Hello Jan, I am an oncology/end of life nurse so maybe I can help you understand the process. I specialize in gyne cancers and/or gyne issues like dysplasia and I have created and sent this info to many patients. I hope this will help you. It is the language that one might see on their pap results. It should answer your question. If you need anything else, you know where to find me, Carm.
HOW TO READ A PAP SMEAR
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)
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.