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Abnormal cervical smear result

Specialties > Obstetrics

Differential Diagnosis Schema 🧠

Pre-Malignant Changes

  • Cervical Intraepithelial Neoplasia (CIN): Graded as CIN1, CIN2, CIN3 based on the extent of abnormal cells, with CIN3 being the most severe.
  • Cervical Glandular Intraepithelial Neoplasia (CGIN): Abnormal glandular cells found in the cervical canal, considered pre-malignant.

Malignant Changes

  • Squamous Cell Carcinoma: The most common type of cervical cancer, typically presents with abnormal bleeding.
  • Adenocarcinoma: Arises from glandular cells of the cervix, often harder to detect on smear tests.
  • Other Rare Malignancies: Includes neuroendocrine tumours, sarcomas.

Benign Changes and Non-Neoplastic Conditions

  • Atrophic Vaginitis: Postmenopausal changes leading to thinning of the cervical epithelium, causing abnormal smear results.
  • Inflammation/Infection: Often caused by chronic cervicitis or sexually transmitted infections such as HPV, chlamydia.
  • Ectropion: Eversion of the endocervical epithelium, can mimic abnormal smear results.
  • Radiation or Chemotherapy Changes: Previous treatment can lead to cellular changes mimicking malignancy.

Other Causes of Abnormal Smear Results

  • Sampling Error: Insufficient or poorly taken samples can lead to unclear results.
  • Technical Errors: Artefacts on the slide or laboratory errors can produce abnormal findings.
  • Hormonal Changes: Pregnancy, hormone replacement therapy can lead to cellular changes noted on smears.

Key Points in History 🥼

Symptoms

  • Abnormal Vaginal Bleeding: Including postcoital, intermenstrual, or postmenopausal bleeding, suggestive of CIN or malignancy.
  • Vaginal Discharge: Watery, blood-stained or foul-smelling discharge may indicate infection, malignancy, or necrotic tumour.
  • Pelvic Pain: Persistent or recurrent pain, especially if associated with bleeding, may suggest advanced malignancy.

Background

  • Previous Cervical Smears: History of abnormal smears, previous CIN, or follow-up for HPV.
  • Sexual History: Multiple sexual partners, early onset of sexual activity, or history of sexually transmitted infections increases the risk of HPV-related CIN.
  • Obstetric History: Parity and age at first pregnancy can affect cervical cancer risk.
  • Smoking: Smoking is a known risk factor for cervical neoplasia.
  • Immunosuppression: HIV infection or long-term immunosuppressive therapy can increase susceptibility to HPV infection and progression to CIN/cancer.

Possible Investigations 🌡️

Further Smear Tests

  • Repeat Smear: Performed after an initial abnormal result, typically within 3-6 months.
  • HPV Testing: High-risk HPV types 16 and 18 are most commonly associated with CIN and cervical cancer.

Colposcopy

  • Visualisation: Allows direct visual examination of the cervix, with the application of acetic acid or Lugol’s iodine to highlight abnormal areas.
  • Biopsy: Directed biopsies of any suspicious areas identified during colposcopy can confirm the diagnosis.

Histopathology

  • Punch Biopsy: Small tissue samples taken during colposcopy, used to diagnose CIN or cervical cancer.
  • Cone Biopsy: Larger, cone-shaped tissue sample from the cervix, often done if CIN 2/3 or cancer is suspected.

Imaging

  • Pelvic MRI: Used to assess the extent of invasive cervical cancer and involvement of adjacent structures.
  • CT Scan: May be used for staging in advanced cervical cancer, particularly to assess lymph node involvement.
  • PET-CT: Useful in advanced or recurrent cervical cancer to assess for distant metastases.

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Obstetrics