Diagnosing Abnormal Pap Test Results

The Pap test is a screening test for cancer of the cervix, the passageway that connects the uterus to the vagina. An NYU Langone gynecologist performs the test during a pelvic exam.

An abnormal Pap test result means there are changes to cervical cells that may require additional testing. Your doctor may check for human papillomavirus (HPV), a condition called cervical dysplasia that is considered to be precancerous, or cervical cancer. The Pap test itself is not a diagnostic test.

The majority of women with abnormal Pap test results do not have cervical cancer, but they may need treatment to prevent cancer.

Your doctor determines if further testing is needed depending on your age, if you have a history of abnormal Pap test results, and the type of irregular cells found—low grade or high grade. If the cells appear to be high grade, this can indicate that cancer may develop.

Human Papillomavirus Test

Your doctor may perform a test to check for certain types, or strains, of HPV that are associated with a high risk of developing cervical cancer.

Your doctor inserts an instrument called a speculum into the vagina to separate its walls. Then he or she uses a soft brush or other collection device to remove cells from the cervix. This sample is sent to a laboratory for analysis.

The HPV test may be performed at the same time as a Pap test, particularly in women older than age 30 and in those who have had prior abnormal Pap test results. This is because women in their 30s who have tested positive for HPV are at a higher risk for cervical cancer. They tend to have had the infection longer, increasing the risk of developing cancer.

Colposcopy

If your Pap test results are abnormal, your NYU Langone doctor may perform a colposcopy to take a closer look at cervical cells using a magnifying instrument called a colposcope.

During the procedure, the doctor may use a slightly acidic vinegar solution to make abnormal tissue more visible. He or she also takes a sample of tissue, called a biopsy, that is sent to a laboratory for further examination.

Cone Biopsy

If a Pap test or biopsy from a colposcopy shows precancerous changes in the cells of the cervix, your doctor may recommend a cone biopsy. In this procedure, a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope. The wedge includes tissue from the cervical canal, the area at the base of the uterus, where most cervical cancers begin.

A cone biopsy is done in the hospital with local, general, or spinal anesthesia. The tissue sample is then examined by a pathologist, a doctor who uses a microscope to look for abnormalities.

Loop Electrosurgical Excision Procedure

If Pap test results indicate high grade abnormal cervical cells, or if HPV test results show high risk strains of the virus, your doctor may recommend a loop electrosurgical excision procedure, or LEEP.

In this procedure, the doctor uses a wire loop heated by an electrical current to remove tissue from the cervix for analysis in a laboratory. LEEP may be performed in the doctor’s office with local anesthesia or in the hospital with general anesthesia.

Your doctor reviews the test results and determines if further treatment is necessary.