Cervical Cytology (Pap) Interpretation Report

Cytopathology — Bethesda 2014 with HPV Co-test Correlation

Report ID: MAA-CYT-7B3F45
Generated: June 3, 2026
Analysis: AI-Powered Image Interpretation

Patient Profile

Sex / Age:
Female, 31 years
Specimen:
Liquid-based cervical cytology (ThinPrep)
HPV co-test (provided):
High-risk HPV positive (HPV 16 negative; HPV 18 negative; other HR-HPV positive)
Reason for screening:
Routine; previous Pap normal 3 years ago
History:
G1P1 (one prior vaginal delivery), no prior cervical procedures, no immunosuppression, HPV vaccination uncertain (likely partial)

Summary Overview

Cervical cytology demonstrates morphologic features consistent with low-grade squamous intraepithelial lesion (LSIL). HPV co-test is positive for non-16/18 high-risk HPV. Combined finding indicates HPV-related cervical changes that require colposcopy per current ASCCP risk-based guidelines.

LSIL
Cytology Result
HR-HPV+
HPV Co-test
Colpo
Recommended

Bethesda 2014 Cytologic Categories (Reference)

NILM:
Negative for intraepithelial lesion or malignancy
ASC-US:
Atypical squamous cells of undetermined significance
LSIL:
Low-grade squamous intraepithelial lesion (encompasses CIN 1 / HPV effect)
HSIL:
High-grade squamous intraepithelial lesion (CIN 2/3)
ASC-H / AGC:
Atypical squamous cells (cannot rule out HSIL) / Atypical glandular cells
Reference:
Nayar R, Wilbur DC. The Bethesda System for Reporting Cervical Cytology, 3rd ed. Springer 2015.

Cytologic Findings

Specimen AdequacySatisfactory
Specimen adequate for evaluation. Endocervical / transformation zone component present. No obscuring inflammation or blood.
Squamous CellsLSIL
Scattered koilocytes with perinuclear halos and irregular nuclear contours. Mild nuclear enlargement (3–4× normal squamous nuclei). Binucleation noted in occasional cells. No high-grade dyskaryosis: nuclei are hyperchromatic but membranes are smooth, chromatin is finely granular, and there is no nuclear molding or coarse clumping.
Glandular CellsNormal
Endocervical cells unremarkable. No atypical glandular cells.
Other FindingsNone
No evidence of trichomonas, candida, BV-pattern, or actinomyces. No reactive changes beyond what is expected with HPV-related koilocytic atypia.

Risk-Based Management (ASCCP 2019)

  • LSIL with positive non-16/18 HR-HPVColposcopy Recommended
    Immediate CIN 3+ risk in this scenario falls in a range supporting colposcopy. Reference: ASCCP 2019 risk-based management guidelines [Perkins RB, J Low Genit Tract Dis 2020].
  • CIN 1 (likely on biopsy)Likely
    LSIL on cytology corresponds histologically to CIN 1 in most cases. CIN 1 frequently regresses spontaneously, particularly in women under 30, and is generally observed rather than treated [Castle PE, Lancet Oncol 2009].
  • CIN 2/3 (occult on cytology)Low–Moderate
    Approximately 10–15% of women with LSIL cytology are found to have CIN 2/3 on biopsy — the reason colposcopy is recommended.

Analytical Summary & Recommendations

Cytologic impression

LSIL on liquid-based cytology with positive non-16/18 high-risk HPV. Findings require colposcopy with directed biopsy per current risk-based guidelines.

Recommended next steps

  • Colposcopy with directed biopsy, ideally within 4–8 weeks [Perkins RB, ASCCP 2019]
  • Endocervical sampling if the squamocolumnar junction is not fully visualized at colposcopy
  • If colposcopy is negative or shows CIN 1: surveillance with HPV/cytology in 12 months for women aged ≤ 25; for older women per ASCCP risk tables
  • If CIN 2/3 confirmed: discussion of excisional treatment (LEEP)
  • Discuss HPV vaccination if not already complete (still benefits adults up to age 45 in shared decision) [CDC ACIP]
  • Smoking cessation if applicable — smoking is an independent risk factor for HPV persistence and progression
⚠ Important
LSIL is not cervical cancer — it represents low-grade changes typically caused by an HPV infection. The recommended next step (colposcopy) is to look more closely and ensure that no higher-grade lesion is present. Many LSIL findings regress on their own. Schedule the colposcopy promptly so the picture is clear.

Key Questions for Your Physician

  • How does the colposcopy work, and how soon can it be scheduled?
  • If a biopsy shows CIN 1, what is the next plan — surveillance or treatment?
  • If CIN 2/3 is found, what does treatment involve?
  • Should I complete the HPV vaccine series?
  • How does this affect my regular screening interval going forward?

What This Means for You

Your Pap test shows low-grade changes (LSIL) — these are mild changes in the cells of your cervix, almost always caused by an HPV infection. Your HPV test confirms that a high-risk HPV strain is present (not the most aggressive types, HPV 16 or 18, but another high-risk type).

This is not cervical cancer. Most low-grade changes (LSIL/CIN 1) resolve on their own, especially in women under 30, when the body clears the HPV. The reason for the recommended next step — a colposcopy — is to take a closer look at the cervix and make sure there are no more advanced changes that the Pap missed.

A colposcopy is an outpatient procedure that takes about 15–20 minutes — your physician uses a special microscope to examine the cervix and may take small biopsies of any abnormal areas. Most patients describe it as similar to a Pap test, with mild cramping. Results usually take 1–2 weeks.

If you have not completed the HPV vaccine series, it is worth discussing — the vaccine can still benefit adults and is approved up to age 45 in shared decision-making. Avoiding smoking also significantly reduces the chance of HPV persistence.

Analysis Confidence 90%

High confidence in the LSIL categorization on standard cytologic morphology. Histopathologic correlation by colposcopy and biopsy provides definitive grading.

References

  1. Nayar R, Wilbur DC, eds. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. 3rd ed. Springer 2015.
  2. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis 2020;24(2):102–131.
  3. Castle PE, Schiffman M, Wheeler CM, Solomon D. Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol 2009;113(1):18–25.
  4. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, ASCCP, and ASCP screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012;62(3):147–72.
  5. CDC Advisory Committee on Immunization Practices (ACIP). Human Papillomavirus Vaccination — Recommendations of the ACIP. MMWR 2019;68(32):698–702.