervical cells were observed but are not concerning
• Negative for intraepithelial lesions or malignancy (NILM): No signs of precancerous or cancerous changes
• Transformation zone component present: Cells from the cervical canal were collected

Results Requiring Further Investigation

• Atypical squamous cells of uncertain significance (ASC-US): Irregular cells of unknown cause
• Low-grade squamous intraepithelial lesion (LSIL): Mild cell changes that may resolve on their own
• High-grade squamous intraepithelial lesion (HSIL): More severe cell changes that may require treatment

When to Seek Further Testing After a Pap Smear

While many Pap smear results are normal or show minor irregularities that resolve on their own, certain findings may necessitate additional testing or follow-up care.

Indications for Further Testing

• Persistent ASC-US results
• LSIL or HSIL findings
• Atypical glandular cells
• Presence of HPV, particularly high-risk strains

What types of follow-up tests might be recommended? Depending on your specific results, your healthcare provider may suggest:

1. HPV testing
2. Repeat Pap smear in 6-12 months
3. Colposcopy with or without biopsy
4. Endocervical curettage

The Importance of Regular Pap Smears in Cervical Health

Regular Pap smears are crucial for early detection of cervical abnormalities and potential cancer. The frequency of screening may vary based on age and individual risk factors.

Recommended Screening Guidelines

• Ages 21-29: Pap smear every 3 years
• Ages 30-65: Pap smear and HPV test every 5 years, or Pap smear alone every 3 years
• Over 65: May discontinue screening if previous results have been consistently normal

How effective are Pap smears in detecting cervical cancer? Pap smears have significantly reduced cervical cancer rates by detecting precancerous changes early, allowing for timely intervention and treatment.

Managing Anxiety After Abnormal Pap Smear Results

Receiving abnormal Pap smear results can be anxiety-inducing, but it’s important to remember that many abnormalities are not indicative of cancer and often resolve on their own.

Coping Strategies

• Educate yourself about the specific findings in your results
• Discuss your concerns openly with your healthcare provider
• Seek support from trusted friends or family members
• Consider joining a support group for women with similar experiences
• Practice stress-reduction techniques such as meditation or yoga

Remember, an abnormal result doesn’t necessarily mean you have cancer. It’s an indication that further investigation is needed to ensure your cervical health.

Lifestyle Factors That Influence Cervical Health

While regular Pap smears are essential for early detection, certain lifestyle choices can impact your overall cervical health and potentially influence Pap smear results.

Factors That May Affect Cervical Health

• Smoking: Increases risk of cervical cancer and abnormal Pap results
• Sexual activity: Multiple partners or early sexual debut may increase HPV exposure
• Immune system health: Compromised immunity can affect the body’s ability to fight HPV
• Diet: A balanced diet rich in fruits and vegetables may support cervical health
• HPV vaccination: Can significantly reduce the risk of cervical abnormalities

How can you promote optimal cervical health? Consider adopting these practices:

1. Quit smoking or avoid secondhand smoke
2. Practice safe sex and limit sexual partners
3. Boost your immune system through a healthy lifestyle
4. Consume a nutrient-rich diet
5. Stay up-to-date with HPV vaccinations and regular screenings

The Role of HPV in Cervical Health and Pap Smear Results

Human Papillomavirus (HPV) plays a significant role in cervical health and is closely linked to abnormal Pap smear results and cervical cancer development.

Understanding HPV and Its Impact

• HPV is a common sexually transmitted infection
• There are many strains of HPV, but only some are considered high-risk for cervical cancer
• Most HPV infections clear on their own within 1-2 years
• Persistent high-risk HPV infections can lead to cervical cell changes and potentially cancer

Why is HPV testing often combined with Pap smears? Co-testing with HPV and Pap smears provides a more comprehensive assessment of cervical health, allowing for earlier detection of potential issues and more targeted follow-up care.

