What should a patient be told if their Papanicolaou (Pap) test result shows an epithelial cell abnormality and is human papillomavirus (HPV) negative?

From the Guidelines

A patient with an epithelial cell abnormality on their Pap test and a negative HPV test result should be advised to undergo a repeat HPV test with or without a concurrent Pap test in 3 years, as per the 2019 ASCCP risk-based management consensus guidelines 1. This approach is based on the most recent guidelines, which prioritize risk-based management of abnormal cervical cancer screening tests and cancer precursors. The guidelines recommend that patients with a negative Pap test result and a negative HPV result should undergo repeat HPV testing with or without a concurrent Pap test in 3 years, as the risk of underlying high-grade disease is low in this population. Some key points to consider when counseling the patient include:

• The negative HPV test result is generally reassuring, as most serious cervical abnormalities are associated with HPV infection 1.
• The epithelial cell abnormality on the Pap test may still require further evaluation, but the risk of significant cervical disease is lower in the context of a negative HPV result.
• The 2019 ASCCP guidelines recommend a more conservative approach to management, with less frequent testing and fewer colposcopies, in order to reduce the risk of overtreatment and potential harms associated with more intensive screening and surveillance 1.
• It is essential to discuss the patient's individual risk factors, medical history, and preferences when determining the best course of action, and to consider the potential benefits and harms of different management strategies. The patient should be informed that the repeat HPV test with or without a concurrent Pap test in 3 years is a reasonable approach, given the low risk of underlying high-grade disease, and that this strategy is supported by the most recent guidelines and evidence 1.

From the Research

Epithelial Cell Abnormality and HPV Negative Result

If a patient's Papanicolaou (Pap) test result shows an epithelial cell abnormality and is human papillomavirus (HPV) negative, the following information can be considered:

• The patient should be informed that an epithelial cell abnormality can range from a low-grade lesion to a high-grade lesion or even cancer 2, 3.
• The patient's age and other demographic factors can influence the likelihood of a high-grade lesion or cancer, with women aged 45 or above being at higher risk 4.
• A colposcopic examination and biopsy may be recommended to further evaluate the abnormality, especially if the Pap smear result shows high-grade squamous intraepithelial lesions (HSIL) or atypical glandular cells of undetermined significance (AGUS) 3, 5.
• The patient should be aware that a negative HPV test result does not completely rule out the possibility of a high-grade lesion or cancer, and further testing and evaluation may be necessary 6.

Possible Next Steps

Some possible next steps for a patient with an epithelial cell abnormality and an HPV negative result include:

• Colposcopic examination and biopsy to further evaluate the abnormality 3, 5
• Repeat Pap smear testing in 3-6 months to monitor for any changes or progression of the abnormality 5
• Referral to a specialist, such as a gynecologist or oncologist, for further evaluation and management 2, 4
• Education and counseling on the risks and benefits of different management options, as well as the importance of regular cervical cancer screening 2, 3