Pap Smear (cont.)

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Why is a woman's past Pap smear history pertinent?

If a woman has had a history of a cellular abnormality on a previous Pap smear, it is important for her to inform the health care practitioner performing the current Pap smear. The patient should provide the details of any previous problems and treatments so that this information can be noted on the lab form. The past history of the woman helps the person who is reading (interpreting) the current Pap smear, because a particular abnormality on previous screening alerts the health care practitioner to look more carefully for specific findings on the current Pap smear.

When might a Pap smear not be adequate for interpretation?

It is a requirement that the report comment on the adequacy of the smear sample for Pap analysis. If the sample is inadequate, the report details the reason. Examples of problems that might be listed under "sample adequacy" include "drying artifact" or "excessive blood." These comments refer to factors that the person analyzing the smear feels may have interfered with his or her ability to interpret the sample.

Sometimes, a Pap smear report will read "unsatisfactory due to excessive inflammation." Inflammation that is present in the woman's cervical area may make it difficult to interpret the Pap smear. Examples of causes of inflammation might include infections or irritation. Inflammation is a common finding on pap smears. If it is severe, your doctor may want to try to determine the cause of the inflammation. In many cases, a repeat pap smear is recommended to determine if the inflammation has resolved and to obtain a sample that is adequate for interpretation.

How is the final Pap smear diagnosis made?

The final Pap smear diagnosis is based on three determining factors:

  1. The patient's history: The reader (the person reading the smear) takes into account the woman's history as noted on the lab request by the clinician performing the smear.
  2. Sample adequacy: The reader then decides whether the sample was adequate for interpretation.
  3. The presence or absence of cellular abnormalities: The reader then notes whether cellular abnormalities were seen on the slides. If the appearance of the Pap smear does not seem to coincide with the woman's clinical history, a comment may also be made to that effect.

The final diagnosis is a short statement that summarizes what the reader has found. Examples of final diagnoses include:

  • Within normal limits;
  • Absence of endocervical cells on the Pap smear;
  • Unreliable Pap smear due to inflammation;
  • Atypical squamous cells of undetermined significance (ASCUS);
  • Low-grade squamous intraepithelial lesion (LSIL); or
  • High-grade squamous intraepithelial lesion (HSIL).

There may also be additional comments such as "low-grade squamous intraepithelial lesion (LSIL) with human papilloma virus."

Medically Reviewed by a Doctor on 2/21/2014

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