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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Screening tests

Traditionally, the Papanicolaou test (Pap test or Pap smear) has been the screening method of choice for detecting cervical dysplasia. For this test a sample of cells from the surface of the cervix is removed by the healthcare practitioner during a pelvic examination with a speculum in place for visualization. The cells are smeared onto a glass slide, stained, and observed under the microscope for any evidence of dysplasia or cancer. The cervical sample may also be placed into a vial of liquid that is later used to prepare a microscope slide for examination.

If the screening tests show abnormal appearing (dysplastic) cells, the results are given as one of the following categories:

• LSIL: Low-grade squamous intraepithelial lesion, or changes characteristic of mild dysplasia.
• HSIL: High-grade squamous intraepithelial lesion, corresponding to severe precancerous changes.
• ASC: Atypical squamous cells. One of two choices are added at the end of ASC: ASC-US, which means undetermined significance, or ASC-H, which means cannot exclude HSIL (see above).

Further testing may be required if the screening test is abnormal. Further tests may include:

Colposcopy

Colposcopy, or a procedure that uses a microscope to visualize the cervix during a pelvic exam. Colposcopy can help identify abnormal areas on the cervix and is a safe procedure with no complications other than mild vaginal spotting of blood.

Biopsies

Biopsies, or tissue samples for examination under the microscope, may be taken of suspicious areas seen during colposcopy.

When dysplasia is identified in tissue biopsies of the cervix, the term cervical intraepithelial neoplasia (CIN) is used. CIN is classified according to the extent to which the abnormal, or dysplastic, cells are seen in the cervical lining tissue:

• CIN 1 refers to the presence of dysplasia limited to the basal 1/3 of the cervical lining, or epithelium (formerly called mild dysplasia).
• CIN 2 is considered to be a high-grade (more serious) lesion. It refers to dysplastic cellular changes confined to the basal 2/3 of the lining tissue (CIN 2 was formerly called moderate dysplasia).
• CIN 3 is also a high grade lesion. It refers to precancerous changes in the cells encompassing greater than 2/3 of the cervical lining up to and including full-thickness lesions. These were formerly referred to as severe dysplasia and carcinoma in situ.

HPV testing to detect whether or not HPV infection with a "high-risk" HPV type is present may be recommended for some women, particularly in the case of uncertain results from a screening test (as with smears interpreted as ASC-US, see above). Because a large number of women are infected with HPV and because the infection can be temporary and short-lived, regular screening of all women for HPV infection is not felt to be useful and is not routinely performed in the U.S.

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