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Pap smear diagnosis: reactive or reparative epithelial changes

As to this file/page, you have been directed to & now @ Dr. Shaw's personal website

I am indebted to Dr. Marshall Austin for this excellent explanation of the above, or similar, diagnostic term which often is the Pap smear diagnosis when we can't actually give a clear diagnosis of "within normal limits".
Reactive Pap tests, classified in the Bethesda System as "Negative For Diagnostic Epithelial Cell Abnormalities", contain cellular changes intermediate between those in "Negative-Within Normal Limits" cases and those in "Atypical [squamous or glandular] Cells of Undetermined Significance" [ASCUS or AGCUS] (The Bethesda System, Springer-Verlag, 1994). A small proportion of these "reactive/reparative" cases will be variably interpreted by multiple qualified pathologists or cytotechnologists as showing at least some degree of atypical [not absolutely normal] cell features (Am. Jour. Clin. Path. 110:653, 1998;....Diag. Cytopath. 11:319, 1994). Careful follow-up studies of women with a Pap diagnosis of "reactive/reparative cells" have later found precancerous change, usually low grade, in about 5% of patients (Cancer Cytopathology 81:144, 1997). Therefore, special attention to have the patient get annual repeat Pap smear testing seems warranted in these "reactive/reparative" cases....possibly at sooner intervals if the patient is otherwise high-risk for uterine cancer or is poorly compliant (won't follow directions).
In general, it is important to remember that the Pap test is not perfect; and it is impossible to make it perfect (with or without computer technology).

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(posted 7/21/98; latest review 4 August 2003)