Work-up of abnormal Pap test results
If the results of your Pap test were abnormal , your doctor may recommend repeat testing (with the Pap test and/or the HPV test), colposcopy, or a loop electrosurgical procedure (LEEP or LLETZ). What tests (or treatment) you need depend upon the results of your Pap test (and HPV test if you had one).
Atypical squamous cells
Recommended testing will be based on whether the Pap results show atypical squamous cells of uncertain significance (ASC-US) or atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H).
For ASC-US, some doctors will repeat the Pap test in 12 months. Another option is to use the HPV DNA test to decide whether or not to do a colposcopy. If HPV is detected, the doctor is likely to order a colposcopy. If HPV is not detected, then the doctor will recommend that both the Pap test and the HPV test be repeated in 3 years.
If the results of a Pap test are labeled ASC-H, it means that a high-grade SIL is suspected and colposcopy will be recommended.
Squamous intraepithelial lesions (SILs)
These abnormalities are divided into low-grade SIL (LSIL) and high-grade SIL (HSIL).
For LSIL, further testing depends on HPV testing. If the HPV test was negative (meaning the virus wasn’t detected), then a repeat Pap test and HPV test are recommended in one year. If the HPV test was positive, then colposcopy will be recommended. If no HPV test was done and the woman is at least 25 years old, colposcopy will be recommended. If the woman is under 25, she should repeat the Pap test in a year. Pregnant women with LSIL should have colposcopy.
For HSIL, either colposcopy or a loop electrosurgical procedure is recommended for women 25 and older. Colposcopy is recommended for women under 25.
Atypical glandular cells and adenocarcinoma in situ (on a Pap test)
If the Pap results read atypical glandular cells or adenocarcinoma but the report says that the abnormal cells do not seem to be from the lining of the uterus (the endometrium), guidelines recommend colposcopy with a type of biopsy called endocervical curettage (endocervical scraping). The doctor may also biopsy the endometrium (this can be done at the same time as the colposcopy). For information about endometrial biopsy, see our document Endometrial (Uterine) Cancer.
If, under the microscope, the atypical glandular or adenocarcinoma cells look like they are from the endometrium, experts recommend a biopsy of the endometrium along with the cervical biopsy (endocervical curettage), but a colposcopy isn’t needed.
Last Medical Review: 04/11/2013
Last Revised: 08/15/2014