A number of abbreviations and technical terms are used to describe smears. Your doctor will usually explain what the report means, but in case you hear medical staff using these words or read your report and are alarmed by terms you don’t understand, here’s a list. Except for the first, the following terms apply to cells that cover the ectocervix.
NAD nothing abnormal detected.
Atypia not typical or not quite ordinary.
These are commonly minor changes in the appearance of cells and are usually of uncertain or unknown significance.
Warty atypia or HPV cells show changes in response to the presence of wart virus (also called human papilloma virus).
CIN cervical intra-epithelial neoplasia. This means that the cells show changes indicating abnormal cell division. There are three grades of CIN (pronounced ‘C-I-N’, not ’sin’!):
CIN 1 means mild change affecting few cells
CIN 2 means moderate change affecting more cells
CIN 3 means marked abnormalities in cell division affecting many cells.
Sometimes the term ‘pre-cancerous’ has been used to describe CIN changes. Most women are very frightened by this term. It is inaccurate, because most CIN does not progress to cancer, and the use of the term is now discouraged by specialists in cervical abnormalities. CIN changes can be compared to the sun-spots that fair-skinned people often develop on sun-exposed skin. Many of these won’t progress to skin cancer, but if they don’t go away after being watched for a while, it’s better to get rid of them all because we can’t tell which might become cancerous.
Abnormalities in the columnar cells that line the canal are described separately in Pap-smear reports, and are rarely seen (around one in a thousand smears examined by a large Sydney laboratory). If no cells from the canal are seen on the smear, the report says ‘endocervical cells absent’. In this case your doctor may suggest a repeat smear in six or 12 months.
Smears can also show infections that may or may not be causing symptoms. These can be treated with appropriate antibiotics.
An abnormal report prompts the following actions:
• If your smear shows atypia only, including HPV, you will usually be advised to have a repeat smear within six months.
• A CIN 1 report will usually lead I recommendation of six-monthly smears. If CIN 1 changes persist beyond 12 months, colposcopy will be recommended.
• If there is a grade of CIN beyond CIN 1, colposcopy will be advised.
Are Pap results reliable?
Not absolutely: false negative results are thought to range from 10-25 per cent. This may be because the spatula hasn’t been wiped right around the circumference of the cervix and over the whole transformation zone so that cells from all regions are not on the slide, or because abnormal cells may not be seen in the laboratory. Now that doctors and women’s health nurses are taught how to take good smears and laboratories reporting on Paps must undergo quality-control assessment, the false negative rate will diminish. The recommendation to repeat smears every two years makes it very unlikely that any serious change could progress undetected.
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