Negative For Intraepithelial Lesion or Malignancy: Decoding

Cervical cancer screening is in general extremely important for the prevention of cancer or the detection of early cancer. For this, two tests: the Pap test also known as the Pap smear examine the changes in cells in the cervix of the women that can lead to cancer if left untreated. Another test is the HPV test checks for Human Papillomavirus (HPV) that can cause cell changes and turn into cervical cancer. You have a Pap test and now you may want to see the cytology results. Well, “Negative for intraepithelial lesion or malignancy” might be a confusing statement for you, but it is a medical term used to report a normal or negative Pap test. It means that there are no signs of cancer, pre-cancer, or other abnormalities. Here, “intraepithelial” defines the location within the cells that form the surface of a cervix. A lesion is affected tissue and malignancy means the presence of cancerous cells that can spread to other parts of the body and damage tissue. Let’s explore the article and learn about some known facts about negative for intraepithelial lesion or malignancy.

What is a Pap Smear Test for and How is It Done?

A Pap smear also known as a Pap test is a procedure used for checking cervical cancer in women. It tests for the presence of cancerous or precancerous cells on the cervix (lower portion of the uterus). During the process, cells are collected from the cervix and are closely examined under a microscope in a lab. How is a Pap smear done? This test can be a little uncomfortable, but it is very quick. Doctors perform the test in the following way:

• Doctors first place the speculum (a plastic or metal tool that helps keep the vagina wide and open to clearly see the cervix) inside the vagina.
• With the help of a brush or spatula, they will take a sample of cells and cervical mucus from the cervix.
• Then, the sample is examined in the lab under the microscope for the presence of abnormal growth of cells.

How are Pap Test Results Reported?

The most popularly used system called “Bethesda System” is used to describe the results of the Pap test. There are three categories to report this test which also have some sub-categories:

• Negative for intraepithelial lesion or malignancy
• Epithelial cell abnormalities
• Other malignant neoplasms

If any abnormalities are shown in the Pap test, you might require further testing.

Negative for intraepithelial lesion or malignancy

Cytology results: negative for intraepithelial lesion or malignancy shows no signs of pre-cancer, cancer, or other abnormalities. However, some other findings might be found that can be unrelated to cervical cancer like signs of infection due to yeast, Trichomonas vaginalis, or herpes. In addition, some samples of women’s mucus might show “reactive cellular changes”, which occur when inflammation or infection is around the cervical cells.

Epithelial cell abnormalities

This shows that the cells present on the surface of the cervix change into pre-cancerous or cancerous cells. This category has two subcategories: squamous cells and glandular cells.

Squamous cell abnormalities

This category has two kinds of abnormalities: Atypical squamous cells (ASCs) and Squamous intraepithelial lesions (SILs)

Atypical squamous cells (ASCs): This category has two kinds of abnormalities: Atypical squamous cells (ASCs) and Squamous intraepithelial lesions (SILs).

• Atypical squamous cells of uncertain significance (ASC-US): It is used to show the presence of abnormal cells but it is impossible to tell whether it is caused by pre-cancer, infection, or irritation. Usually, the cells marked as ASC-US are not pre-cancer cells, so to make sure, more screening like the HPV test is needed.

• Atypical squamous cells where high-grade lesion can’t be excluded (HSIL): It is used to describe the presence of abnormal cells which is possible to be caused by pre-cancer. It requires more screening and might need treatment.

Squamous intraepithelial lesions (SILs): If SIL comes on the Pap test results, further testing is required. If there is a need for treatment, it can help prevent cancer from developing. The risky factor that might contribute to cervical cancer is HPV. As per a study, about 46,711 cancer cases are seen each year in the U.S.A., among which 37,000 cases are caused by HPV. Two subcategories fall under this category:

• Low-grade SIL (LSIL): The cells appear slightly abnormal but can’t be determined as cancerous. Other testing can help with it like biopsy. They themselves return to normal without any treatment. These cells may also be termed “mild dysplasia” or “cervical intraepithelial neoplasia grade 1”.
• High-grade SIL (HSIL): The cells seem extremely abnormal. If left untreated, there are more chances of these cells turning into cancer cells. So, the doctor might recommend other tests like biopsy. This might also be termed as “moderate to severe dysplasia” or cervical intraepithelial neoplasia grade 2 or 3.

Glandular cell abnormalities

• Atypical glandular cells: In this category, glandular cells look abnormal, having a feature of cancer. Doctors recommend more testing in this case.
• Adenocarcinoma: Glandular cell cancer is known as adenocarcinoma. Professionals examine the cells to check whether this type of cancer develops in the uterus, endocervix, or other parts of the body.

