Cervical cytology and the evaluation of the abnormal Papanicolaou smear

The pap smear is a safe, easy, and inexpensive method for the screening of large numbers of sexually active women for the presence of neoplasia of the cervix. When the pap smear is reported as being abnormal, it is highly accurate. Unfortunately, some cytology laboratories report lesions as "Class II" or "atypical." These reports are not helpful to the clinician and require further evaluation. Most sexually active women are at "high risk" for the development of cervical neoplasia because of early sexual activity for multiple sexual partners. All women at high risk should have annual pap smears. If a woman has a pap smear that suggests the presence of CIN (dysplasia or carcinoma in situ), colposcopy should be performed. This office procedure allows for the detection of the areas causing the abnormal cytology. Colposcopy can often allow outpatient therapy of CIN lesions. Conization should be performed only when the colposcopic examination is unsatisfactory or patient or lesion factors are not favorable for office therapy. Hysterectomy is not recommended for treatment of cervical dysplasia or carcinoma in situ.