Dr. Guy Gutman, M.D. Senior Specialist in Gynecology and Obstetrics and a Leading Surgeon in the Field

Abnormal Pap Results

בדיקת פאפ לא תקינה

Cervical cancer is one of the most common types of cancer in Israel and the world. In Israel, five women out of every 100,000 have cervical cancer. In developing countries worldwide, the situation is slightly less alarming, but cervical cancer is still the second most common type of cancer among women.

The positive news is that cervical cancer is starting to form from premalignant changes that develop slowly and are therefore detectable early. In addition, the leading cause of cervical cancer is consistent and well-known: HPV – the human papillomavirus. There is a vaccine against this virus, which is currently given before the start of sexual activity (eighth grade), in order to reduce the infection and reduce the cause of cervical cancer and other infections. This vaccine is the primary and safest protective wall against cervical cancer.

Another barrier that significantly reduces the number of cervical cancers is a routine PAP test, which should be performed once a year for up to three years.

Why is it important to perform a routine Pap test?

A Pap smear is considered one of the most effective ways to prevent the development of cervical cancer. Through this test, it is possible to detect cancerous or precancerous processes in the cervical mucosa and to provide the appropriate treatment to amputate their development as early as possible.

In countries that have made the Pap test a mass screening test, there has been a significant decrease in the incidence of cervical cancer and the incidence of deaths from this disease. Therefore, it should not be taken lightly and performed according to the doctor’s recommendation.

How is a PAP test performed?

A Pap test is performed by a gynecologist during a routine gynecological examination. This is not a painful test, but it may cause discomfort to the patient. In this examination, the doctor has to examine the patient’s pelvic organs, so she will have to lie on the treatment chair with her legs spread apart on the raised legs of the chair. To examine the lining and canal of the vagina, the doctor will first insert a speculum into the vagina to expand it slightly.

The doctor will then take a sample of cells from the cervical mucus, using a thin stick inserted into the vagina until the cervix shows. The doctor will scrape the inspected area slightly with a thin brush to remove a layer of cells and send it to the lab for examination. This specimen is stained and examined under a microscope to detect abnormal cell structure or culture. The results will return from the lab after two or three weeks.

What are the possible test results?

There are several possible results for Pap testing:

  • Negative for Neoplastic Cells – The expected results and no damage was observed.
  • Inadequate Pap Smear – It is necessary to perform the test again because the sample taken is insufficient quantitatively and/or qualitatively.
  • Benign Pap Smear Changes – Benign changes have been observed in the cervical cells, but most often it is just inflammation or infection, not cancer. In each of these cases, follow-up tests should be administered by the gynecologist.
  • ASC – This result demonstrates a change in the structure of cells in the tissue. This result will require further testing and follow-up, or a colonoscopy, at the discretion of the physician.
  • AGUS – This result requires further clarification through a colposcopy examination, as it indicates the existence of changes in glandular cells.
  • LGSIL – Further clarification is needed, as slight changes in the epithelial cells have been observed and their malignancy can not be ruled out.
  • HGSIL – This finding indicates more significant changes in epithelial cells, and is considered a precancerous finding with a high risk of becoming cancerous. This finding requires further in-depth treatment and clarification at the discretion of the physician.

CIN – Changes in the epithelial cells of the cervix, which are defined as precancerous and at risk of becoming malignant tumors. There are 3 degrees of severity that can be distinguished by examining the Pap:

  • CIN 1 – Slight changes in the cells, at a depth of up to one third of the thickness of the cervical mucosa.
  • CIN 2 – Moderate changes – up to two-thirds of the thickness of the cervical mucosa. Requires treatment.
  • CIN 3 – High-grade changes, on any thickness of the mucosal layer.
    • It is important to note that CIN 2 and CIN 3 are not cancerous tumors, but should be treated so that they do not develop further.
About the Author
Dr. Guy Gutman

Dr. Guy Gutman

A senior physician at the Clalit Health Fund's Women's Health Center, a specialist in gynecology and cervical medicine, with 20 years of successful experience in fertility, obstetrics and gynecology.

Dr. Guy Gutman

Dr. Guy Gutman

A senior physician at the Clalit Health Fund's Women's Health Center, a specialist in gynecology and cervical medicine, with 20 years of successful experience in fertility, obstetrics and gynecology.