Atypical squamous cells in Papanicolaou smears

Between 1980 and 1984, 406 patients were referred to Tripler Army Medical Center's cervical clinic for the evaluation of atypical squamous cells in a Papanicolaou smear. Their evaluation included repeating the smear, colposcopy in all cases, colposcopically directed biopsies, and/or endocervical curettage in 70%. The results of the repeat Papanicolaou smear in 400 patients were 274 (68.5%) negative, 77 (19%) atypical squamous cells, 40 (10%) cervical intraepithelial neoplasia (CIN) 1, seven (2%) CIN 2, and two (0.5%) CIN 3. No invasive cancer was detected. Dysplasia was documented histopathologically in 18.7%, but a repeat smear was reported as negative in 10.9% of patients with biopsy-proven dysplasia. A Papanicolaou smear report of atypical squamous cells should not be considered normal, and further evaluation of the patient is required. If colposcopy is impractical, serial follow-up smears are recommended.