When your result sheet arrives after a screening and you see unfamiliar English abbreviations and the words ‘abnormal finding’, that one line can feel enormous. If you have already read about the difference between a cervical cytology test and an HPV test, this time let us go step by step through what each finding name on the result sheet means and in what order things are checked next.
A generated image showing someone reading a result and writing down questions. It is not a real result sheet.
Does an ‘abnormal’ result mean I have cancer?
No. A cytology test is not a diagnosis but a screening test that picks out who needs a closer look, and ‘abnormal’ is a signal that further checking is needed. Cancer is rarely found in people who have been screened regularly, and most people who receive an abnormal result either have an HPV infection or have early cell changes that sometimes go away on their own over time.
A cytology test looks only at the shape of cells taken from the surface of the cervix. Cells can therefore look different for reasons unrelated to cancer, such as inflammation or hormonal changes, and the test cannot accurately show changes deeper in the tissue. How much change there really is can only be said after tissue is taken, when needed, and examined under a microscope.
In Korea’s National Cancer Screening Program, women aged 20 and over have a cervical cytology test every 2 years. The national screening result sheet reports the result with category phrases such as ‘no abnormal findings’, ‘reactive findings and infectious disease’, ‘atypical cell abnormality’, ‘suspected precursor stage of cervical cancer’, ‘suspected cervical cancer’ and ‘other disease unrelated to cervical cancer’, and each category comes with what to do next. Looking at the detailed finding name written alongside the category phrase helps you gauge what needs further checking.
What do ASCUS, LSIL and HSIL each mean?
The English abbreviations on the result sheet record which cells looked different, and how much, using an internationally shared classification (the Bethesda system). Even among ‘abnormal’ results, how quickly the next step is taken depends on the finding.
| On the result sheet | Meaning | Common next step |
|---|---|---|
| Reactive cell changes | Cell shapes are slightly changed by inflammation, hormones or similar influences, but these are not abnormal cells | Under national screening standards, the next screening without further tests. If there are symptoms such as discharge or itching, seek care for those symptoms |
| ASC-US (ASCUS, atypical squamous cells of undetermined significance) | A mild change that is hard to call either normal or a clear lesion. The most common abnormal finding | An HPV test or a repeat test after a set period. Colposcopy if high-risk HPV is found or the abnormality is found again |
| LSIL (low-grade squamous intraepithelial lesion) | A mild change related to HPV infection. Often goes away on its own | Colposcopy or follow-up testing to make sure a higher-grade change is not hidden |
| ASC-H (atypical squamous cells, cannot exclude a high-grade lesion) | The change is not clear-cut, but the possibility of HSIL is hard to rule out | Colposcopy and biopsy |
| HSIL (high-grade squamous intraepithelial lesion) | A moderate or more severe change that, if left untreated, can progress to cancer over time | Colposcopy and biopsy. Treatment depending on the result |
| AGC (atypical glandular cells) | A change seen in the glandular cells lining the canal inside the cervix or the inside of the uterus | Colposcopy together with sampling from inside the cervical canal, and an endometrial evaluation if needed |
If the result sheet says ‘unsatisfactory specimen’, it means there were too few cells or the cells were hidden by blood or mucus and could not be read. It is neither normal nor abnormal; the sample simply needs to be taken again. Even with the same finding, the next step can differ depending on age, previous results and treatment history. The table summarizes common pathways, so confirm your own schedule with the healthcare professional who explained your result.
What changes when the HPV result is considered as well?
If the cytology test tells you ‘how the cells look now’, the HPV test tells you ‘whether there is a high-risk virus that can keep that change going’. Looking at both results together helps decide whether to wait and watch or to check further right away, even for the same ASCUS.
- ASCUS + high-risk HPV negative: The likelihood that the change is virus-related is low, so it is usually watched with another test after a set period.
- ASCUS + high-risk HPV positive: The change may involve the virus, so colposcopy is often recommended.
- Normal cytology + high-risk HPV positive: There are no visible cell changes now, but whether the virus remains is checked again after a set period. If a higher-risk type such as HPV 16 or 18 is found, the check may be brought forward.
- HSIL, ASC-H or AGC: These are findings for which colposcopy is recommended regardless of the HPV result. A negative HPV result is not a reason to take these findings lightly.