Advances in Cervical Cancer Screening and Prevention

The field of cervical cancer screening and prevention is constantly evolving, with new technologies and approaches emerging to improve detection and reduce cancer rates.

Recent Advancements

• HPV primary screening: Using HPV testing as the primary screening method in some cases
• Liquid-based cytology: Improving the quality and accuracy of Pap smear samples
• Computer-assisted screening: Utilizing AI to help identify abnormal cells
• Self-sampling methods: Allowing women to collect their own samples for HPV testing
• Extended-genotype HPV testing: Identifying specific high-risk HPV strains

How might these advancements impact cervical cancer screening in the future? These technologies have the potential to increase screening accuracy, improve accessibility, and provide more personalized risk assessment and management strategies.

Navigating Healthcare Systems: Ensuring Regular Cervical Screening

Access to regular cervical screening is crucial for maintaining cervical health, but navigating healthcare systems can sometimes be challenging.

Tips for Ensuring Regular Screening

• Set reminders for when your next Pap smear is due
• Research free or low-cost screening options in your area
• Discuss any financial concerns with your healthcare provider
• Consider mobile screening clinics or community health centers
• Advocate for yourself and prioritize your cervical health

What resources are available for those without insurance or with limited access to healthcare? Many countries offer national screening programs, and organizations like Planned Parenthood provide affordable cervical cancer screening services. Additionally, some local health departments and community clinics offer sliding scale fees based on income.

The Psychological Impact of Pap Smear Results

The psychological impact of Pap smear results, particularly abnormal ones, should not be underestimated. It’s important to address the emotional aspects of cervical screening and results.

Addressing Emotional Responses

• Anxiety and fear are common reactions to abnormal results
• Some women may experience feelings of guilt or shame
• Uncertainty about the future can be distressing
• The wait for follow-up appointments can be emotionally challenging
• Cultural beliefs and stigma may influence emotional responses

How can healthcare providers better support patients emotionally during the screening process? Providers can:

1. Offer clear, compassionate communication about results
2. Provide resources for emotional support and counseling
3. Encourage patients to ask questions and express concerns
4. Offer timely follow-up and clear next steps
5. Be sensitive to cultural and individual differences in coping strategies

The Future of Cervical Health: Research and Innovations

The field of cervical health is continually evolving, with ongoing research and innovations aimed at improving prevention, detection, and treatment of cervical abnormalities and cancer.

Emerging Areas of Research

• Development of more effective HPV vaccines
• Exploration of biomarkers for more precise risk assessment
• Investigation of novel therapeutic approaches for cervical lesions
• Studies on the microbiome’s role in cervical health
• Research into personalized screening and treatment protocols

What potential breakthroughs might we see in cervical health in the coming years? Possible advancements include:

1. Single-dose HPV vaccines for improved global coverage
2. Non-invasive screening methods using blood or urine samples
3. Targeted therapies for specific HPV strains or cervical lesions
4. AI-driven risk prediction models for more personalized screening schedules
5. Immunotherapy approaches for treating cervical cancer

As research progresses, these innovations have the potential to further reduce cervical cancer rates and improve outcomes for women worldwide.

Endocervical and Squamous Metaplastic Cells on a Pap Smear

Seeing squamous metaplastic or endocervical cells on your Pap smear test results may raise some questions and concerns. However, the presence of these cells isn’t usually a cause for concern.

The phrase “endocervical cells present” simply means that your doctor sampled cells from the inside of your cervix during the Pap smear. The phrase “squamous metaplastic cells present” means that the pathologist who examined your Pap smear found cells that were growing and repairing themselves regularly.

In this article, we take a look at squamous and endocervical cells and what they mean on a Pap smear test result. We also decode the meaning of other terms that may show up on a Pap test. Read on.

Squamous cells are types of cells found in various tissues throughout your body, including:

• your skin
• the outer surface of the cervix (ectocervix)
• the linings of your organs

When changes occur within these thin, flat-shaped cells, they may be described as metaplastic.

