The Pap smear report should indicate whether the smear was adequate. Unless the patient has had a hysterectomy, this report should include cytologic evidence that the transformation zone was sampled.
The Bethesda system has provided a uniform nomenclature for Pap smear cytology interpretation and attempts to address much of the confusion regarding Pap smear terminology. In September 2001, the Bethesda consensus conference convened for the third time and provided revisions of the reporting system.
- A consensus group hosted by the American Society of Colposcopy and Cervical Pathology (ASCCP) has developed guidelines for the management of abnormal cervical cytology. See Colposcopy for more information. The ASCCP Guidelines are summarized with algorithms that can be found at http://www.asccp.org/consensus/cytological.shtml. These algorithms can guide clinicians through evidence-based recommendations for most abnormal Pap smear scenarios.
- A report that describes glandular or adenomatous atypia warrants immediate colposcopy with endocervical curettage to rule out a high-grade lesion and cervical adenocarcinoma. If the findings of AGS are definite, conization, pelvic ultrasound, and even laparoscopy may be indicated. See Endometrial Biopsy and Colposcopy for more information.
- Patients who are immunocompromised may require different and, in general, more aggressive follow-up and management strategies. See Colposcopy for more information.