How Cervical Intraepithelial Neoplasia Is Diagnosed

It starts with a pap smear test

Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is a medical condition where cells on a cervix change.

Since the cervix is deep inside at the lowermost part of the uterus which connects to the vagina, you usually can’t see this internal area at home. To see if you have CIN, you’ll need to go to a qualified medical professional (ie. a doctor, nurse, or gynecologist) who can examine through Pap smear exam and Human papillomavirus (HPV) testing to determine your risk factors.

A type of biopsy called a cone biopsy may also be necessary to test any internal skin lesions on the cervix. This is why you can’t self-diagnose CIN. However, there are options for at-home STI testing that can help in the overall diagnostic process.

Practice Nurse/doctor doing smear test

Peter Dazeley / Getty Images

At-Home Testing

Human papillomavirus
is the leading underlying cause of infection that comes before cell changes of the outer lining of the cervix (AKA the intraepithelial lining). HPV is also the infection that, if left untreated over years (these cells change slowly), can eventually progress to cervical cancer.

HPV is also responsible for several other types of cancers including vulva, penis, anus, and back of the throat or oropharynx cancer. Doing at-home STI testing is an option for first-line detection of a potential problem.

If you get a positive test result from your at-home HPV test, don’t panic. This does not mean you have cancer. It may not even mean you have a strain of HPV that causes cervical cancer, either. Human papillomaviruses are common and pretty much everywhere, but they’re relatively harmless. Still, if you have a positive home test, check with your doctor to see if you need further testing to check for the 14 out of the more than 100 HPV-related viruses linked to cancer.

At-home HPV tests range from about $50 to $100. Depending on your age, HPV testing may be combined with your routine Pap smear at you doctor’s office or clinic, which is often covered by insurance. If not, the cost may vary depending on where it is done.

The Centers for Disease Control and Prevention say that most of the time, HPV goes away by itself within two years and does not cause health problems.

Physical Examination

The earlier you find cervical cancer, the easier it is to treat. This is why you should always follow the most recent screening guidelines:

The American College of Obstetricians and Gynecologists (ACOG) recommends the following:

  • Women ages 21 to 29 should get a Pap test every three years.
  • Women ages 30 to 65 should have a Pap test combined with an HPV test every five years. 
  • Some women with certain conditions may need more frequent testing, including women with a history of cervical cancer, HIV/AIDS, or a weakened immune system. 

Your physical examination consists of these tests. The Pap test looks for the precancerous cells that could indicate the presence of CIN. This test is done in a clinic. If indicated, the HPV test is usually done at the same time.

During a Pap test, a plastic or metal tool will be slowly inserted into the vaginal canal to the point where it reaches the bottom of your cervix. The instrument, technically called a speculum, will open to widen the vagina so the professional can see and have enough space to collect a small cell sample as well as any cervical mucus. These cells will be sent for diagnostic examination. 

When Will I Get My Pap Results?

After your Pap test, you can return to what you were doing. It may take a few weeks to hear back about your results. If you experience some spotting, it will be short in duration and low in flow (nothing a light-flow maxi pad or lightday period pantie can’t handle).

Your Pap test will come back reported as one of the following:

  • Normal: Everything looked as it should and you can continue following the regular screening protocol.
  • Unclear or inconclusive: The cell sample may not have been large enough or may be showing inconsistent results for other reasons. Depending on your medical history, your doctor may decide to do another Pap to confirm or wait 6 months to a year to have another test. 
  • Abnormal: The cells examined looked abnormal but this doesn’t mean you have an HPV infection or cancer. Your doctor may suggest further testing to get a better understanding of what’s happening. 

One in 10 Pap smears come back showing some type of abnormality, but most are not serious.

Labs and Tests

If your Pap tests are abnormal and suggest abnormal cell growth, there are a few other methods of testing your doctor will consider. Imaging can be done to examine the cells in better detail and various biopsy types may be done to determine if it is nonmalignant (precancerous) or if it’s malignant (cancerous). 

  • Colposcopy: Similar procedure to a Pap smear test except it includes a lit-up magnifying instrument that is used in conjunction with the speculum. It can be used to look for cell changes, growths or lesions, and inflammation. It does not go all the way to the uterus.
  • Endocervical curettage: Cells are scraped and collected for testing from the cervical canal.
  • Punch biopsy: Cervical tissue is removed for testing.
  • Cone biopsy: A cone biopsy gets its name from the shape of tissue removed (a cone). This shape allows the doctor to examine deep into the tissue without taking as much tissue from the area.

Cone biopsies can be used to diagnose and, in many cases, treat CIN.

Three ways of performing a cone biopsy:

  • Laser surgery, which uses a laser beam to take out or excise a portion of tissue.
  • Loop electrosurgical excision (LEEP), which uses a thin wire loop attached to a generator to electrically remove a piece of tissue.
  • Cold knife conization (CKC) in which tissue is removed with a surgical scalpel.

Misinterpreted Results

A diagnosis of CIN isn’t the same as a diagnosis of HPV. Only an HPV test can detect the presence of the human papillomavirus. A positive result doesn’t mean you have the type of HPV that may one day develop into cervical cancer (if left undetected and untreated), either. Even more, a positive HPV test doesn’t necessarily mean you need to do anything right away. Your doctor can help determine your level of risk.

Other reasons for unclear results include life changes like:

  • Pregnancy
  • Menopause
  • Infection

The CDC reassures women there are many reasons why Pap smear test results might not be normal, but it usually does not mean you have cancer. 

A Word From Verywell

The diagnostic process for CIN may sound like a lot, but it really comes down to going and getting a Pap test and sticking to the recommendations for screening, which includes screening for HPV, the infection that most commonly is the culprit behind the cell changes that later lead to cervical cancer.

The good news is, Paps are relatively quick and painless routine procedures and most of the time everything is totally fine. When there’s something outside the norm, you’ll know with plenty of time to take action.

Frequently Asked Questions

  • What happens if my cervical biopsy is abnormal?

    Some cervical cell changes may not need treatment because your immune system will destroy them and replace them with healthy, normal cells. If the abnormality or spread of abnormal cells is severe, treatment such as biopsy or cold laser therapy may be necessary.

  • What happens if CIN 3 is left untreated?

    It is dangerous and risky to leave CIN untreated for a long period of time because abnormal cells left alone can spread and develop into cervical cancer. Treatment protects against cervical cancer.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Cancers associated with human papillomavirus (HPV).

  2. World Health Organization. Human papillomavirus (HPV) and cervical cancer.

  3. Centers for Disease Control and Prevention. What do my cervical cancer screening test results mean?

  4. American College of Obstetricians and Gynecologists. Updated cervical cancer screening guidelines.

  5. Office on Women’s Health. Pap and HPV tests.

  6. American Pregnancy Association. Pap smear.

  7. American Cancer Society. Treatment options for cervical cancer, by stage.

  8. National Cancer Institute. Cervical cancer treatment (PDQ)—patient version.

By Michelle Pugle
Michelle Pugle, BA, MA, is an expert health writer with nearly a decade of contributing accurate and accessible health news and information to authority websites and print magazines. Her work focuses on lifestyle management, chronic illness, and mental health. Michelle is the author of Ana, Mia & Me: A Memoir From an Anorexic Teen Mind.