Most cancers of the cervix and vagina are squamous cell carcinomas. However, the presence of squamous metaplastic cells in your Pap test results doesn’t automatically mean cancer. It just means that these cells were sampled during the Pap smear and that the pathologist who examined them found them to be growing in a standard manner.

Atypical squamous cells of undetermined significance (ASC-US)

If the pathologist finds atypical squamous cells of undetermined significance (ASC-US), this usually means that the pathologist has found irregular cells and could not determine why they were irregular.

This could mean that you have an HPV infection, in which case your doctor will need to conduct further testing for HPV to confirm. The irregular cells could also be due to other inflammatory or noncancerous changes of the cervix that will likely resolve on their own.

Squamous intraepithelial lesions (SIL)

Squamous cells that may be precancerous or more likely to turn into cancer are described on a Pap test result as squamous intraepithelial lesions (SIL). These may be further classified as low-grade (LSIL) or high-grade (HSIL), indicating a low to high risk of cancer development.

In the case of HSIL, your doctor may recommend further examination of these cells using a colposcopy.

A colposcopy allows a doctor to examine your cervix under magnification using a colposcope, which is a microscope with a bright light. They can also take tissue samples of irregular cells that can be sent to a lab for further examination by a pathologist.

Endocervical cells are mucus-producing glandular cells located within the inner cervix (endocervix). During a Pap smear, your doctor or nurse may take a sample of these cells, but not always.

If your Pap smear results doshow that endocervical cells are present, it means that your test included cells from your endocervix as part of the sample examined under a microscope. It’s standard to have endocervical cells, and their presence does not indicate cancer or precancer.

However, if cancer cells are detected in the endocervix, your Pap smear may indicate some form of carcinoma. Adenocarcinoma or squamous cell carcinoma are the two most common cell types for cancers of the cervix.

Your doctor will most likely recommend a colposcopy to examine these areas in more detail and gather tissue samples.

While your Pap smear results may indicate a standard result, it can be concerning to see codes and phrases and not know their meaning. If your doctor recommends further testing, it’s helpful to understand what your Pap test results show so that you can have an informed discussion with your doctor.

Below is a breakdown to help you decode common phrases you may see on both a standard and irregular Pap test result:

Phrases associated with standard results

Phrases that may mean you need further testing

If your Pap smear results are standard, you do not need to take any further action. Unless told otherwise by your doctor, you may stick to your regular Pap testing schedule.

On the other hand, if any irregularities are found, your doctor will likely order further testing. According to the American Cancer Society, next steps could include:

• a physical exam
• blood testing
• a follow-up Pap test in 1 year
• HPV testing
• colposcopy to examine the cervix, especially if your HPV test is positive
• cervical biopsies, which consist of tissue samples taken directly from the cervix for further lab testing

How often should you have a Pap smear?

The general guidelines for Pap smears are as follows:

• Ages 21 to 29. Every 3 years.
• Ages 30 to 64. Every 3 years or a combination of Pap and HPV testing every 5 years.
• Age 65 and older. Your doctor may recommend that you stop having regular Pap smears if you have never had an irregular result and have had at least two negative tests in a row.

If you’ve recently had an irregular Pap smear or are considered to be at high risk for cervical cancer, your doctor may recommend more frequent testing.

You should also still see your OB-GYN annually. Pap smear guidelines change often, and your doctor can let you know if and when you need a Pap smear or other gynecological testing.

Was this helpful?

When it comes to reporting Pap smear test results, most medical professionals will either tell you that your results were standard or that you may need to undergo further testing to confirm possible irregularities.

It’s important to discuss any concerns about your Pap smear results with your doctor. Also follow any next steps, including further testing recommendations.

Cervical cancer screenings are designed to detect possible precancer and cancerous cells for the earliest possible treatment.

