Seeing squamous metaplastic or endocervical cells on your Pap smear test results may raise some questions and concerns. However, the presence of these cells isn’t usually a cause for concern.

The phrase “endocervical cells present” simply means that your doctor sampled cells from the inside of your cervix during the Pap smear. The phrase “squamous metaplastic cells present” means that the pathologist who examined your Pap smear found cells that were growing and repairing themselves regularly.

In this article, we take a look at squamous and endocervical cells and what they mean on a Pap smear test result. We also decode the meaning of other terms that may show up on a Pap test. Read on.

Squamous cells are types of cells found in various tissues throughout your body, including:

  • your skin
  • the outer surface of the cervix (ectocervix)
  • the linings of your organs

When changes occur within these thin, flat-shaped cells, they may be described as metaplastic.

Most cancers of the cervix and vagina are squamous cell carcinomas. However, the presence of squamous metaplastic cells in your Pap test results doesn’t automatically mean cancer. It just means that these cells were sampled during the Pap smear and that the pathologist who examined them found them to be growing in a standard manner.

Atypical squamous cells of undetermined significance (ASC-US)

If the pathologist finds atypical squamous cells of undetermined significance (ASC-US), this usually means that the pathologist has found irregular cells and could not determine why they were irregular.

This could mean that you have an HPV infection, in which case your doctor will need to conduct further testing for HPV to confirm. The irregular cells could also be due to other inflammatory or noncancerous changes of the cervix that will likely resolve on their own.

Squamous intraepithelial lesions (SIL)

Squamous cells that may be precancerous or more likely to turn into cancer are described on a Pap test result as squamous intraepithelial lesions (SIL). These may be further classified as low-grade (LSIL) or high-grade (HSIL), indicating a low to high risk of cancer development.

In the case of HSIL, your doctor may recommend further examination of these cells using a colposcopy.

A colposcopy allows a doctor to examine your cervix under magnification using a colposcope, which is a microscope with a bright light. They can also take tissue samples of irregular cells that can be sent to a lab for further examination by a pathologist.

Endocervical cells are mucus-producing glandular cells located within the inner cervix (endocervix). During a Pap smear, your doctor or nurse may take a sample of these cells, but not always.

If your Pap smear results doshow that endocervical cells are present, it means that your test included cells from your endocervix as part of the sample examined under a microscope. It’s standard to have endocervical cells, and their presence does not indicate cancer or precancer.

However, if cancer cells are detected in the endocervix, your Pap smear may indicate some form of carcinoma. Adenocarcinoma or squamous cell carcinoma are the two most common cell types for cancers of the cervix.

Your doctor will most likely recommend a colposcopy to examine these areas in more detail and gather tissue samples.

While your Pap smear results may indicate a standard result, it can be concerning to see codes and phrases and not know their meaning. If your doctor recommends further testing, it’s helpful to understand what your Pap test results show so that you can have an informed discussion with your doctor.

Below is a breakdown to help you decode common phrases you may see on both a standard and irregular Pap test result:

Phrases associated with standard results

PhraseWhat it means
endocervical cells presenta healthcare professional sampled some of the mucus-producing glandular cells located within your inner cervix and found no irregularities
endocervical cells absentno endocervical cells were collected during your Pap smear
endometrial cells presentcells from your endometrium were collected during your Pap smear
squamous metaplastic cells presentchanges within cervical squamous cells were seen but without any concerning irregularities
negative for intraepithelial lesions or malignancy (NILM)no signs of malignancy or lesions were noted
acute inflammationthis may indicate the presence of white blood cells in your sample
transformation zone component absent/presentthis indicates whether cells were collected within the cervical canal
atrophic changesyour cervix may be exhibiting signs of menopause

Phrases that may mean you need further testing

PhraseWhat it means
atypical squamous cells of uncertain significance (ASC-US) changes within squamous cells on the outside of your cervix that may indicate an HPV infection or be due to other inflammatory or noncancerous changes of the cervix that will likely resolve on their own
low-grade squamous intraepithelial lesion (LSIL) indicates lower-risk cervical cell changes
high-grade squamous intraepithelial lesion (HSIL) cervical cell changes are present and may be at a higher risk of turning into cancer
atypical squamous cells (ASC-H)changes were found within the squamous cells of your cervix, and you may also have HSIL
atypical glandular cells (AGC)changes within the glandular cells of the endocervix exhibit possible signs of precancer or cancer
endocervical adenocarcinomaindicates cancerous cells of the endocervix
endometrial/extrauterine adenocarcinomapresence of cancerous cells in the endometrium, ovaries, or fallopian tubes
adenocarcinoma, unspecifiedcancer cells of an unknown site of origin

If your Pap smear results are standard, you do not need to take any further action. Unless told otherwise by your doctor, you may stick to your regular Pap testing schedule.

On the other hand, if any irregularities are found, your doctor will likely order further testing. According to the American Cancer Society, next steps could include:

  • a physical exam
  • blood testing
  • a follow-up Pap test in 1 year
  • HPV testing
  • colposcopy to examine the cervix, especially if your HPV test is positive
  • cervical biopsies, which consist of tissue samples taken directly from the cervix for further lab testing

How often should you have a Pap smear?

The general guidelines for Pap smears are as follows:

  • Ages 21 to 29. Every 3 years.
  • Ages 30 to 64. Every 3 years or a combination of Pap and HPV testing every 5 years.
  • Age 65 and older. Your doctor may recommend that you stop having regular Pap smears if you have never had an irregular result and have had at least two negative tests in a row.

If you’ve recently had an irregular Pap smear or are considered to be at high risk for cervical cancer, your doctor may recommend more frequent testing.

You should also still see your OB-GYN annually. Pap smear guidelines change often, and your doctor can let you know if and when you need a Pap smear or other gynecological testing.

Was this helpful?

When it comes to reporting Pap smear test results, most medical professionals will either tell you that your results were standard or that you may need to undergo further testing to confirm possible irregularities.

It’s important to discuss any concerns about your Pap smear results with your doctor. Also follow any next steps, including further testing recommendations.

Cervical cancer screenings are designed to detect possible precancer and cancerous cells for the earliest possible treatment.