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Trying to understand Pap results
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An_245499 posted:
I just received my results in the mail for my pap smear though had already spoken to nurse on phone but still confused of results other than I need to go see a regular gyn. It says for diagnosis - epithelial cell abnormality - low-grade squamous intraepithelieal lesion (LGSIL); human papillomavirus effect is present. Predominance of coccobacilli consistent with shift in vaginal flora is present.
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georgiagail responded:
A good article that discusses Pap results:

http://www.mayoclinic.com/health/pap-smear/my00090/dsection=results

Gail
 
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Jane Harrison Hohner, RN, RNP responded:
Dear An: GeorgiaGail's reference is excellent (as usual) so read it first. Then I would like to add more specific to you information.

The bacterial report: predominance of coccobacilli consistent with shift in vaginal flora, is suggestive of but not a definitive diagnosis of bacterial vaginosis (BV). BV does not create abnormal PAP smears; it is a common vaginal infection which can be treated with antibiotics like metronidazole.

In terms of the LGSIL, including likely outcome, here is an edited quote from the British Journal of Cancer, March 2004:

Low-grade squamous intraepithelial lesion (SIL) has been defined as a cytologic diagnosis for patients with smears showing cytologic criteria of permissive HPV infection or CIN I . This classification is also used for histopathologic diagnosis, and low-grade SIL and low-grade CIN are used synonymously. The gold standard for the definition of cervical disease is histopathologic evaluation. However, it has to be kept in mind that even between expert pathologists inter- and intraobserver variability is high: in a recent study on 194 cervical tissues of different histologic severity, the agreement rate between five expert pathologists was 52% for the diagnosis of CIN I . Agreement could be improved to 91% by immunohistochemical staining for p16ink4a a marker associated with the presence of high-risk HPVs.

In addition to the problem of defining the disease accurately, the natural course of low-grade SIL is variable: The majority of lesions (up to 70%) regress and only 10% of low-grade SIL may progress to high-grade CIN. When patients with the cytologic diagnosis of low-grade SIL are stratified in high-risk HPV negative or high-risk HPV positive using a GP5 GP6 system, all high-risk HPV-negative and 70% of high-risk HPV-positive smears become normal over a period of 4 years (Nobbenhuis et al, 2001). In this series, 62% of smears were high-risk HPV positive. Not a single patient out of 64 patients with the cytologic diagnosis of low-grade SIL progressed to high-grade CIN (Nobbenhuis et al, 1999). However, using the only commercially available HPV test in clinical practice, Hybrid Capture II triaging low-grade SIL in regressors and progressors is not recommended due to the high rate of high-risk HPV positives with this system (i.e. 83%) (Koutsky et al, 1992; Stoler, 2001
).

An_245499, LGSIL (also known as CIN 1) tends not to progress to something more concerning. You might receive a repeat PAP or a colposcopy if your HPV was one of the "high risk" subtypes. A GYN should be able to give you the best explanation of your specific results.

Yours,
Jane
 
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Mo1her replied to Jane Harrison Hohner, RN, RNP's response:
Hello, I had an abnormal pap smear in Nov and a normal colposcopy. Six months later I had another abnormal pap and will get the results of my colposcopy and ecc on Friday. Is it abnormal for 2 pap smears in a row to be abnormal?
 
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tbkittycat replied to Mo1her's response:
Depends on why they were abnormal?


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