Follow-up Guidelines; Pap test results
Ontario interim recommendations for follow-up of Pap test results. These are minimum guidelines only. There may be clinical situations that require earlier follow-up / referral for colposcopy. Any repeat Pap test should not be performed earlier than three months.
The Pap test should not be used in the assessment of a visible cervical lesion. These patients require biopsy for accurate diagnosis.
Statement of Adequacy | Recommendation |
Within normal limits: Satisfactory for evaluation | Continue with normal screening interval. |
Within normal limits: Satisfactory for evaluation but limited by: state reason | If previous Pap tests have been normal, and satisfactory for evaluation, continue normal screening interval. If there is no previous Pap test or no test satisfactory for evaluation, the test should be repeated earlier than one year. |
Unsatisfactory for evaluation | Repeat in three months |
Diagnostic Category | Recommendation |
Benign cellular changes: Inflammation | Culture and treatment, if appropriate Continue with normal screening interval |
Benign cellular changes: Non-specific | If previous tests have been normal and satisfactory for evaluation, continue with normal screening interval. |
Atypical squamous cells of undetermined significance (ASCUS) Low-grade intraepithelial lesion (LSIL) |
The minimum recommendation is to repeat at six-month intervals for up to two years. If a second diagnosis of ASCUS or LSIL occurs in a two-year period, colposcopy could be considered. If there is no evidence of cytological progression on repeat Pap tests, it is acceptable to follow the patient for up to two years, at which point all patients with persistent abnormalities should be referred for colposcopy. It is noted that there will be clinical situations (e.g. poor compliance, previous abnormal Pap test) in which immediate colposcopy and biopsy is the recommended forms of investigation. |
High -Grade Squamous Intra-epithilial Lesion (HSIL) | Colposcopy |
Squamous cell carcinoma | Colposcopy |
Endometrial cells cytologicallly benign in a post menopausal woman | These findings shoud be interpreted in light of the clinical scenario. |
Atypical glandular cells of undetermined significance [AGUS]: favour endometrial origin | Suggest endometrial sampling |
AGUS: favour reactive endocervical cells | Repeat test in six months |
AGUS: favour neoplastic endocervical cells AGUS: not otherwise specified |
Colposcopy: It is recognized that follow-up of pap tests recognized as AGUS may include sampling of the endocervical canal, in addition to colposcopy |
Atypical glandular cells, consistent with adenocarcinoma in situ |
Colposcopy: With cytological evidence of adenocarcinoma in situ, a diagnostic cone biopsy should be performed.(ie, knife excision, not loop electrodiathermy excision procedure.-LEEP) |
Malignant cells present , consistent with adenocarcinoma | Suggest further investigation |
Malignant cells present, NOS | Suggest further investigation |