Tips for Best Practice on Unsatisfactory Cytology
Post date: November 15, 2024
Reviewed by: Erin L. Nelson, MD
An unsatisfactory cytology result is reported when there are insufficient cells for the cytopathologist to evaluate the specimen. This occurs in approximately 2% of cytologic samples. A number of factors can contribute to this outcome, including atrophy, poor or improper collection technique, obscuring inflammation, poor slide preparation, presence of blood, excessive lubricant in the specimen, and increased thickness of the smear.
When specimen results are reported as unsatisfactory, the 2019 Management Guidelines have been revised1 (2023). For patients with an unsatisfactory cytology result and no, unknown, or a negative HPV test result, repeat age-based screening (cytology, cotest, or primary HPV test) as soon as convenient and no later than 4 months is recommended (BIII).
Waiting 2 months before repeating the cytology test is not necessary and in the presence of cancer could lead to potential harm, specifically if other recommended workup for symptomatic patients is not performed. For this reason, the 2019 recommendations were updated.
A negative HPV test obtained in conjunction with unsatisfactory cytology should not be considered a valid result. In this scenario, the recommendation is to repeat both the cytology and HPV test as soon as convenient and not later than 4 months is recommended.
Colposcopy should be performed if the subsequent cytology result is again unsatisfactory.
This topic may become less relevant with more widespread adoption of primary HPV testing over time.
Standard Abbreviations
HPV - Human Papillomavirus
hrHPV - High-Risk Human Papillomavirus
HSIL - High-Grade Squamous Intraepithelial Lesion
VaIN - Vaginal Intraepithelial Neoplasia
NCCN - National Comprehensive Cancer Network
LSIL - Low-Grade Squamous Intraepithelial Lesion
NILM - Negative for Intraepithelial Lesion or Malignancy
ASC-H - Atypical Squamous Cells, Cannot Rule Out High-Grade Lesion
ASC-US - Atypical Squamous Cells of Undetermined Significance
AGC - Atypical Glandular Cells
AIS - Adenocarcinoma In Situ
LEEP - Loop Electrosurgical Excision Procedure
ECC - Endocervical Curettage
CIN - Cervical Intraepithelial Neoplasia
SCJ - Squamocolumnar Junction
mRNA - Messenger Ribonucleic Acid
CO2 - Carbon Dioxide
WHO - World Health Organization
- Perkins, Rebecca, Guido, Richard, Castle, Philip, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023. J. low. genit. tract dis. 2024;28(1):3-6. doi:10.1097/LGT.0000000000000788.
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