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Inadequate Pap Smear
Aka: Inadequate Pap Smear, Unsatisfactory Pap Smear Cytology, Negative Pap Smear Cytology but Missing Transformation Zone
- Definitions
- Inadequate Pap Smear
- Pathologist unable to use Pap Smear due to poor quality
- Causes
- Inadequate sampling (Cervix transformation zone not included)
- Air drying (conventional sampling methods before thin-prep Pap Smear)
- Excessive Red Blood Cells or White Blood Cells
- Management: Generally unsatisfactory sample (2014 and 2019 guidelines)
- Consider Colposcopy if HPV positive at age 25 years or older or HPV 16 or HPV 18
- Repeat cytology in 2-4 months
- Negative repeat testing
- Repeat testing with HPV and cytology in one year if HPV positive
- Otherwise, return to routine screening
- Abnormal repeat testing
- See Pap Smear for guidelines
- Unsatisfactory sample again on repeat cytology
- Colposcopy
- Measures that may improve Pap Smear quality
- Obtain cytology during mid-cycle
- No intercourse for 24 hours before Pap Smear
- No vaginal preparations for 24 hours before Pap Smear
- Management: Transformation Zone absent, but negative for intraepithelial lesion or malignancy (2014 and 2019 guidelines)
- Age 21-29 years old
- Continue routine screening
- Age 30 years or older
- HPV Negative
- Continue routine screening
- HPV Unknown
- Obtain HPV testing and manage based on result (preferred)
- Repeat cytology at 3 years
- HPV Positive
- Cytology and HPV testing in 1 year (co-testing) OR
- HPV Genotyping
- References
- (2014) ASCCP Guidelines
- http://www.asccp.org/Guidelines-2/Management-Guidelines-2