• What does it mean when pap smears show ASCUS but your doctor suggests waiting before declaring recurrence?

    Asked by HardyGirl on Wednesday, May 1, 2013

    What does it mean when pap smears show ASCUS but your doctor suggests waiting before declaring recurrence?

    2 Answers from the Community

    • carm's Avatar

      what a great question. I made a detailed description of how to read a pap smear and I give it to all my patients so here it is:


      ASCUS (Atypical Cells of Undetermined Significance)
      This definition signifies that your cervix contains atypical squamous cells that the pathologist is not 100% sure is due to a benign process.
      Recommendation...3 follow-up options:
      1-Repeat Pap Smear in 4-6 months
      2-Perform an HPV test ("reflective HPV test" automatically with ASCUS diagnosis)
      3-Undergo Colposcopy
      ASCUS-H (Atypical Cells of Undetermined Significance-Cannot Exclude High-Grade Intraepithelial Lesion)
      Further catagorized as "ASCUS favor HSIL" or "ASCUS, cannot rule out HSIL."
      These diagnoses tell the clinician that the pathologist is very concerned that the atypical cells she is seeing may be coming from HSIL. In fact, a large percentage of women with this diagnosis will prove to have an HSIL, somewhere around 40%.
      Recommendation-Colposcopy and biopsy of any worrisome areas. HPV is not recommended in this instance because we know that the vast majority (over 80%) of women with ASCUS, favor HSIL pap results will have a positive HPV test.
      SIL (Squamous Intraepithelial Lesion)
      A diagnosis of either LSIL (L=Low-grade) or HSIL (H=High grade) on a pap smear indicates that the cells present on the pap smear have come from a precancerous lesion, either low-grade or high-grade.
      Recommendation-Colposcopy and biopsy of the cervix. The difference between cervical biopsy and pap smear is that a pap samples cells on the surface of the cervix. A biopsy is a "mini-excision" of a tiny portion of intact tissue that allows the pathologist to see a cross section of the entire depth of the cervical lining. A definitive diagnosis cannot be made until a biopsy has confirmed the pap smear diagnosis.
      LSIS (Low-Grade Squamous Intraepithelial Lesion)
      For LSIL diagnoses, the 2007 ASCCP guidelines for most women recommend cervical colposcopy followed by a biopsy of any visible lesions. There is a sensible rationale behind recommendation. We know that a significant number of women with LSIL on their pap smears will later prove by biopsy to have an HSIL, the most worrisome lesion for persistence and cervical cancer. As an interesting note, it seems that just the act of cutting into the cervix seems to speed up the disappearance of an LSIL. It is thought that the trauma to the cervix may stimulate a womans immune system to rid itself of the lesion at a faster rate!
      Post menopausal women are unique in that they can sometimes have abnormal pap smears that look very much like dysplasia but reflect non-HPV related changes called "Postmenopausal Atypia" for which they don't need treatment. This atypia may disappear on subsequent pap smears.
      HSIL (High-Grade Squamous Intraepithelial Lesion)
      Recommendation-confirmation by colposcopy, tissue biopsy, followed by removal of loop procedure (Loop Electrosurgical Excision Procedure-LEEP). HSIL diagnosed on the cervical biopsy tissue can be divided into two levels of severity: Moderate dysplasia and Severe dysplasia. "Watchful Waiting" recommended for moderate dysplasia in adolescent females, excision with severe dysplasia.
      AGUS (Atypical Glandular Cells of Undetermined Significance)
      "Atypical glandular cells, not otherwise specified" can be either endocervical or endometrial cells.
      Recommendation for endometrial cells-Endometrial biopsy
      Reccomendation for endocervical cells-Endocervical curettage, sometimes biopsy. If from endocervix, then the concern is that you have adenocarcinoma in situ (AIS). Two types of diagnosis-AGUS, or AGUS, favor neoplastic.
      AIS (Adenocarcinoma in Situ)
      This diagnosis signifies a definite endocervical precancerous lesion related to HPV infection.
      Recommendation-Loop Procedure or Cone Biopsy (Cold Knife Cone).
      Squamous Cell Carcinoma and Adenocarcinoma
      Invasive cancers no longer restricted to the cervical surface lining cells but have invaded into the underlying tissue. By invading, these tumors now have the ability to metastasize elsewhere in the body.
      Inflammation of the Cervix.

      Hope this helps answer your question, pass it on and empower a sister, Carm RN.

      over 3 years ago
    • derbygirl's Avatar

      Hi HardyGirl. ASCUS is atypical cells of undetermined significance. As a clinical assistant who worked in an OBGYN practice, I can't tell you how many patients whose test results came back stating ASCUS. Most of the patients expected the worst and got good news. The first thing a doctor will do is a repeat PAP in 3-6 months. The doctor may also recommend an HPV screening which is similar to a PAP. This can be done separately or, with the repeat PAP, it can be checked off on the lab slip to include the HPV screen. I know the doctor I worked for requested the HPV screening be done automatically for women under the age of 35 when they had their yearly visit. For women age 21-25, he usually did nothing because he said their body will be able to take care of this. The other step a doctor can take is to perform a colposcopy which enables them to use a colposcope to check for the presence of abnormal cells. This test can be done in the office and takes about 15 minutes. The best advice I can give you is to relax and not worry until the doctor tells you there is something to worry about. Take care and if you need more information on the colposcopy and what to expect if that is the step your doctor plans to take, send me a message and I'll tell you how it is done.

      over 3 years ago

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