From the Research
A satisfactory Pap smear with endocervical and/or squamous metaplastic cells present is a normal, good quality result, indicating that the sample was adequate for proper evaluation and included cells from the transformation zone, which is the most important area to sample because it's where most cervical abnormalities develop. This means that the sampling technique was appropriate and reached the critical areas needed for accurate screening. The transformation zone is where the columnar cells of the endocervical canal meet the squamous cells of the outer cervix, and this junction is where most cervical cancers originate. When these cells are present in the sample, healthcare providers can be confident that the most relevant tissue was examined.
According to the most recent study 1, the presence of these specific cell types is essential for determining the adequacy of the Pap smear. The study highlights the importance of the Bethesda System in reporting Pap test results, which includes the categorization of squamous intraepithelial lesions (SIL) and atypical squamous cells (ASCs).
Some studies have suggested that the presence of atypical metaplastic cells may be associated with high-grade squamous intraepithelial lesions (HSIL) 2, but this is not directly relevant to the interpretation of a satisfactory Pap smear with endocervical and/or squamous metaplastic cells present.
The key point is that the presence of endocervical and/or squamous metaplastic cells in a satisfactory Pap smear indicates that the sample is adequate for evaluation, and no further action is required beyond routine screening according to age-appropriate guidelines. Patients can be reassured that their Pap test was both technically adequate and showed no abnormal cells.
In terms of management, the study by 3 suggests that Pap smears reporting atypical squamous cells cannot exclude HSIL (ASC-H) and those reporting low-grade squamous intraepithelial lesions with occasional high-grade cells (LSIL-H) have similar predictive value for high-grade dysplasia. However, this is not directly relevant to the interpretation of a satisfactory Pap smear with endocervical and/or squamous metaplastic cells present.
Overall, the presence of endocervical and/or squamous metaplastic cells in a satisfactory Pap smear is a good quality result, indicating that the sample is adequate for evaluation and that no further action is required beyond routine screening.