The minimally abnormal Papanicolaou smear

The Bethesda system has helped to standardize the nomenclature for cervical cytology. Previously used cytologic classification systems failed to define modern histopathologic concepts. The Bethesda system also has dramatically increased the number of Papanicolaou smears classified as minimally abnormal. While high-grade squamous intraepithelial lesions (cervical intraepithelial neoplasia 2 and 3) clearly require colposcopic evaluation, the minimally abnormal Pap smear may not always require colposcopic assessment. Common minimally abnormal cytologic categories include atypical squamous cells of undetermined significance, low-grade intraepithelial lesions and atypical glandular cells. New guidelines propose a conservative and expectant approach for these mild abnormalities. Understanding the meaning of these Pap smear reports and instituting appropriate treatments will improve patients care, reduce clinician anxiety and help ensure the best care for patients.