Because the basic test in national screening is cytology, your result sheet may not include an HPV result. At your result consultation, also check whether an HPV test was added on the same sample or whether you need to have one separately. That an HPV-positive result does not mean cancer, and that the time of infection cannot be pinpointed, are covered in detail in the earlier article.
In what order are the next tests done?
If the finding is mild, it is watched with a repeat test or an HPV test; if a change is suspected, the cervix is examined closely with colposcopy and tissue is taken from any area that needs it. Not every abnormal result leads straight to a biopsy or surgery.
- Repeat test and HPV test Mild findings often return to normal over time, so a cytology test or HPV test is repeated after a set period to compare changes. The interval is set according to the finding, age and previous results.
- Colposcopy A speculum is inserted, a vinegar-based solution is applied to the cervix, and a magnifying instrument is used to look closely for abnormal areas. The magnifying instrument does not go inside the body, and you may feel discomfort or stinging during the test.
- Biopsy If an area looks abnormal on colposcopy, a very small piece of tissue is taken for pathology testing. You may feel a pinching sensation, and for a few days afterwards you may have period-like pain or a small amount of bleeding or discharge. The result of this biopsy becomes the basis for deciding on treatment.
What are CIN grades, and when is conization needed?
A biopsy grades the degree of dysplasia as CIN 1, 2 or 3, and treatment is usually considered for CIN 2 or higher. LSIL on cytology generally corresponds to CIN 1, and HSIL to CIN 2 or CIN 3, but the final grade is set by the biopsy.
- CIN 1 (mild dysplasia) This is a mild change that often goes away on its own, so follow-up testing at set intervals is usually done without treatment.
- CIN 2 (moderate dysplasia) Treatment to remove the abnormal area is usually recommended, but it can also go away on its own. Taking things such as pregnancy plans into account, it is sometimes watched for a period with colposcopy and biopsy after consultation, and it is treated if it progresses or does not go away.
- CIN 3 (severe dysplasia) It is not yet cancer, but at this stage it can progress to cancer if left untreated, so treatment is recommended. If you are pregnant, the timing of treatment is decided separately.
Conization is surgery that removes the abnormal area of the cervix in a cone shape, and it is different from surgery that removes the whole uterus. LEEP, which cuts with a thin wire loop carrying an electric current, is the typical method, and the removed tissue is sent for pathology again to check the degree of the lesion and whether abnormal cells remain at the cut edges. It is therefore both a treatment and a process that confirms the diagnosis. Besides high-grade lesions, it is also sometimes done for diagnosis when the extent or depth is hard to judge from a biopsy alone.
After surgery, complications such as bleeding, infection or stenosis (narrowing of the cervix) can occur, and in some people the risk of preterm birth and similar problems may increase in later pregnancies. If you are planning a pregnancy, be sure to say so before treatment. Even after treatment, regular follow-up testing is needed to make sure abnormal cells do not return. LILEAP’s surgical process and precautions during recovery are summarized in Guide to conization (LEEP).
What should I prepare before the result consultation?
Bringing the exact wording of your result sheet makes the consultation much more accurate. If you can say ‘ASC-US, and I did not have an HPV test’ rather than ‘they said it came back abnormal’, the next step can be decided right away.
- The category and detailed finding on the result sheet Write down the category phrase, such as ‘atypical cell abnormality’, and the finding name, such as ASC-US or LSIL, exactly as written, or bring a photo.
- Previous test results and treatment history Let us know your previous cytology and HPV test results, and if you have had colposcopy or conization, when it was and what the result was.
- Pregnancy status and plans If you are pregnant now or planning a pregnancy, this is essential information for deciding the test method and the timing of treatment.
- HPV vaccination history Knowing whether and when you were vaccinated lets us discuss it together. Even if you have been vaccinated, follow-up testing suited to this result is still needed.
Applying other people’s repeat-test intervals or treatment courses that you read about online tends to increase anxiety instead. While waiting for results, it is enough to confirm just two things: ‘what is the name of my finding, and what is the next test and when’.
You can find cervical cancer screening, care after an abnormal result and referral to a university hospital in our Cervical Cancer Screening Information.