Interpreting Your Results

A standardized system for analyzing Pap smears was developed at the National Institutes of Health (NIH) located in Bethesda, Maryland. The aim in developing the Bethesda system was to get all doctors to use an identical system for reporting Pap smear results. It was hoped that through such standardization and the use of uniform terminology, a Pap smear would receive an identical report no matter which laboratory did the analysis. An additional benefit of a uniform system is that both patients and physicians find Pap smear reports a great deal less confusing.

The Bethesda System was the response to a workshop given by the National Cancer Institute in 1988 about ongoing efforts to standardize Pap smear reports. The guidelines used in the Bethesda System served to address most aspects of Pap smear tests and their results. But in 2001, the guidelines underwent a revision and were further improved. The Bethesda system for reporting Pap smear analyses has received almost universal acceptance within the United States.

Three Categories

The Bethesda System uses three major categorizations for reporting abnormal smears:

* ASC-US or ASC-H: The first three letters of this classification stand for "atypical squamous cells." Before Bethesda, this category was called simply ASC. But Bethesda breaks this category into two subcategories: ASC-US adds the designation "undetermined significance" and ASC-H specifies that "high-grade squamous intraepithelial lesion" (HSIL—see below) cannot be excluded.

*LSIL: Low-grade squamous intraepithelial lesion. Before Bethesda, this category was known as CIN grade 1.

* HSIL: High-grade squamous intraepithelial lesion. Before Bethesda, this category was called CIN grade II, CIN grade III, or CIS.

Abnormal Findings

"Sqaumous" refers to cells found on the cervix's surface. These cells are thin and flat.

"Intraepithelial" signifies that the topmost layer of the cells is affected.

"Lesion" suggests that abnormal tissue was found.

Report Details

Your Pap smear report will start with identifying information, your name and the name of the physician who took the sample. The report will describe your menstrual status, for instance, whether you are still menstruating or are menopausal. Next the report may state whether your sample consisted of one or two slides.

The report will also give any relevant medical history, for instance, the report may state: "history of genital warts." There will also be a description of the specimen in terms of whether there was enough of a sample on which to base a report. The word "adequate" may be used to signify that the specimen was large enough for testing.

The final diagnosis will also appear and may say, "within normal limits." There may also be a recommendation, for instance, "recommend routine follow-up," or, "recommend repeat smear."

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