Understanding Pap Smear Results – What They Really Mean

put confused about what your pap test really means

Have you ever received a copy of your pap smear results in the mail or through your online patient chart, only to be completely befuddled by what it means? If your doctor is kind, they’ll include a note with the results that says if everything is fine, or if you need more testing. But sometimes you get a copy of the actual report, which feels like it’s written in another language. Most medical testingfrom blood tests to radiology exams to your pap testsare still reported out in medical-speak that seems very far from English. Let me decode the mysterious language, and what it means for you.

Phrases in your pap smear results that mean everything’s fine:
  • Endocervical cells present. This phrase means that cells from the inside of your cervical canal were sampled at the time of the pap test, which is something your doctor tries to do. Sometimes it’s hard to reach these cells, which may lead to the phrase…
  • Endocervical cells absent. This means that the sampling of cells during your pap didn’t include those inside-the-canal cells. If you’ve never had an abnormal pap in the past, it’s fine for an occasional pap to not sample these cells. But if your pap was performed to follow-up an abnormal test, your doctor may want you to return to the office for a repeat pap.
  • Acute inflammation.  Some white blood cells were seen on the pap test. This finding most often means nothing  and RARELY is a sign of infection. But if you’re not having any signs of infection – no abnormal discharge, no odor, no itching – I wouldn’t be concerned.
  • Atrophic change means that the cervix is showing signs of menopause (and the accompanying lack of estrogen). So that’s fully expected if you’re in peri-menopause or if your periods have stopped altogether.
  • Squamous metaplastic cells present. Here the pathologist noted cells that were growing or repairing themselves, which is a normal process.
  • Endometrial cells present. Your pap also picked up some cells from the inside of your uterus. This finding often happens if your pap was done around the time of your period. If you’re menopausal and no longer having periods, your doctor may recommend a follow-up test.
  • Transformation zone component present. Another phrase that means your pap sampled cells both on the surface of your cervix and inside the canal. A thorough pap test!
  • Transformation zone component absent. Like with “endocervical cells absent,” your pap didn’t pick up cells at the transition of the outside to the inside of your cervix. Nothing to worry about.
  • Negative for intraepithelial lesion or malignancy. This is the complicated way of saying everything’s fine!
Phrases in your pap smear results that indicate a problem:
  • Atypical squamous cells of uncertain significance. Also called “ASCUS.” The pathologist sees abnormal cells, but doesn’t know why. Could be an infection, could be the start of a true abnormality. Your gyno will either repeat the test in 6-12 months, or order an HPV test. If the HPV test was done at the same time and was negative, you’re in the clear. But if the HPV test was positive, you’ll need a follow-up test.
  • Atypical glandular cells. Also called “AGC.” Could be you were near your period, but could be a sign of abnormal tissue in either your cervix or your uterus. Your gyno will likely perform a colposcopy, a special exam of your cervix, and may want to do a small biopsy of the lining of your uterus.
  • Cannot rule out high-grade abnormality (or SIL). When the pathologist isn’t sure if your cells look normal or not, they give this result. To be safe, your gyno will perform colposcopy and possibly take biopsies.
  • Low-grade or high-grade squamous intraepithelial lesion (LSIL or HSIL). These results indicate that abnormal cells are noted, and both are indications for colposcopy.