Benign Reactive Changes in Cervical Cytology
Squamous cells with benign reactive changes on a Pap smear represent a non-neoplastic finding that typically indicates inflammation, infection, or other benign cellular responses, and in most cases requires only routine follow-up with repeat cytology in 3 months if severe inflammation is present. 1
Clinical Significance
The finding of benign reactive changes carries important clinical implications:
- Benign reactive changes account for approximately 92% of all benign cellular change diagnoses, with specific infections representing only 8% 2
- The majority of these cases represent reactive and inflammatory processes rather than pre-malignant conditions 2
- In patients with no prior cervical abnormalities, this diagnosis represents a benign reactive process that does not require aggressive intervention 2
Underlying Causes
When biopsies are performed on patients with benign reactive changes, the most common findings include:
- Cervicitis (31.5%) - the most frequent histologic diagnosis 2
- Immature squamous metaplasia (16.3%) 2
- Reserve cell hyperplasia (10.8%) 2
- No significant pathologic change (8.3%) 2
Management Recommendations
For Severe Inflammation with Reactive Changes:
- Repeat Pap smear within 3 months 1
- Treat any underlying infection before obtaining the repeat smear 1
For Patients with Prior Cervical Abnormalities:
- Closer surveillance is warranted if the patient has a previous history of cervical intraepithelial neoplasia (CIN) or human papillomavirus (HPV) 2
- In one study, 53.5% of patients with benign cellular changes had a previous diagnosis of CIN/HPV, indicating that context matters 2
For Patients Without Prior Abnormalities:
- Resume routine annual screening after appropriate follow-up 1
- No colposcopy or biopsy is indicated for isolated benign reactive changes 1
Important Caveats
Do not confuse benign reactive changes with atypical squamous cells of undetermined significance (ASCUS) - these are distinct diagnostic categories with different management algorithms 1
The Pap smear is not an effective screening test for sexually transmitted diseases, so additional testing may be needed if infection is suspected clinically 1
If severe cervicitis is present on examination, consider deferring the Pap smear until after antibiotic therapy to obtain an optimal specimen 1
Risk Stratification
The clinical context determines significance:
- Low-risk scenario: No prior cervical abnormalities, isolated finding of benign reactive changes - represents a benign process requiring only standard follow-up 2
- Higher-risk scenario: Previous history of CIN/HPV with current benign reactive changes - warrants closer surveillance as 14% of such cases may harbor CIN 1/HPV on biopsy 2