Management of the abnormal Papanicolaou smear

Since 1943, Papanicolaou (Pap) smears have been widely used to screen for cervical cancer. Over the past 25 years, new understanding of the natural history of cervical epithelial neoplasia has defined the existence and importance of dysplasia, also termed cervical intraepithelial neoplasia (CIN), and more recently, its probable link to human papilloma virus (HPV). Inflammatory atypia (IA) is a common cytological diagnosis whose significance is less understood. Current gynecological opinion strongly supports a practice of colposcopic evaluation for all women with cytology showing any degree of CIN. Data from studies in our health service and elsewhere establish that 15% to 30% of patients with IA will have CIN if evaluated by colposcopy. Although clinicians may choose to follow such patients with repeated Pap smears, there are strong arguments for offering colposcopic evaluation to patients with IA. Potential problems with false-positive cervical biopsy reports, however, may limit the utility of colposcopy in patients with IA cytology.