Cervical dysplasia is usually detected during a routine gynecological examination, in which a physician reviews a patient’s medical history and performs a pelvic examination. During the exam, the physician will perform a Pap smear, a common screening test used to detect the presence of precancerous and cancerous cells.

During the Pap smear, the physician inserts a speculum (an instrument for examination of canals) into the vagina to examine the cervix. The physician removes cells from the cervix using a small spatula and a brush or cotton swab. The cells are placed on a glass slide or into a fluid-filled bottle and sent to a laboratory for analysis. Physicians can usually determine whether the cervical dysplasia is mild, moderate or severe from the cell sample.

Results of a Pap smear can also be ASCUS (atypical squamous cells of unknown significance). This result means the cells do not look like typical cervical cells, but they are not clearly abnormal. An atypical test can be caused by a yeast infection or the use of birth control pills. With atypical tests, physicians typically repeat the test within a few months.

Although Pap smears are a useful diagnostic tool, they can also produce “false negative” results, meaning that test results are normal when cervical dysplasia is present. For this reason, women should consult their gynecologist on an appropriate screening schedule. Physicians may recommend more frequent retesting as a precaution for women who have had abnormal Pap smears in the past.

A Pap smear will usually identify the presence of abnormal cells. To confirm the diagnosis and further identify the severity of the dysplasia, the physician will perform a colposcopy (examination of the cervix with a colposcope). A colposcope is a microscope that allows physicians to visually examine the cervix.

Before the colposcope is used, the cervix is lightly washed with a vinegar solution that makes abnormal cells stand out more clearly against the surrounding tissue. A colposcopy reveals white areas, atypical blood vessels, or mosaic-like patterns on the cervical surface. 

When a colposcopy is performed, a biopsy (the removal of a tiny piece of tissue from the cervix) is often completed at the same time. The biopsy allows laboratory technicians to study the tissue to ensure the diagnosis is accurate. A biopsy is the definitive method to diagnose cancer.

In some cases, a cone biopsy might be performed to remove abnormal tissue and to determine whether that tissue is cancerous. This procedure removes a cone-shaped or cylinder-shaped piece of the cervix. In many cases, a cone biopsy that is performed for diagnosis is also successful in treating the problem by removing all affected tissue.

Immediately following a colposcopy exam, physicians may now use a new imaging device to determine whether there are other areas of the cervix that need to be biopsied. Approved by the Food and Drug Administration in March 2006, the LUMA Cervical Imaging System shines a light on the cervix and analyzes how the areas of the cervix respond to the light. Based on the response, the LUMA system assigns a score to small areas of the cervix and produces a color map of the surface. The score and color map can help physicians distinguish between healthy tissue and precancerous or cancerous tissue. With the score and color map, physicians can determine where to perform biopsies on the cervix. It should be noted that the LUMA system is meant to supplement – and not replace – the colposcopy exam. Physicians will perform the cervical biopsies only after reviewing the information from both the colposcopy and LUMA exams.

In addition, human papillomavirus (HPV) DNA testing may soon replace conventional Pap smear testing as the initial screening method for cervical dysplasia and cancer. A new large scale study found that the test for HPV, which is present in almost all cervical cancers, is more sensitive than cytology (examination of cells under a microscope) in detecting precancerous or malignant cervical lesions.