Cervical cytology results

Bethesda System: — What Your Pap Smear Result Means

A Pap smear report uses the Bethesda System — a standard set of terms that describes what your cervical cells looked like under the microscope. The category on your report tells your doctor what to do next, not what your diagnosis is.

Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026

Not a diagnosis — A Pap smear looks at cell appearance. A biopsy is needed to confirm any abnormality found.
Categories, not grades — Each Bethesda category describes what cells look like under the microscope and guides which test comes next.
Most results are normal — NILM — the category for no changes found — is the most common result in routine screening.
One result is not the whole picture — Your doctor uses this result alongside your HPV status, age and screening history to decide next steps.

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A Pap smear report written in the Bethesda System gives your cervical cells a category, from NILM (normal) to HSIL (high-grade changes). The category tells your doctor how cells looked under the microscope — not a diagnosis, and not cancer. Your gynaecologist uses it alongside your age, HPV test and history to decide what to do next.

What does each Bethesda category mean?

Bethesda category	What the lab is saying	What usually follows
NILM	No abnormal cell changes were found in this sample.	Routine screening at the standard interval.
ASCUS	Squamous cells look slightly unusual; the cause is not clear. The most common cause is HPV.	An HPV test or a repeat smear, depending on your age and HPV status.
ASC-H	Minor cell changes where a high-grade lesion cannot be ruled out — a more urgent category than ASCUS.	Colposcopy — a magnified examination of the cervix.
LSIL	Cell changes consistent with HPV infection; low-grade.	An HPV test or colposcopy, depending on age and history.
HSIL	More significant cell changes that need prompt investigation.	Colposcopy, usually arranged promptly and often with a biopsy at the same visit.
AGC	Changes in glandular cells; the source and type need investigation.	Colposcopy plus sampling from inside the cervical canal.
Squamous carcinoma or adenocarcinoma	Features in the smear that suggest cancer. Tissue biopsy is needed to confirm.	Urgent specialist referral and biopsy.

What should I check on my Pap smear report?

Check the specimen adequacy line first — if it says 'unsatisfactory,' the sample needs to be repeated before the category can be used.
Note the exact category — ASCUS and ASC-H look similar but have different clinical pathways.
Check whether an HPV test was done at the same time; the result changes what your doctor recommends.
Bring the physical report to your appointment, not just the verbal result you were told.
Ask your doctor which guideline they are following — ASCCP, NCCN, FOGSI, or Indian national guidance.
Note the date — your doctor will want to see your recent screening history alongside this result.

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What do the terms on the report mean?

Specimen adequacy: Whether the sample contained enough cells to read reliably — 'satisfactory' or 'unsatisfactory.' An unsatisfactory result must be repeated; it says nothing about your cell health.
NILM: Negative for Intraepithelial Lesion or Malignancy. The standard term for a normal result: no precancerous or cancerous cell changes were seen in this sample.
ASCUS: Atypical Squamous Cells of Undetermined Significance. Minor squamous cell changes that do not fit clearly into normal or abnormal. The most common abnormal Pap category in routine screening.
ASC-H: Atypical Squamous Cells — cannot exclude High-grade lesion. A separate and more clinically urgent category than ASCUS, despite the similar name. Follow-up is colposcopy, not a repeat smear.
LSIL: Low-grade Squamous Intraepithelial Lesion. Cell changes associated with HPV infection. Many resolve without treatment, but follow-up is still needed.
HSIL: High-grade Squamous Intraepithelial Lesion. More marked cell changes that need colposcopy promptly. Not cancer, but changes that require tissue investigation.
AGC: Atypical Glandular Cells. Changes in the glandular cells lining the cervical canal, separate from the squamous categories above. Needs investigation of the cervix and sometimes the uterine lining.
CIN: Cervical Intraepithelial Neoplasia — a biopsy term, not a smear term. CIN grades come from tissue examination and are more definitive than a Bethesda category.
Colposcopy: A magnified examination of the cervix, done in a clinic, usually with a small biopsy. The step that follows most abnormal Pap results and gives a tissue-level answer the smear alone cannot.

What your Pap smear result cannot tell you on its own

A Pap smear looks at how individual cervical cells appear under the microscope. It cannot confirm whether a precancerous change is present in the tissue beneath — that requires a colposcopy and biopsy.

This is why an HSIL result does not mean you have cancer. It means cells in your sample had changes that need tissue-level investigation. Some will show CIN on biopsy; some will not.

The Bethesda category is the starting point, not the answer. The smear screens for cells worth investigating; the biopsy tells you what is in the tissue.

Did you know?

Cervical cancer typically takes ten or more years to develop from a precancerous lesion. That long window is what makes screening effective — a Pap smear that finds HSIL today is catching a change years in the making, at a point when it remains straightforwardly treatable.

Source: WHO / IARC Cervical Cancer Screening Guidelines, 2022

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Common questions

Frequently asked questions

My result says ASCUS — does that mean I have cancer?

ASCUS does not mean cancer. It is the most common abnormal Pap category and means squamous cells looked slightly unusual but could not be clearly classified. The most common cause is HPV. What happens next depends on your HPV status and age — either a co-test or a repeat smear. Many ASCUS results return to normal at the next screen without any treatment.

What is the difference between LSIL and HSIL?

Both describe squamous cell changes, but at different levels. LSIL — low-grade — describes changes that look like an HPV effect; many resolve without treatment. HSIL — high-grade — describes more significant changes that need colposcopy promptly because they carry a higher risk of underlying tissue abnormality. Neither is a cancer diagnosis. The grade determines how soon colposcopy is arranged and what the biopsy looks for.

My report says 'unsatisfactory specimen' — what does that mean?

Unsatisfactory means the sample did not contain enough cells to read reliably, or cells were obscured — often by blood or mucus. It says nothing about your cell health. The test needs to be repeated, usually after a few weeks to let the cervix recover. Your doctor will advise on timing. It does not mean an abnormality was found.

What is the difference between a Pap smear result and a biopsy result?

A Pap smear looks at individual cells and uses Bethesda categories. A biopsy takes a small piece of tissue and uses CIN grades, which are more definitive because they show changes in the tissue layer, not just surface cells. An abnormal Pap result such as HSIL or ASC-H prompts a biopsy. The two systems answer different questions and should not be read as interchangeable.

How does my HPV test relate to my Bethesda category?

They answer different questions. The Bethesda category describes how cells look under the microscope. The HPV test tells you whether a high-risk HPV type is present. Together they give a more complete picture than either result alone. For an ASCUS result specifically, your HPV status usually determines whether you need colposcopy now or a repeat smear at the next scheduled interval.

What does AIS on a Pap smear report mean?

AIS stands for Adenocarcinoma in Situ — a glandular cell finding that is distinct from the squamous categories ASCUS, LSIL and HSIL. It needs prompt specialist investigation: colposcopy, endocervical sampling and usually early involvement of a gynaecological oncologist. It is more specific and more clinically significant than an AGC result, and it should not be managed on a routine follow-up schedule.

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