What do I tell a patient with a PAP (Papanicolau test) result that is unsatisfactory for evaluation and a negative HPV (Human Papillomavirus) Aptima test result?

Management of Unsatisfactory Pap Test with Negative HPV

You must inform the patient that her Pap test was unsatisfactory and needs to be repeated in 2-4 months, even though her HPV test was negative. 1, 2

Why the Test Must Be Repeated

• An unsatisfactory Pap test means that insufficient cells were collected to adequately evaluate for cervical abnormalities, making it impossible to reliably screen for cervical cancer or precancerous changes. 1

• The negative HPV result does not eliminate the need for a repeat Pap test because current HPV tests lack confirmatory measures for adequate squamous cellularity—meaning we cannot be certain that enough cervical cells were sampled to ensure the HPV test is truly negative. 1

• The repeat Pap test must be reported by the laboratory as "satisfactory for evaluation" before you can resume normal screening intervals. 1

Specific Patient Communication Points

• Explain that this is a technical issue with specimen collection, not an indication of disease or abnormality. 3

• The most common cause of unsatisfactory results is low squamous cellularity (insufficient cells collected), which occurs in approximately 0.2-10% of Pap tests. 4

• Reassure the patient that the negative HPV test is encouraging—research shows that women with unsatisfactory Pap tests and negative HPV have a very low risk (0.4%) of high-grade cervical lesions. 2

Follow-Up Timeline

• Schedule a repeat Pap test in 2-4 months according to current American Society for Colposcopy and Cervical Pathology guidelines. 2

• Recent evidence suggests that with a negative HPV cotest, the interval could potentially be extended beyond 4 months with low risk, though official guidelines still recommend the 2-4 month timeframe. 2

Optimizing the Repeat Test

• Avoid scheduling during menstruation, as blood can interfere with specimen adequacy. 1

• If the patient has vaginal discharge or infection, consider treating any identified infections before the repeat test, though this is not always necessary if proper collection technique is used. 1

• Ensure adequate sampling technique with proper collection of both ectocervical and endocervical cells. 1

Important Caveat

• If the patient is over 50 years old or has a history of gynecologic cancer, be particularly vigilant about ensuring follow-up, as these populations have higher rates of unsatisfactory tests and subsequent abnormalities (29% in one study). 4