Cervical cytology: how to read your result
A cytology result arrives as a sheet of paper with four Latin letters on it, and the days between reading it and seeing a doctor are usually spent searching. Here is what each line of the report means, what happens next, and why none of those letters says cancer.
The important part first
Cytology does not make a diagnosis. It is a screening test: it selects the people who need a closer look, and nothing more. An abnormal result means a next step is needed, not that something has been found.
The changes cytology picks up develop over years. From the first altered cells to cervical cancer, untreated, usually takes 10–15 years. That is precisely why screening works: there is a great deal of time to intervene. A few weeks waiting for an appointment mean nothing on that scale.
And third: most abnormal smears return to normal on their own. Below you will see which results do so in nine cases out of ten.
What cytology is and what it sees
At the visit the doctor uses a small brush to collect cells from the surface of the cervix and from the canal. It does not hurt and takes a few seconds. The sample goes to a laboratory and is examined under a microscope.
What is looked at is the shape of the cells — whether the nucleus has changed, whether the ratio of nucleus to the rest of the cell is disturbed. Those changes appear when human papillomavirus alters the cell. Almost all cervical changes are HPV-related, so cytology is a way of seeing the trace of the virus even when the virus itself was not tested for.
There are two methods: conventional cytology (the smear goes straight onto a slide) and liquid-based, LBC, where the brush is rinsed into a vial. LBC produces fewer unreadable slides, and an HPV test can be run from the same vial without calling the patient back. In Poland it appears on forms as cytologia płynna or LBC.
How a Polish report is laid out
Results in Poland use the Bethesda system, the same one used worldwide. A report usually has three parts:
| On the report | In English | What it means |
|---|---|---|
| Materiał nadaje się do oceny | sample adequate for evaluation | the smear was taken properly and the result can be relied on |
| Materiał nie nadaje się do oceny | sample inadequate | too few cells, or blood and mucus in the way — the smear is repeated in 6–12 weeks. This is not a result and not a worry |
| Obecne komórki strefy przekształceń | transformation zone cells present | sampled from the right place. Their absence is not an error, but sometimes a reason to repeat sooner |
| Zmiany zapalne | inflammatory changes | signs of inflammation. Not precancerous in itself; sometimes the inflammation is treated first and the smear repeated |
| Zmiany zanikowe / atroficzne | atrophic changes | a common finding after menopause, caused by low oestrogen |
| NILM | no intraepithelial lesion | normal. This is what a good result looks like |
The third part is the result itself — those Latin abbreviations. Here they are in order of severity.
What each result means
| Result | In full | What it means | What happens next |
|---|---|---|---|
| NILM | Negative for Intraepithelial Lesion or Malignancy | normal, no altered cells | next screen on schedule |
| ASC-US | Atypical Squamous Cells of Undetermined Significance | cells differ slightly from normal, but not enough to say why. The most common abnormal result | HPV test; colposcopy if high-risk HPV is found |
| LSIL | Low-grade Squamous Intraepithelial Lesion | low-grade changes, usually the picture of an active HPV infection. Corresponds to CIN 1 | usually colposcopy; in younger women sometimes observation |
| ASC-H | Atypical Squamous Cells, cannot exclude HSIL | changes where high-grade disease cannot be excluded | colposcopy, always |
| HSIL | High-grade Squamous Intraepithelial Lesion | high-grade changes. Corresponds to CIN 2 and CIN 3 — precancerous, not cancer | colposcopy with biopsy, then treatment based on histology |
| AGC | Atypical Glandular Cells | altered glandular cells — from the cervical canal or the uterine cavity | colposcopy and assessment of the uterine cavity |
| AIS | Adenocarcinoma in situ | precancerous change of the glandular epithelium | colposcopy, histology, treatment |
Note the right-hand column: for five results out of seven the next step is colposcopy. That is an examination of the cervix under 10–40× magnification which shows where the altered cells are — cytology only says that they exist. What colposcopy is like and whether it hurts is covered separately.
ASC-US: why it frightens people, and why it usually should not
ASC-US is the single most common reason anyone searches for a text like this. The wording is unfortunate: "atypical cells of undetermined significance" sounds like a verdict, and means literally "we see something not quite ordinary and cannot say what it is".