Other malignant neoplasms

In this category, there are reports of other cancer types that barely ever impact the cervix. Those types of cancer may include lymphoma, malignant melanoma, and sarcomas.

What Does Negative for Intraepithelial Lesion or Malignancy Mean?

Negative for intraepithelial lesion or malignancy category in the Pap test means there are no cancerous or pre-cancerous cells on the cervix. Additionally, it shows no evidence of any abnormalities. All the glandular and squamous cells seen during the test have normal cellular material. It is a normal or negative report. The following are the types of cells that undergo the Pap test:

• Superficial Squamous Cells
• Intermediate Squamous Cells
• Squamous Metaplastic Cells
• Parabasal Cells
• Endocervical Cells
• Mature Squamous Metaplasia
• Immature Squamous Metaplasia

Other normal cells that are often seen on the Pap test are:

• Ciliated Endocervical Cells
• Endometrial Cells

How Do Pathologists Make this Diagnosis?

Pathologists diagnose negative for intraepithelial lesion or malignancy with the help of the Pap test. This test is done on the sample taken from the cervix that is examined by the pathologists or laboratory technologists under a microscope. Such tests show several types of normal cells, for instance, endocervical cells, squamous cells, and metaplastic cells. For the diagnosis, the pathologists make use of enough squamous cells. The presence of endocervical or metaplastic cells is taken as a good indicator, however, it does not need to be available in each sample. Normal cells from the uterus lining or infrequently infectious elements such as viruses, yeast, and bacteria may be found on the Pap test.

What Does Negative for Intraepithelial Lesion or Malignancy But HPV Positive Mean?

A negative for intraepithelial lesion or malignancy but HPV positive means there are no pre-cancerous or cancerous cells but there can be the presence of HPV infection. Some other findings that can be irrelevant to cervical cancer such as infections or inflammation around the cervical cells show HPV in Pap test results. The infection and inflammation of the cervical cells are due to the “reactive cellular changes” So, even if you have a negative Pap smear test, there is a possibility of changes in the cervical cells that can give a report of HPV infection. Hence, you need to go for the Pap test as well as the HPV test every 3 years.

What Does Negative for Intraepithelial Lesion or Malignancy Reactive Cellular Changes Indicate?

A negative for intraepithelial lesion or malignancy reactive cellular changes indicates the presence of inflammation or infection around the cervical cells found in the cervix. Inflammation may be caused due to the cell response to injury or cell death. It might also be due to the white blood cells that are seen on the Pap test. On the other hand, infection around the cervical cells might be because of yeast or Human Papillomavirus (HPV). In such cases, healthcare providers recommend further testing.

What Does An Inflammatory Smear Negative for Intraepithelial Lesion or Malignancy Mean?

Inflammatory smear-negative for intraepithelial lesion or malignancy means the presence of inflammation on the cervical cells. It can be seen in the Pap test. So, if inflamed cells are found in the cervix during the pap smear, it indicates the existence of some white blood cells (WBCs). Inflammation of the cervical cells is common and it is usually not a matter of concern. However, professionals recommend further examination in such cases.

What Does Negative for Intraepithelial Lesion or Malignancy Mild and Moderate Inflammation Mean?

A negative for intraepithelial lesion or malignancy mild inflammation in the Pap test does not indicate any specific disease or injury. Hence, in such cases, there is no need for routine treatment. The mild inflammation of the cervical cells is possibly due to certain factors. Those may include exogenous hormones found especially in oral contraceptives or menopausal hormone replacement therapy which can cause the turning of columnar epithelium (a single layer of columnar epithelial cells found in the stomach and intestines) inside out. On the other hand, a negative for intraepithelial lesion or malignancy moderate inflammation in the Pap test shows a sign of infection due to yeast or HPV. So, doctors may suggest a pelvic exam for the diagnosis of the infection that will also help to determine the right treatment plan to prevent such kind of inflammation.

Final Thoughts

A Pap test is a procedure used for checking cervical cancer in women. It helps examine the presence of cancerous or precancerous cells on the cervix. The reports of the Pap test are described in the phrase “Negative for intraepithelial lesion or malignancy”, “Epithelial cell abnormalities”, and “other malignant neoplasms”. Well, when it comes to the phrase “Negative for intraepithelial lesion or malignancy”, this category shows no signs of pre-cancer, cancer, or other abnormalities. However, some findings unrelated to cervical cancer like infection or inflammation around the cervical cells can be seen. In such cases, doctors recommend further testing to prevent the possibility of the development of cervical cancer.

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