Endocervical Cells and Pap Test

Every time I go for my yearly Pap smear exam, my cytology report comes back saying “no endocervical cells present. ” My ob-gyn says this is not unusual after menopause. I keep thinking if they are not looking at cervical cells, then what good is the Pap test for me? I could have cervical cancer and it would not be detected. What is your thought on this dilemma, and what can I do about it?

A Pap smear involves lightly scraping the surface of the cervix to collect cells. A pathologist then examines a Pap smear under a microscope, looking for two types of cervical cells: squamous cells, which are typically found in the outer surface of the cervix, and columnar endocervical cells, which come from the lining of the narrow opening in the cervix leading to the inside of the uterus (the endocervical canal).

Pathologists report on the appearance of both types of cells, and they report if no endocervical cells are seen, as in your case. Your ob-gyn is correct that this is not unusual in a woman who has gone through menopause. The reason is that after menopause, the cervix may be less pliable and the transformation zone (the section of the endocervical canal where squamous cells begin to change to columnar cells) moves higher up the cervical canal, making it more difficult to routinely obtain endocervical cells. However, in a premenopausal woman, the transformation zone is fairly close to the opening of the cervix, allowing the smear to capture both types of cells easily.

It will probably be reassuring to you to know that all the Pap smears that you have had did indeed look at the surface cells of the cervix, so the test has still been useful. Women whose Pap smears show no endocervical component but who have had otherwise normal results and are not seeing abnormal bleeding or other symptoms generally do not need another Pap smear performed until the next annual examination.

At your next yearly exam, you could discuss with your ob-gyn your concern about prior Pap smears lacking an endocervical component. He or she may be able to make a special effort to reach the endocervical canal with the Pap instrument. Sometimes, if it is difficult to reach the cervical canal, a small brush can be inserted into the canal to obtain the endocervical component.

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Cytological examination with Leishman’s stain (with a description of the cytogram), 2 slides, Papanicolaou’s stain hand over in Moscow

PAP test, or cytological examination of smears from exo- and endocervix by the Papanicolaou method, is a screening method for diagnosing cervical pathology. This type of cytological examination is recommended by most communities and is included in modern clinical guidelines. For the purposes of this analysis, PAP test is carried out by the classical method, namely the material is applied to the glass. Smears are taken by a doctor using special endobrushes (cytobrushes) for isolated smears from the surface of the cervix (exocervix) and from the cervical canal. Smears are applied to glass, which will later be sent to cytologists to evaluate the material obtained. The Papanicolaou method is the most accurate examination of exo- and endocervix cells. Unlike other methods, several complex stains are used to better stain the cytoplasm and nuclei. The smear is also fixed with 96% alcohol. This technique reduces the number of errors made due to insufficient preparation of the material directly for the study, and also allows cytologists to evaluate the most stained material. The description of the cytogram is always detailed, and the conclusion is according to the existing classification of Bethesda.

Smear quality assessment:
The material is complete, contains cells of flat and cylindrical epithelium in sufficient quantity.

Unsatisfactory for assessment (uninformative) material, Poor number of cells or their absence.

Cytogram within normal limits (NILM):
Contains cells of the superficial and intermediate layers of stratified squamous epithelium, metaplastic epithelium cells, leukocytes, cylindrical epithelium cells, endometrial epithelial cells.

Metaplasia (normal), squamous metaplastic epithelium cells indicate that the material was taken from the transformation zone.

Reactive changes:
Cytogram of inflammation, degenerative and reactive cell changes, inflammatory atypia, squamous metaplasia, hyperkeratosis, parakeratosis, koilocytosis and other signs of viral damage.

Atrophy, cells of basal and parabasal types – small cells with a hyperchromic nucleus and poor cytoplasm. They can often be misinterpreted as cells with atypia, giving a false positive cytology result.

