Pap Smear Classification

Pap smear testing checks the cervix for cell abnormality that can develop into cervical cancer. The Bethesda classification of Pap smear testing is the standard cytologists use to report and record cervical pathology findings (Grubbs, 2015). Clinicians’ management guidelines are based on this system and is dependent on the cervical cancer risk factors involved (Bickley & Szilagyi, 2013).

The Bethesda system uses three categories for evaluation. These categories include: adequacy of specimen, general categorization, and interpretation/result (Cash & Glass, 2014).

In the category adequacy of specimen, it is determined if the specimen is adequate to use or inadequate for evaluation and the reason for it (Cash & Glass, 2014).

In the category

The first interpretation/result section is the squamous cell abnormality category and it includes: atypical squamous cell of undetermined significance (ASCUS), in which the abnormality cause is not clear (infection is a common cause); atypical squamous cells that are unable to exclude high-grade squamous intraepithelial lesion (ASC-H); squamous cells with low grade intraepithelial lesions (LSIL), which may be indicative of HPV, mild dysplasia, or cervical intraepithelial neoplasia (CIN) I; high-grade squamous epithelial lesions (HSILs), which may indicate moderate to severe dysplasia (carcinoma in situ or CIN II, and CIN III); and squamous cell carcinoma (Cash & Glass, 2014). The second interpretation/result category includes glandular cell, which involves atypical glandular cells (AGCs), such as atypical endocervical or endometrial cells specified or not otherwise specified (NOS); atypical endocervical or glandular cells-AGCs that favor neoplastic; adenocarcinoma in situ; and adenocarcinoma (Bickley & Szilagyi, 2013). The third interpretation/result category is other, and can include endometrial cells in older women (Cash & Glass, 2014) or malignant neoplasms which are rare (Bickley & Szilagyi, 2013).

Common causes of abnormal Pap smear results include sexually transmitted diseases

For patients with ASC-H, a colposcopy should be performed (Cash & Glass, 2014). In LSIL patients with positive or negative HPV, a colposcopy should be used to manage these patients, and pregnant women should also be managed with colposcopy or wait until they are 6 weeks post-delivery (Cash & Glass, 2014). For HSIL patients, management includes loop excision or a colposcopy. All ACG patients, except atypical endometrial cells, should use colposcopy for management. And for atypical endometrial cells, and women over age 35, endometrial sampling is needed (Cash & Glass, 2014). All unsatisfactory cytology (unknown, HPV positive or negative) should repeat cytology in 2-4 months, and if there are two unsatisfactory cytology tests, a colposcopy should be performed (Cash & Glass,