What are the implications of a patient with epithelial cell abnormality?

From the Guidelines

For a patient with epithelial cell abnormality, I recommend prompt referral to a gynecologist or specialist for further evaluation and management. This finding typically comes from a Pap smear and requires additional testing to determine the specific type and severity of the abnormality. The next steps usually include colposcopy with possible biopsy to visualize the cervix and obtain tissue samples for definitive diagnosis. While waiting for the specialist appointment, reassure the patient that many epithelial abnormalities do not represent cancer but rather precancerous changes that can be effectively treated.

Key Considerations

• The presence of epithelial cell abnormalities, including atypical squamous cells, squamous intraepithelial lesion, glandular cell abnormalities, and squamous cell carcinoma, warrants further evaluation 1.
• Pap test screening techniques that use liquid-based media appear to increase sensitivity, decrease the number of tests with inadequate sampling, and reduce but not eliminate false-negative results; they also offer the possibility of direct testing for HPV and other STDs on collected specimens 1.
• The role of HPV testing as an adjunct to the routine Pap test in HIV-infected women has not been defined, but recent evidence suggests that the absence of oncogenic HPV is associated with a low incidence of squamous intraepithelial lesions over a 3-year period in HIV-infected women with CD4 cell counts >500 cells/µL, comparable to that described in HIV-seronegative women 1.

Management Options

• Treatment options depend on the specific diagnosis and may range from watchful waiting with repeat testing in 6-12 months for mild abnormalities to procedures like LEEP (Loop Electrosurgical Excision Procedure), cryotherapy, or conization for more significant findings.
• These abnormalities are often caused by human papillomavirus (HPV) infection, which can lead to cellular changes that may progress to cervical cancer if left untreated.
• Early intervention is key to preventing progression to more serious conditions.

Screening Interval

• Consideration should be given to increasing the screening interval to 3 years if both Pap and HPV testing results are negative, which is now an option for HIV-negative women aged >30 years 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Epithelial Cell Abnormality Treatment and Diagnosis

• The treatment of epithelial cell abnormality can vary depending on the specific condition and severity, with options including topical imiquimod cream, surgical excision, and other modalities 2, 3, 4.
• Topical imiquimod 5% cream has been shown to be effective in treating certain types of epithelial cell abnormalities, such as focal epithelial hyperplasia and high-grade intraepithelial neoplasia, with minimal side effects 2, 3.
• Diagnosis of epithelial cell abnormality often involves cytology tests, such as Pap smears, and may be followed up with biopsy to confirm the diagnosis and guide treatment decisions 5.

Classification and Grading of Epithelial Dysplasia

• The classification and grading of oral epithelial dysplasia can be challenging, with poor inter-pathologist agreement using conventional 3-tiered and 2-tiered grading systems 6.
• The use of p53/p16 immunohistochemistry can improve the classification and grading of oral epithelial dysplasia, with fair-to-good inter-pathologist agreement 6.
• The classification of epithelial dysplasia as p53 wildtype, p53 abnormal, or HPV-associated may be more effective in predicting patient outcomes and guiding management decisions than conventional grading systems 6.

Follow-up and Management of Epithelial Cell Abnormality

• Follow-up smears and biopsies are important for monitoring the progression of epithelial cell abnormality and guiding treatment decisions 5.
• The ratio of atypical squamous cells to squamous intraepithelial lesions can be used as a quality assurance parameter to evaluate the effectiveness of cervical cytology screening tests 5.
• Non-surgical treatment options, such as topical imiquimod, may be effective in treating advanced basal cell carcinoma in patients who refuse surgical treatment or have contraindications to surgery 4.