Pathological changes in the epithelium:
ASCUS (atypical squmous cells of undetermined significance) Changes that are difficult to differentiate between reactive epithelial changes and dysplasia. In ASCUS, cells are detected that are difficult to interpret – cells with dyskaryosis, enlarged and hyperchromic nuclei. Dynamic observation and additional examination is recommended, namely, repeated cytological examination after 6 months and HPV testing. In case of confirmation of ASCUS and the presence of human papillomavirus of high oncogenic risk, a colposcopy is performed. Studies show that 20% of women with ASC have dysplasia after a more thorough examination.

Precancerous changes:
LSIL (CIN I), a mild intraepithelial lesion involving human papillomavirus infection. Surveillance without active therapy is recommended. In most women, LSIL regresses on its own within a few years. All changes with low malignant potential are grouped into this group, since the cytologist often cannot distinguish between changes in HPV infection and CIN 1.

HSIL (CIN II-III), moderate to severe intraepithelial lesion. It is recommended to remove all affected tissues by the method (conization) with subsequent morphological examination. This group includes all changes with a high malignant potential.

AGC (atypical glandular cells), Atypical cells of the columnar epithelium. Curettage of the cervical canal for histological examination is recommended.

Tumor changes:
Squamous cell carcinoma, a malignant tumor of the squamous epithelium.

Glandular cancer, a malignant tumor of the glandular epithelium of the endocervical type.

Endometrial cancer, a malignant tumor that develops from the lining of the uterus and grows into the cervical canal.

Pap test. What do the abbreviations say?

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Pap test. What do the abbreviations say?

Every woman who has ever been to a gynecologist knows that at the reception they will definitely take smears from her, including for a cytological examination. In many cases, only after a comprehensive examination of the cervix – extended colposcopy, smears for flora and cytology, and, if necessary, a biopsy – the specialist will be able to establish a diagnosis and prescribe the optimal method of treatment.

The term “dysplasia” or “neoplasia” will no longer surprise women, even those who are far from medicine. They understand that we are talking about the presence of atypical cells, which can be in both malignant and benign processes.

And yet, when you hold the result of a smear with incomprehensible abbreviations in your hands, there is always excitement.

What is cytological screening and why every woman should undergo it?

— Inna Vitalievna, tell us what is the PAP test and how often should it be taken?

— Pap test, also called cytological screening, helps to detect and treat moderate and severe precancerous conditions of the cervix in a timely manner. Regular screening at the onset of sexual activity significantly reduces the risk of developing cervical cancer. In most countries of the world, it is recommended to take a Pap test every three years from the age of 21, but Ukrainian doctors consider it expedient to start it in Ukraine earlier, from the age of 18, and complete it at 65, as in most countries of the world. This is due to certain epidemiological features: early onset of sexual activity, the prevalence of various forms of immunodeficiency, an extremely low level of HPV vaccination and a large number of cases of smoking among women.

— Do I need to prepare for a Pap test?

— It is better to be examined in the first dry days after menstruation. For women who take birth control pills, it does not matter which day of the cycle to take the test, and women in menopause can take it on any convenient day. 48 hours before the test, you should exclude sexual intercourse, do not use vaginal suppositories, irrigation, gels and creams.

The Pap test is a painless procedure. Some women may experience discomfort and aching pain in the lower abdomen during the sampling. This is fine.

Cellular material is taken with a special brush, which is placed in a container with a fixing transport solution or applied in a thin layer on a glass slide. Cotesting (simultaneous cytological examination and determination of the human papillomavirus (HPV) by the polymerase chain reaction method) makes the first, but confident steps in Ukraine.

– What might be the results of this study? What is recommended for each of them?

– For a descriptive cytological conclusion, the Bethesda classification is used, according to which the results are interpreted:

• ASCUS – inflammation or mild dysplasia of unclear significance;
• LSIL – low-grade squamous intraepithelial lesion (traditional cytology CIN I (Cervical Intraepithelial Neoplasia) or “mild dysplasia”;
• HSIL – high-grade squamous intraepithelial lesion (traditional cytology CIN III/CIN III) or “moderate-severe dysplasia”;
• NILM – absence of intracellular lesions or malignancy, that is, the “norm”.

