Atypical squamous cells of undetermined significance treatment

Don’t panic.  A pap smear is a screening test for cervical cancer and pre-cancer.  The pap test is usually done in conjunction with an HPV test. There are many causes of abnormal pap smears, and most can be managed in the office.  Once your test comes back abnormal, your provider reviews the test results and decides on a plan of action.

What are the different types of abnormal pap test results?

• Atypical squamous cells of undetermined significance (ASC-US)—ASC-US means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. The changes may also be a result of infection or inflammation. ASC-US is the most common abnormal Pap test result.
• Low-grade squamous intraepithelial lesion (LSIL)—LSIL means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.
• High-grade squamous intraepithelial lesion (HSIL)—HSIL suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be associated with pre-cancer and cancer.
• Atypical squamous cells, cannot exclude HSIL (ASC-H)—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.
• Atypical glandular cells (AGC)—Glandular cells are another type of cell that make up the thin layer of tissue that covers the inner canal of the cervix. Glandular cells also are present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of pre-cancer or cancer.

What testing is done after an abnormal result?

• Colposcopy with or without cervical biopsy—Colposcopy is an in office exam of the cervix with a magnifying device. If an area of abnormal cells is seen, your health care provider may decide that a cervical biopsy is needed. For a biopsy, the health care provider removes a small sample of tissue and sends it to a lab for testing. The lab tests can determine whether abnormal cells are present and, if so, how severe.
• Endocervical sampling – A small brush or other instrument is used to take a tissue sample from the cervical canal.
• Endometrial sampling— In the case of an AGC result, a sample of the endometrium (the lining of the uterus) may be collected for study using an instrument which looks like a small straw.

What are the potential results of the biopsy?

• Cervical intraepithelial lesion (CIN) is used to report cervical biopsy results. CIN is graded as 1, 2, or 3.
• CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment.
• CIN 2 is used for moderate changes.
• CIN 3 is used for more severe (high-grade) changes.
• Moderate and high-grade changes can progress to cancer. For this reason, they may be described as “pre-cancer,” and are usually treated.

How are abnormal cervical cells treated?

• Loop electrosurgical excision procedure (LEEP)—A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix. This procedure can be done in the office or in the operating room.
• Conization—A cone-shaped piece of the cervix that contains the abnormal cells is removed. This procedure must be done in the operating room.

These procedures are usually curative.  Once complete, patients are asked to come in for a follow up visit two weeks after the procedure to review pathology results and to form a plan for future testing.

Information adapted from ACOG Patient Information FAQ 187

When a Pap smear detects atypical squamous cells, follow-up testing is required to determine the underlying cause. In most cases, the presence of abnormal squamous cells does not indicate the presence of cervical cancer. However, abnormal Pap results should always be discussed with a medical professional so that an individualized action plan can be created.

Atypical squamous cells can be a sign of:

• HPV (human papillomavirus) infection
• Benign (noncancerous) cellular changes
• Cervical cysts or polyps
• Low hormone levels (in patients who are menopausal or post-menopausal)

Usually, when atypical squamous cells are found, the cell sample is re-analyzed to check for the presence of certain viruses, such as HPV. While having HPV does not necessarily mean that a woman will develop cervical cancer, it does increase her risk of developing the condition, which means that more frequent Pap smears may be necessary to detect abnormal changes should they occur. Additional tests, such as cervical biospies, endocervical sampling exams and colposcopies may also be recommended after an atypical Pap result.

If cancerous squamous cells are detected during a Pap smear, prompt treatment is advised. The earlier that cancer is detected, the more treatment options a patient typically has.

At Moffitt Cancer Center, we offer a comprehensive range of diagnostic tests and treatments that are backed by the latest advances in cervical cancer research. As a National Cancer Institute-designated Comprehensive Cancer Center, we are continually investigating the newest options for preventing, detecting and treating cancer, and our patients directly benefit from our acclaimed clinical trials.

Medically reviewed by Jing-Yi Chern, MD, gynecologic oncologist

If you’ve recently received abnormal Pap smear results involving the presence of atypical squamous cells, call 1-888-663-3488 or submit a new patient registration form online to request an appointment with one of Moffitt’s gynecologic oncologists. We welcome patients with and without physician referrals. Virtual visits appointments are available, however, in most cases, a complete exam and evaluation in person will be needed to decide the best treatment.

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