PAP Smear

Question 1

Results of PAP smear:
squamous cell abnormality most common.

ASC-US

LSIL

Answer 1

Atypical Squamous Cell- of Undetermined Significance

Low grade Squamous Intraepithelial Lesion:
- equivalent to CIN I (Cervical Intraepithelial Neoplasia)

57% with LSIL will spontaneously regress
1% with LSIL will proceed to invasive cancer.

Question 2

What do you do if the 1st PAP smear shows ASC- US or LSIL?

Answer 2

• Repeat PAP smear in 6-12 months.

- If still ASCUS or LSIL, refer for colposcopy.

Question 3

What is ASC- H?

Next step?

Answer 3

Atypical Squamous Cell, cannot exclude HSIL

Refer for colposcopy

Question 4

What is HSIL?

Next Step?

Answer 4

High grade Squamous Intraepithelial Lesion
=CIN II and III
-Greater than 12% will proceed to invasive carcinoma.

Refer for colposcopy.

Question 5

What do you if Squamous Carcinoma is found on the smear?

Answer 5

-Refer for Urgent Colposcopy.

Question 6

What other cells are found on the smear besides squamous cells?

Answer 6

-Glandular Cells
Cells from the endocervical canal.

So on the smear you can get Atypical Glandular Cells

Question 7

Next step for AGC?

Answer 7

-Refer for colposcopy

Question 8

What else can be found?

Answer 8

-Adenocarcinoma (ca that begins in glandular cells) or
adenocarcinoma in situ

-Needs urgent colposcopy.

Question 9

What other cells can be found on the smear besides squamous and glandular?

Answer 9

-Endometrial Cells

If smear shows abnormal endometrial cells
then endometrial sampling should be done by using a pippete

Question 10

Contraindications of PAP smear:

Answer 10

Not appropraite if you see an abnormal cervix.

Instead you do a punch biopsy and send for histology

Question 11

What are PAP Smear alternatives?

Answer 11

1. Liquid Based Cytology
   - Increased sensitivity
   - Expensive
2. HPV Testing:
   - Alternative screening for women > 30 yrs
   - Expensive
   - Useful for smear result of ASC-US

-If high risk HPV (16 and 18) found, refer for colposcopy.

3. Visual Inspection
   - Cheap
   - Allows for immediate treatment

Question 12

How is visual inspection of cervix done?

Answer 12

1. Ascetic Acid
   - Abnormal cells express protein
   - Protein coagulates when exposed to ascetic acid, white are seen = abnormal cells
2. Lugol’s Iodine/Schiller’s test
   -Normal cells contain glycogen.
   Iodine plus glycogen = black.
   -Precancerous cells do not stain.
   -Mustard colour= abnormal.