PAP TEST INTERPRETATION

How to interpret the PAP Test

If the Pap smear results show “changes”, it is natural to worry. However, it is important to remember that the Pap smear is not exclusively for cancer screening, so there may be other reasons why the results may be abnormal.
The Pap smear test allows gynaecologists to identify – and if necessary treat – any abnormal cells in the cervix that, in some cases, in long term and if they remain for years without treatment – follow-up, may develop into cervical cancer.
For this reason, it is very important to arrange your PAP test appointments.

Interpreting PAP Test results

Pathological result:
You may have been told in the past that you have a “pathological result”. This means that some abnormal cells were found in the laboratory from the sample taken from your cervix.

Many pathological results are related with :
• microbial causes (hemophilus, trichomonas, etc.)
• benign lesions (polyps),
• hormonal causes (medicines, menopause) or even with
• natural causes (sexual intercourse, postpartum injury or curettage).

But the main reason for Pap test is:

The detection of herpes simplex viruses (HSV I-II), and the human papilloma virus (HPV) ,as well as precancerous lesions caused by these.


You may therefore be asked to do a second Pap smear test, or in some cases you may referred for a colposcopy. be asked to do a second Pap smear test, or in some cases you may referred for a colposcopy. The doctor will advise you on what will happen next and should be able to answer any questions you may have.

Borderline result:
If you are told that you have a “borderline” result (ASCUS) on the Pap test, again, you should not worry. This means that some abnormal cells were found in your sample at the laboratory, which may be due to microbial, hormonal, accidental or viral causes.
In this case, you may be advised to re-do a Pap smear within 3-6 months, and / or colposcopy along with a HPV DNA TEST in order to exclude viral damage.

Unspecified Damage:
If you have an ASCH result, the cytologist has discovered a precancerous lesion without being able to determine its degree. Surely you will be asked for further virus check, L1 protein detection, colposcopy with directed biopsies.

Unsatisfactory sample:
Some women are informed that they have an «unsatisfactory result». This means that they were unable to examine the cells they received in the laboratory. There are many reasons for this: it could be that a little blood overshadowed the cells, or because the cell specimens were too thick or very thin on the sample. In this case, you may be advised to repeat the Pap test soon.

What is Cervical Intraepithelial Neoplasia (CIN)?
When the HPV virus is presented in the cervix, the first cellular changes observed in the Pap test are koilocytosis, parakeratosis, binucleosis and nuclear enlargement. With all these cellular lesions, the lesion is characterized as an HPV infection..


If the lesion progresses to the next stage of cellular abnormality, then light cell swellings and abnormalities, referred to as “low-grade cervical intraepithelial neoplasia” (CIN-I), occur.
Similarly, if further changes in the cells continue, “middle-grade cervical intraepithelial neoplasia” (CIN-II) – and with even greater cellular changes of “high-grade cervical intraepithelial neoplasia” (CIN-III). A woman who does not do the check-up regularly, 3-5 years after the first development of the lesion, can develop cervical cancer.
In a nutshell, CIN-I, CIN-II, CIN-III is a categorization-staging of cellular changes caused by HPV if it remains.
The process of carcinogenesis is slow with several stages, which are fully treatable in an easy way.

What is Squamous Intraepithelial Lesion (SIL)?
For easier management of precancerous lesions, a new classification of cellular changes has been developed. All stages were merged into two, placing the HPV infection and CIN-I in the «Low Grade Squamous Intraepithelial Lesion», (LGSIL)

while CIN-II and CIN-III in ” High Grade Squamous Intraepithelial Lesion” or (HGSIL).

What happens with the abnormal Pap Test results?
Developments in cytology (with Thin Prep Pap Test), automated cytology, molecular cytology (with the detection of HPV types, HPV DNA TESTING), immunocytochemistry (with the detection of L1, E6 and E7 proteins) i.e. auto-cure lesion factors, improvements in colposcopy, developments in laser and electrocauterization (Large Loop Excision of the Transformation Zone – LLETZ), completely differentiate our attitude towards the abnormal Pap Test results.
Possible differences in the treatment of cases are related to the abilities of the laboratories, the skills of the gynaecologists themselves and the financial capacity of each patient.
So, when we have a problematic result in the Thin Prep Pap Test, first of all we assure the woman that she is safe and will be very healthy soon. Cutting down smoking, a healthy diet with vitamins and minerals, good biorhythms, positive and optimistic thinking are our first recommendations for reinforcing the body’s defence.

Second step:

After the result announcement, follows the collection of further information regarding the nature of the lesion. DNA virus identification (DNA-HPV Test) gives us the chance to manage the lesion.
The detection and quantitation of chlamydiae, mycoplasmae and/or ureaplasmae through molecular examinations is absolute reliable, a fact that distinguishes them from microbiological cultures for microbial detection which are likely to favour the presence and development of HPV and lesions.This is also done by the liquid based cytology (Thin-Prep).

Detection of L1, E6 and E7 proteins offers us the possibility of auto-cure, while colposcopy shows us the topography of the lesion. At the same time, biopsies confirm the Pap Test and the possible colposcopy findings.

The last step:
It is more complex and depends on the findings of the previously mentioned tests. It includes from simple monitoring, simple destruction to removal of the affected part of the cervix.

Dr. Stefanos Georg.Valantasis
Surgeon-Obstetrician-Gynaecologist