Papanicolaou Smear


Pap smear, cervical smear.

To establish a cytological diagnosis of cervical and vaginal disease and identify the presence of genital infections, such as human papillomavirus, herpes, and cytomegalovirus.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction. Instruct the patient to avoid douching or sexual intercourse for 24 hr before specimen collection. Verify that the patient is not menstruating.

Normal Findings
Method: (Microscopic examination of fixed and stained smear). Reporting of Pap smear findings may follow one of several formats and may vary by laboratory. Simplified content of the two most common formats for interpretation are listed in the table.

Manual Review (Bethesda System)
  • Specimen type: Smear, liquid-based, or other.
    Specimen adequacy:
  • Satisfactory for evaluation—endocervical transformation zone component is described as present or absent, along with other quality indicators (e.g., partially obscuring blood, inflammation).
  • Unsatisfactory for evaluation—either the specimen is rejected and the reason given or the specimen is processed and examined but not evaluated for epithelial abnormalities and the reason is given.
    General categorization:
  • Negative for intraepithelial lesion or malignancy.
  • Epithelial cell abnormality (abnormality is specified in the interpretation section of the report).
  • Other comments
  • Negative for intraepithelial lesion or malignancy
    • List organisms causing infection:
      • Trichomonas vaginalis; fungal organisms consistent with Candida spp.; shift in flora suggestive of bacterial vaginosis; bacteria morphologically consistent with Actinomyces spp.; cellular changes consistent with herpes simplex virus
    • Other nonneoplastic findings:
      • Reactive cellular changes associated with inflammation, radiation, intrauterine device; glandular cell status post-hysterectomy; atrophy
  • Epithelial cell abnormalities
    • Squamous cell abnormalities
      • ASC of undetermined significance (ASC-US) cannot exclude HSIL (ASC-H)
      • LSIL encompassing HPV, mild dysplasia, CIN 1
      • HSIL encompassing moderate and severe dysplasia, CIS/CIN 2 and CIN 3 with features suspicious for invasion (if invasion is suspected)
      • Squamous cell carcinoma
    • Glandular cell
      • Atypical glandular cells (NOS or specify otherwise)
      • Atypical glandular cells, favor neoplastic (NOS or specify otherwise)
      • Endocervical adenocarcinoma in situ
      • Adenocarcinoma
  • Other
    • Endometrial cells (in a woman of age 40 yr or older)
    Automated review (any system):
  • Indicates the case was examined by an automated device and the results are listed along with the name of the device.
    Ancillary testing:
  • Describes the test method and result.
    Educational notes and suggestions:
  • Should be consistent with clinical follow-up guidelines published by professional organizations with references included.
ASC = atypical squamous cells; ASC-H = high-grade atypical squamous cells; ASC-US = atypical squamous cells undetermined significance; CIN = cervical intraepithelial neoplasia; CIS = carcinoma in situ; HSIL = high-grade squamous intraepithelial lesion; LSIL = low-grade squamous intraepithelial lesion.

Critical Findings and Potential Interventions

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