Often, women and especially young girls come with an incomprehensible result of a cytological examination of the cervix and with an exciting question “What to do next?” Upon receipt of any of the results of the PAP test, there are absolutely clear and scientifically based methods of additional examination and patient management tactics, which are based on international recommendations and evidence-based medicine data.

If you receive a “Poor Bethesda Cytology” result, it is recommended that you repeat the Pap test in 2-4 months (regardless of age).

Conclusion ASCUS (Atipical Squamous Cells of Undetermined Significance, atypical squamous cells of unknown significance) – characterizes such structural changes in cells, which are qualitatively and quantitatively insufficient for the diagnosis of CIN. This means that the cytological picture does not allow differentiating changes in the squamous epithelium between reactive and dysplastic, that is, precancerous. In most patients with these results, the cellular composition normalizes during follow-up, but 10-20% progress to dysplasia. However, the risk of developing severe CIN III dysplasia in women with ASCUS and a negative result for HPV (-) does not exceed 1-2%, therefore, such patients are observed without the use of invasive examination methods, and the tactics of observation depend on age and the presence or absence of highly oncogenic types of HPV in study of urogenital secretions.

Screening result ASC-H (Atypical Squamous Cells Can not Exlude HSIL) – regardless of HPV status, extended colposcopy is recommended, and biopsy, cervical curettage is indicated for any signs of damage. In women of peri- and menopausal age, if the transition zone of the squamous and columnar epithelium of the cervix is ​​NOT visualized colposcopically, and curettage did not provide reliable information, conization of the cervix can be considered as a diagnostic measure. Such an intervention should be performed by an expert-level specialist. Further tactics depend on the results of histological examination.

Pap test with result CIN I or LSIL (Low-grade Intraepithelial Lesion, mild epithelial lesion) – Cytological changes due to HPV (koilocytosis) and non-specific inflammatory changes. CIN I often regresses on its own, therefore, in this group of patients, dynamic monitoring tactics are most often used. However, it is imperative to perform an HPV test to determine further tactics.

For women with CIN I and HPV (-), cytological control after 6 months is recommended, a double cotesting test after 12 months is possible. If after 12-18 months. based on the results of observation, we obtain NILM – it is recommended to move on to routine screening.

For women with CIN I / HPV (+), colposcopy is recommended, and if severe damage to the cervical epithelium is detected, a biopsy, and in its absence, repeated cytological control after 6 months. or double test after 12 months. In such patients, it is necessary to create conditions for the elimination of HPV: it is recommended to stop smoking, if necessary, to treat chronic infections, correct the vaginal microbiome – candidiasis, bacterial vaginosis, chronic herpes infection, etc. It is worth remembering that 12-25% of HPV ( +) Women with CIN I may progress to more severe CIN within 4 years.

In the presence of a cytological conclusion of CIN II and CIN III or HSIL, in 70-80% of cases, patients have CIN II / III in the histological material after biopsy and cervical curettage, and in 1-3% – invasive cancer. Therefore, regardless of HPV status, colposcopy is always recommended by a trained specialist, biopsy of altered areas under colposcopy control, endocervical curettage in non-pregnant women, followed by a morphological study of the material obtained. A colposcopic examination of the vagina is also recommended. In cases with a cytological result of CIN II/III, if colposcopy shows no changes or a mild lesion is detected, biopsy and endocervical curettage (if not performed before) and/or diagnostic cone biopsy are recommended.

As an exception, girls under 21 years of age. The risk of invasive cancer is extremely low, and colposcopy and cytology should be repeated after 3-6 months, provided that the colposcopy is adequate, that is, the transformation zone is visualized, and endocervical curettage is negative.

Human immunodeficiency virus (HIV) testing is always recommended prior to invasive procedures, as these women are at increased risk for cervical neoplasia.

— What to do if there is a histological confirmation of mild or moderate and severe cervical dysplasia?

