• See Definitions of interpretation categories section

Contributed by Rachel Jug, M.B.B.Ch., B.A.O. and Sarah M. Bean, M.D.

• Cervix, Pap smear:
  • Cytologic diagnosis:
    • Specimen adequacy:
      • Satisfactory for evaluation - endocervical component absent
  • Interpretation:
    • Epithelial cell abnormality
    • Low grade squamous intraepithelial lesion (LSIL)
    • Fungal organisms morphologically consistent with Candida species
  • Comment: This specimen has been analyzed by the ThinPrep Imaging System (Hologic Corp), along with an additional manual rescreening by a cytotechnologist or pathologist.

• Human papillomavirus DNA, high risk:
  • HPV 16: negative
  • HPV 18: negative
  • HPV OTH: positive
  • Human papillomavirus 16, 18 or high risk pool (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68) is detected by an FDA approved DNA amplification test. Positive for the high risk pool indicates that one or more of the genotypes was detected. A negative for any of the genotypes indicates that the genotype(s) was undetectable or below the threshold of the test.

B. 5,000. A minimum of 5,000 well visualized / well preserved squamous or squamous metaplastic cells is considered adequate for a liquid based preparation from a woman with a cervix. Certain circumstances based on the patient’s clinical history may allow for a lower adequacy threshold of 2,000 cells in the instance of postmenopausal atrophic changes, prior chemotherapy / radiation therapy or women posthysterectomy. The cellularity threshold for a conventional preparation is a minimum of 8,000 to 12,000 well preserved and well visualized squamous epithelial cells.

Comment Here

Reference: Bethesda system

Under the interpretation category of the Bethesda system, which epithelial cell abnormality is described by squamous cells with nuclear enlargement 3 times the size of the normal intermediate cell nucleus, hyperchromasia, anisonucleosis, uniform chromatin, bi or multinucleation and koilocytosis or perinuclear cavitation?


1. Atypical glandular cells, not otherwise specified
2. Atypical squamous cells of undetermined clinical significance (ASCUS)
3. High grade squamous intraepithelial lesion (HSIL)
4. Low grade squamous intraepithelial lesion (LSIL)
5. Negative for intraepithelial lesion or malignancy (NILM)

D. Low grade squamous intraepithelial lesion (LSIL). In contrast to normal squamous epithelial cells of the cervix (consistent with a diagnosis of NILM), squamous type epithelial cell abnormalities feature changes in nuclear size and features along a spectrum. ASCUS nuclei are enlarged by 2 to 3 times, have smooth to slightly irregular nuclear membranes, finely granular chromatin, inconspicuous nucleoli and questionable cytoplasmic cavitations. LSIL nuclei are enlarged by 3 to 4 times, have smooth to slightly irregular nuclear membranes, slightly more granular chromatin, absent nucleoli and diagnostic HPV cytoplasmic cavitations. HSIL nuclei are more variable than LSIL but the cytoplasmic area is decreased, resulting in a higher N:C ratio. HSIL nuclei have more irregular membranes, nuclear hyperchromasia with fine or coarse chromatin, generally absent nucleoli and can occur singly or in sheets or syncytial-like aggregates. Atypical glandular cells have features such as increased N:C ratio, mitotic activity, feathering and may show pseudostratification.

Comment Here

Reference: Bethesda system

B. Adenocarcinoma, endometrial. Endometrial adenocarcinoma cells may be seen in Pap smears as single or small clusters of cells with variably sized nuclei, loss of nuclear polarity, nuclear hyperchromasia, prominent nucleoli, scant vacuolated cytoplasm, intracytoplasmic neutrophils and watery tumor diathesis. In contrast, endocervical adenocarcinoma cells may present as pseudostratified strips of cells with crowding, nuclear enlargement and peripheral feathering. Block positive p16 staining can help differentiate endocervical adenocarcinoma in situ (or invasive) from endometrial adenocarcinoma. Extrauterine adenocarcinoma will often present in a clean background as opposed to endometrial adenocarcinoma with tumor diathesis.

Comment Here

Reference: Bethesda system