The figures worth knowing:
- ASC-US is the most common abnormal cytology result;
- in most women with ASC-US, further investigation finds nothing serious;
- high-grade disease (CIN 2+) is found in roughly one in twenty;
- if the high-risk HPV test is negative, the chance of a serious finding becomes very small — and colposcopy is usually not needed.
Hence the order of steps: ASC-US is followed by an HPV test, not by immediate colposcopy. If the cytology was liquid-based, the test is run from the same vial and there is no need to come in again.
ASC-US also arises from things unrelated to the virus: inflammation, low oestrogen after menopause, recent intercourse, or a pessary used the night before the sample was taken.
LSIL and HSIL: the difference
LSIL is most often simply the picture of an active HPV infection. In women under 30 such changes resolve on their own in the majority of cases within a year or two, as the immune system clears the virus. That is why observation rather than treatment is sometimes offered to younger patients.
HSIL is a different matter. These are established changes that rarely resolve by themselves, and treating them is what prevents cancer. "Precancerous" is the right word here; "cancer" is not: years and a definite threshold separate CIN 3 from cancer, and the changes have not crossed it.
HSIL in Poland is usually treated with konizacja or loop excision (LEEP/LLETZ): the area of cervix containing the altered cells is removed. It is an outpatient procedure and pregnancy afterwards is possible.
How often to have it done
Poland runs a cervical screening programme: cytology is free for women aged 25–64 once every three years at a practice with an NFZ contract, and no referral is needed. Some conditions — HIV infection, or immunosuppression after a transplant — call for a shorter interval.
International practice is gradually moving to a different schedule: HPV testing as the primary screen every five years, because it is more sensitive than cytology. That transition is under way in Poland and different practices offer different things — it is worth asking what is actually being taken.
Practical rules for the sample, so it does not have to be repeated:
- not during a period; days 10–20 of the cycle are best;
- no intercourse, pessaries, creams, douching or tampons for 48 hours beforehand;
- after treating an infection, wait at least a week after finishing the course;
- after menopause the day does not matter.
Results in Poland usually take 7–14 days.
Where to have it done and what to bring
Taking the sample is included in the price of the visit; only the laboratory work is charged separately — usually 60–120 zł for cytology. For a private appointment no referral or NFZ insurance is needed and a PESEL number is not required. Consultations are held in Polish, Russian and Ukrainian.
Bring your previous results. One smear is a point; two in a row are a direction. What matters to the doctor is whether the change has appeared for the first time or has persisted into a second year — that determines directly whether to observe or to act.
If you already have a result and it frightened you, it can be discussed without a visit, through an online consultation. But if the result calls for colposcopy, that has to be done in person.
Short answers
What does ASC-US mean on a cytology report?
Atypical squamous cells of undetermined significance: the cells differ slightly from normal but not enough to say why. It is the most common abnormal result, and in most women further investigation finds nothing serious. The next step is a high-risk HPV test.
Does an abnormal smear mean cancer?
No. Cytology does not make a diagnosis; it selects the people who need a closer look. Even HSIL is a precancerous change rather than cancer, and untreated it usually takes 10–15 years to progress. Only histology after a biopsy gives a diagnosis.
What is the difference between LSIL and HSIL?
LSIL means low-grade changes, most often the picture of an active HPV infection; in women under 30 they resolve on their own in most cases within a year or two. HSIL means high-grade changes corresponding to CIN 2 and CIN 3, which rarely resolve alone and need treatment.
What happens after an abnormal cytology result?
With ASC-US a high-risk HPV test is done first, and colposcopy follows if it is positive. With LSIL, ASC-H, HSIL, AGC and AIS, colposcopy is arranged straight away. Colposcopy shows where the altered cells are and allows a biopsy to be taken from the right place.
How often should cytology be done?
In Poland cytology is free for women aged 25–64 once every three years under the screening programme, at a practice with an NFZ contract and without a referral. Some conditions call for a shorter interval, decided individually.
This text describes the general picture and does not replace a consultation. Timings and indications differ from woman to woman and are decided at the appointment, from your history and test results.