— If a low-grade LSIL lesion (mild dysplasia, CIN I) is detected on biopsy and if the colposcopy results are satisfactory (the type 1 transformation zone is completely visible), two approaches are possible: observation, which is recommended in most cases, or active treatment, which may be considered for signs of long-term persistence of CIN I.

Surveillance is the best management strategy, especially for young women and those planning pregnancy. It consists in cytological control + HPV testing + colposcopy every 6 months until there is cytological and colposcopic evidence of regression of mild dysplasia. It is worth noting that in patients with untreated CIN I, there is a 13% risk of detecting CIN II, CIN III during two years of follow-up.

Surgical, namely excisional treatment of CIN I may be offered to patients with long-term persistence of the lesion for more than 18 months, especially those with a positive HPV status and in women older than 30 years; patients who do not have reproductive plans and refuse to undergo regular control gynecological examination; women with a positive HIV status.

With histological confirmation of HSIL, that is, CIN II and CIN III, the treatment tactics are more likely to be surgical. However, it is worth remembering that about 40% of cases of CIN II can regress within 2 years, especially in young women. CIN III regression is extremely rare.

Treatment recommendations for severe CIN III dysplasia are unanimous: mandatory removal of the pathologically altered part of the cervix, i. e. excision / conization in non-pregnant patients. The only exception is HSIL (CIN II) in girls under 21 years of age, in the absence of a positive HIV status, since young patients are more likely to regress. In this category of patients, it is also desirable to conduct an immunohistochemical study of the proliferative activity index using monoclonal antibodies to the p16 or p16 / Ki67 protein to clarify the biological potential of dysplastic changes in the cervical epithelium. Observation is possible in the absence of p16 overexpression for no more than 12 months. With persistence of HSIL (CIN II) and HPV (+) for more than 12 months. The use of excisional treatments is recommended. Surgical treatment of HSIL (CIN II / III) can be performed by trained experts under colposcopy guidance.

Since the cervix is ​​covered not only with a flat, but also with a cylindrical glandular epithelium, which is located in the cervical canal, accordingly, oncological problems also occur here.

The cytological conclusion of the PAP test – AGC (cervical intraepithelial lesion of glandular cells) and AIS (adenocarcinoma in situ) in each case requires a consultation with a cytologist, oncogynecologist, gynecologist of an expert level.

Atypical glandular cells in a cytological smear may be of endocervical origin, i.e. from the cervix, or endometrial, i.e. from the uterine cavity. Therefore, all patients in this group are recommended extended colposcopy and cervical curettage. Examination over the age of 35 includes mandatory endometrial curettage or hysteroscopy, especially in the presence of concomitant extragenital pathology (obesity + diabetes mellitus + hypertension), pathological uterine bleeding and a family history burdened with cancer.

If there is atypia of glandular cells or AIS on biopsy but no evidence of invasive cancer, conization of the cervix may be considered as the method of choice in young patients with reproductive plans for the future, however, women who have realized their reproductive function and do not plan to give birth in the future are recommended hysterectomy – removal of the uterus, especially with histologically confirmed AIS, taking into account the high probability of incomplete removal of the lesion during conization (up to 26%) or invasive cancer (1. 2%), frequent relapses of the disease after treatment, the multifocal nature of the disease, and the uninformative cytological manifestations of AIS.

Remember that with early detection of cervical cancer, the disease has a favorable prognosis for treatment and full recovery, so you should take care of your own health first of all!

You can undergo an examination by a gynecologist, pass all the necessary tests, do a Pap test and, if necessary, undergo treatment for identified precancerous diseases at the Israeli Oncology Hospital LISOD. The best oncogynecologists will give a detailed consultation on the results of the tests and prescribe an effective treatment.

Sign up for a consultation:

0-800-500-110 — free of charge within Ukraine;

+ 38-044-277-8-277.

the 14 th of July
Cervical cancer is not psychomatic.