Inadequate Pap Smear

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