When your biopsy is analysed in the laboratory, they will be looking for different changes in the cells.
The changes they review are:
- The cell nucleus – irregular size, shape and colour of the cell nucleus (the part of the cell that contains the DNA) is the first indication of an abnormality
- The maturity of the cells – a normal cell will grow from an immature to mature cell. Cells that are abnormal can often still grow into mature cervical cells, which will still function in a similar way to normal cells. If the abnormal cells are still able to mature it indicates a low grade abnormality (eg. CIN 1). New cells that grow with increased abnormalities may no longer be able to function normally and may remain as immature abnormal cells. The more immature the abnormal cells there are, the higher the grade of abnormality (eg. CIN2 and CIN3). Immature abnormal cells have a greater potential to develop into cancerous cells than mature abnormal cells
- The thickness of abnormal cells in the lining of the cervix – the grading for CIN cells comes from the thickness of immature abnormal cells within the ectocervix.
If your biopsy comes back positive it is because you have abnormal cells or cervical intraepithelial neoplasia (CIN), you will have both abnormal mature cells and variable quantities of immature abnormal cells. Abnormal cells may develop into cancer, so the quantity of these cells within the ectocervix is important. The grading of CIN is established according to the amount of immature cells within the sample taken and all the results below mean that you have cervical abnormalities.
Grading of CIN means that if you have:
- CIN1: the lining of the cervix has fully normal cells at the surface and the lower third has immature abnormal cells
- CIN2: the lining of the cervix has normal cells at the surface and the lower two-thirds have abnormal cells
- CIN3: the lining of the cervix has abnormal cells throughout its entire thickness.
Your biopsy letter may also mention the word koilocytosis or koilocytotic atypia. This just means that some of the cells in your biopsy show specific changes that are commonly caused by HPV infections. Koilocytosis is sometimes referred to as a calling card for HPV. It is often seen in biopsy samples that also have abnormal cell growth (sometimes called dysplasia). It is the abnormal cell growth that will be watched and treated if necessary, as it is these cells that may become precancerous or cancerous if left untreated.
Having cervical abnormalities does not mean that you have or will get cancer. It just means that the laboratory has detected some changes to your cells that are abnormal and, if they are not treated, they may develop into cervical cancer in the future.
Read our 'Understanding positive screening results and abnormal cells' document.
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