Role of Conventional Pap’s Smear in Diagnosis of Atypical Squamous Cell-Indeterminate Significance (ASC-US) and Low-Grade Squamous Intraepithelial Lesion (LSIL) in Comparison with Human Papillomavirus PCR Test

  • Anju Khairwa
Original Article



Human papillomavirus (HPV) infection is most common etiological agent of carcinoma cervix. Most prevalent carcinogenic HPV types are 16 and 18. Cervical lesion can be detected by conventional Pap’s smears and polymerase chain reaction (PCR). Molecular techniques are costly and not available everywhere.


The aim of study was to evaluate efficacy of conventional Pap’s smear in comparison with HPV PCR for diagnosis of ASC-US (atypical squamous cell-indeterminate significance) and LSIL (low-grade squamous intraepithelial lesion).


We prospectively collected data of conventional Pap’s smears from May 2017 to September 2017. Pap’s smears showing epithelial cell abnormality were sent for HPV DNA PCR as per Bethesda guidelines 2014.


Total 252 Pap’s smears were collected. Age range of affected women was 21–45 years. Chief complaints of patients were discharges, pain, and bleeding per vagina. Out of 252 Pap’s smears, 47 Pap’s smears showed epithelial cell abnormalities. The abnormalities included ASC-US in 59.5%, LSIL in 17.0%, ASC-H (cannot exclude HSIL) in 10.6%, HSIL (high-grade squamous intraepithelial lesion) and AGC in 4.2% each, adenocarcinoma in situ and squamous cell carcinoma in 2.1% each. Out of 36 ASC-US and LSIL abnormal Pap’s smears, six patient’s (five ASC-US and one LSIL) samples were sent for HPV DNA PCR. All six patients were negative for HPV DNA on PCR.


Early-stage lesions of cervix may be detected by Pap’s smear even in PCR-negative cases. Conventional Pap’s smear is cost-effective method for detection of cervical lesions like ASC-US and LSIL.


ASC-US Pap’s smear Conventional HPV 


Compliance with Ethical Standards

Conflict of interest

The author declares that there is no conflict of interest.


  1. 1.
    Human papillomavirus (HPV) vaccine background paper. Geneva: World Health Organization, 2008. Accessed on 15th May, 2015.Google Scholar
  2. 2.
    Burchell AN, Tellier PP, Hanley J, Coutlee F, Franco EL. Human papillomavirus infections among couples in new sexual relationships. Epidemiology. 2010;21:31–7.CrossRefGoogle Scholar
  3. 3.
    Atkinson W, Wolfe S, Hamborsky J. Centers for disease control and prevention: epidemiology and prevention of vaccine-preventable diseases. 12th ed. Washington, DC: Public Health Foundation; 2012.Google Scholar
  4. 4.
    Guan P, Howell-Jones R, Li N, Bruni L, de Sanjo S, Franceschi S, Clifford GM. Human papillomavirus types in 115,789 HPV-positive women: a meta-analysis from cervical infection to cancer. Int J Cancer. 2012;131:2349–59.CrossRefGoogle Scholar
  5. 5.
    Lorincz AT, Reid R, Jenson B, et al. Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types. Obstet Gynecol. 1992;79:328–37.CrossRefGoogle Scholar
  6. 6.
    Arends MJ, Buckley CH, Wells M. Aetiology, pathogenesis, and pathology of cervical neoplasia. J Clin Pathol. 1998;51(2):96–103.CrossRefGoogle Scholar
  7. 7.
    Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385–94.CrossRefGoogle Scholar
  8. 8.
    Papanicolaou GN. Cytologic diagnosis of uterine cancer by examination of vaginal and uterine secretions. Am J Clin Pathol. 1959;19:301–8.CrossRefGoogle Scholar
  9. 9.
    Nayar R, Wilbur DC. The Pap test and bethesda 2014. Acta Cytol. 2015;59:121–32.CrossRefGoogle Scholar
  10. 10.
    Wong AK, Chan RCK, Nichols WS, Bose S. Human papillomavirus (HPV) in atypical squamous cervical cytology: the invader HPV test as a new screening assay. J Clin Microbiol. 2008;46(3):869–75.CrossRefGoogle Scholar
  11. 11.
    Ekalaksananan T, Pientong C, Kongyingyoes B, et al. Combined p16INK4a and human papillomavirus testing improves the prediction of cervical intraepithelial neoplasia (CIN II–III) in thai patients with low-grade cytological abnormalities. Asian Pac J Cancer Prev. 2011;12:1777–83.Google Scholar
  12. 12.
    Wright TC Jr, Cox JT, et al. 2001 Consensus guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002;287:2120–9.CrossRefGoogle Scholar
  13. 13.
    Hausen ZH. Papillomaviruses and cancer: from basic studies to clinical application. Nat Rev Cancer. 2002;2:342–50.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2018

Authors and Affiliations

  1. 1.Department of PathologyESIC Model Hospital GurugramGurugramIndia

Personalised recommendations