Cervical Cancer - Diagnosis

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These classifications are based on the 2001 Bethesda System (TBS), which is formulated to standardize the reporting of Pap test results:

Atypical Squamous Cells. Atypical squamous cells (ASC) are mildly abnormal cells on the surface of the cervix. They may simply represent inflammation. Over 80% of these cells become normal, but unfortunately, 5 - 17% of these women have a chance for having cervical intraepithelial neoplasia (CIN) II and III dysplasia, which indicates potentially invasive cells. Atypical squamous cells are further categorized as:

• ASC-US. These atypical squamous cells of undetermined significance (ASC-US) are the lowest risk abnormal cells. Women with these cells should be tested for HPV. If results indicate they are infected with HPV, they should have a colposcopy to determine if the condition is actually at a more aggressive stage. If they do not have HPV they are simply monitored with repeat Pap smears.
• ASC-H. This category refers to the presence of atypical squamous cells, but a doctor cannot exclude possible high-grade squamous intraepithelial lesions. Such women have a higher risk of having CIN II and III. All are referred for colposcopy.

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Among those with atypical squamous cells, immunosuppressed women and those with high-risk human papillomavirus infections are at higher risk for cervical intraepithelial neoplasia II and III and should always be given colposcopy. Postmenopausal women with normal immune systems have a lower risk than younger women. In general, the actual risk for cervical cancer in women with atypical squamous cells is only 0.1 - 0.2%.

Squamous Intraepithelial Lesions (SILs). Squamous intraepithelial lesions (SILs) are classified as either low-grade (LGSIL) or high-grade (HGSIL). High-grade SILs are more serious than low-grade SILs, and need to be treated because they can develop into invasive cancer. Pap tests can identify the presence of SILs but not their grade. All patients with SILs should undergo colposcopy. A colposcopy can determine whether SILs are high-grade or low-grade and whether treatment is required.