[Cervix smears with mild atypia classified as Pap-class IIIA: results of a changed policy]

To evaluate the changed policy regarding cervical smears with mild atypia in the Netherlands (before 1988 classified as Pap II, thereafter as Pap IIIA), an descriptive study was carried out in the laboratory of gynaecological cytology Cyt-U-Universitair (University of Utrecht). All women who in 1988 had a first smear with mild atypia were included. After a follow-up period of 2 years the final diagnosis was noted. The results of the follow-up of cervical smears with mild atypia were compared with the follow-up results of moderate atypia. A selection was made of 477 women. In 55% of the cases no dysplasia was found during the 2 years of follow-up. In 12% of the cases severe dysplasia, carcinoma in situ or carcinoma was found. Compared with the smears with moderate atypia the dysplasia in the follow-up of mild atypia led to fewer cases of proven dysplasia. In addition the dysplasia in these cases was of a lower grade. The group of women referred to the gynaecologist after the smear with mild atypia was remarkably large (30%). As the results show, the policy of careful follow-up of women with mild atypia in the cervical smear has been a good one. It implies classifying mild atypia as Pap IIIA. As many women (55%) do not display cervical dysplasia within a 2 year follow-up period, the policy of making a repeat smear before referring appears justified.