ASCUS and CIN1: Navigating Abnormal Pap Smear Results and Pregnancy Concerns

The Pap smear showed atypical squamous cells of undetermined significance (ASCUS), and the biopsy results indicated cervical intraepithelial neoplasia grade 1 (CIN1)?

I usually go to a nearby hospital for Pap smear tests (ThinPrep Pap test).
On March 4, 2020, the results were normal; on June 3, 2020, normal; on September 16, 2020, normal; and on December 23, 2020, there were abnormal cells reported as ASCUS.
On April 7, 2021, inflammation was noted; on July 21, 2021, inflammation again; and on December 8, 2021, inflammation was reported.
On March 16, 2022, abnormal cells were again reported as ASCUS.
The doctor recommended surgery.
On March 24, 2022, I went to the main hospital for a biopsy, and the result was CIN1.
I informed the doctor that I wanted to become pregnant, and it is usually recommended to perform surgery only for CIN2/3.
The doctor advised me to continue with Pap smear tests for monitoring.
On April 9, 2022, I went to another hospital and informed the doctor that the biopsy result was CIN1.
The doctor asked me to have another Pap smear in three months, and if it is still CIN1, surgery would be necessary.
Three months later, the Pap smear report indicated inflammation (conventional Pap test).
I would like to inquire about my situation and what would be the best course of action, as I am concerned about the worsening of my condition but also want to become pregnant.
Why are the results of the Pap smear different from the biopsy? Which is more accurate, the ThinPrep Pap test or the conventional Pap test?

Ms. Li, 30~39 year old female. Ask Date: 2022/08/01

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
Pap smears are used for screening, with an accuracy rate of about 70 to 80 percent.
The liquid-based Pap smear is a more accurate type of Pap test, while a biopsy is used for definitive diagnosis.
2.
CIN1 does not necessarily require surgical excision; it can also be monitored.
Since it is unlikely to progress to cancer immediately, it is advisable to discuss options with a physician.
The general recommendation is to approach treatment in the least invasive manner possible.

Reply Date: 2022/08/01

More Info

Navigating the complexities of abnormal Pap smear results, particularly ASCUS (Atypical Squamous Cells of Undetermined Significance) and CIN1 (Cervical Intraepithelial Neoplasia grade 1), can be challenging, especially for women who are considering pregnancy. Your situation involves a series of Pap smear results and subsequent biopsies, which can understandably lead to confusion and concern about your health and future plans for pregnancy.

Understanding ASCUS and CIN1
ASCUS is a term used when the cells collected during a Pap smear show some abnormalities, but these changes are not definitive for cancer. It often indicates that further testing is needed to determine the cause of the abnormality. In many cases, ASCUS can be associated with benign conditions, such as inflammation or infection, and may resolve on its own.

CIN1, on the other hand, indicates mild dysplasia, which means that there are some abnormal cells on the cervix, but they are not cancerous. CIN1 is often considered a low-grade lesion, and in many cases, it may regress without treatment. The management of CIN1 typically involves monitoring rather than immediate intervention, especially in women who are planning to conceive.

Your Medical Journey
From your reports, it appears that you have experienced a pattern of abnormal results followed by normal findings, which can be common. The fact that your biopsies have shown CIN1 suggests that while there are some abnormal cells, they are not severe enough to warrant immediate surgical intervention. Your doctors' recommendations to continue monitoring with Pap smears and to consider surgery only if the condition progresses to CIN2 or CIN3 is consistent with current medical guidelines.

Concerns About Pregnancy
If you are considering pregnancy, it is crucial to have a clear understanding of your cervical health. While CIN1 is generally not a barrier to conception or carrying a pregnancy to term, it is essential to maintain regular follow-ups with your healthcare provider. They may recommend more frequent Pap smears to monitor any changes in your cervical cells, especially if you have a history of ASCUS and CIN1.

Differences Between Pap Smear Types
Regarding the differences between the New Bethesda System (New柏式抹片) and traditional Pap smears, both methods aim to detect cervical abnormalities, but they may differ in sensitivity and specificity. The New Bethesda System is designed to provide more detailed information about the types of cell changes present, which can help guide management decisions. However, both methods are generally reliable, and discrepancies between results can occur due to various factors, including sampling techniques, the presence of inflammation, or the pathologist's interpretation.

Recommendations
1. Regular Monitoring: Continue with the recommended follow-up Pap smears as advised by your healthcare provider. This will help ensure that any changes in your cervical health are detected early.

2. Consultation with a Specialist: If you have concerns about your ability to conceive or the implications of your cervical health on pregnancy, consider consulting a gynecologist or a reproductive endocrinologist. They can provide tailored advice based on your medical history and current health status.

3. Stay Informed: Educate yourself about cervical health and the implications of ASCUS and CIN1. Understanding your condition can help alleviate anxiety and empower you to make informed decisions about your health and family planning.

4. Discuss Pregnancy Plans: If you are actively trying to conceive, discuss this with your healthcare provider. They can help you understand any potential risks and the best timing for pregnancy in relation to your cervical health.

In summary, while ASCUS and CIN1 can be concerning, they are often manageable with careful monitoring. Your healthcare team is best positioned to guide you through this process, ensuring that both your cervical health and your desire to conceive are addressed appropriately.

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