Finding | Measures | Follow-up |
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Satisfactory for evaluation, no glandular cells | Consider taking a new sample | |
Evaluation unreliable | Consider taking a new sample | |
Unsatisfactory for evaluation | Take a new sample | |
Negative for intraepithelial lesion or malignancy |
Inflammation | If necessary, microbe-specific therapy and follow-up as recommended by the cytologist | |
Regeneration | Follow-up as recommended by the cytologist; colposcopy if strong evidence of regeneration persists | |
Atrophic vaginitis | Local oestrogen therapy is recommended, follow-up as recommended by the cytologist | |
Change caused by radiation | Repeat sample after 4-12 months as recommended by the cytologist; colposcopy if the change is significant and recurring. | Annual smear test |
Epithelial cell abnormality |
ASC-US (atypical squamous cells of undetermined significance) | Repeat sample after 12-24 months. Colposcopy if the change recurs 2-3 times during 12-24 months. Further treatment according to findings. | According to colposcopy findings |
ASC-H (as above but cannot exclude high-grade squamous intraepithelial lesion) | Colposcopy within 1-2 months. Treatment is warranted if CIN 2 or 3 is detected, in other cases repeat samples at 6 month intervals until the finding is normal (CIN = cervical intraepithelial neoplasia; CIN 1 = mild dysplasia, CIN 2 = moderate dysplasia, CIN 3 = severe dysplasia or carcinoma-in-situ). | According to colposcopy findings |
LSIL (low-grade squamous intraepithelial lesion) | Women > 30 yrs.: colposcopy within 6 months. The same applies to women < 30 yrs if recommended by the cytologist or when ASC-US or a more marked change is detected in the follow-up sample after 6-12 months. Treatment is warranted if CIN 2 or 3 is detected in colposcopy, otherwise repeat samples at 6-12 month intervals until the finding is normal. | According to colposcopy findings. In CIN 1, follow-up for 2 years. Treatment, if not cured during follow-up. Thereafter annual smear tests for 30 months. Later on, the interval between smear tests must not exceed 5 years. |
HSIL (high-grade squamous intraepithelial lesion) | Colposcopy within 1-2 months. Treatment is warranted if CIN 2 or 3 is detected, in other cases repeat colposcopy after 6 months and take repeat samples at 6 month intervals until the finding is normal. | According to colposcopy findings. In CIN 2-3, annual smear tests for 60 months after treatment; thereafter, the interval between smear tests must not exceed 5 years. |
Squamous cell carcinoma | Colposcopy, loop excision and treatment of the carcinoma according to the degree of invasion. | Follow-up at an oncology clinic |
Atypical glandular cells of endocervical origin | Colposcopy within 1-2 months, in undetermined glandular atypia a repeat smear within 4-6 months may be sufficient as recommended by cytologist. | According to colposcopy findings. Annual smear test |
Atypical glandular cells of endometrial origin | Vaginal ultrasound and endometrial biopsy | Postmenopausal endometrial follow-up |
Adenocarcinoma | Colposcopy, treatment of the carcinoma depending on the case | Follow-up at an oncology clinic |
Other malignancy | Colposcopy and histological samples | Follow-up at an oncology clinic |
Hormonal state inconsistent with age and history | Depending on the case; information from the Pap smear is always only indicative (N.B. oestrogen-secreting tumours after menopause) | |