Colposcopy totally clear but still recommended LLETZ?

Hello all,

I would be very grateful for some advice. I had an abnormal PAP in August (suspected CIN 3,) and tested positive for HPV 16.  In September, I did a colposcopy with a doctor in the Netherlands.  No abnormal cells were found during the colposcopy, my cervix was so "clear" that the doctor didnt even take a biopsy as there was no abnormal tissue to examine. We did a repeat PAP, which came back again as CIN 3. I have since moved to South Africa and consulted with a specialist here, who feels that we still need to do a LLETZ, as its unusual for PAPs to repeatedly indicate CIN 3, while the colposcopy can't pick up any abnormal cells. My doctor in the Netherlands, however, said I should wait for a few months and do nothing.  I would rather not undertake a LLETZ - I am 35, never given birth, and afraid of the complications of a LLETZ.  Did anyone else have a similar expereince where the colposcopy revealed no abnormal tissue but the Paps indicate otherwise?  How did you deal with it? 

Reply contains descriptions of pregnancy and children




I think it’s generally unusual for smears to pick up CIN, only for it not to be picked up on colposcopies, but it is possible. As you can’t have a false positive with smears, only false negatives. However, I had a similar experience as you, but it was CIN1 and I was offered LLETZ as it was explained that it could kick start my immune system to clear it. I refused and wanted to wait to see if my immune system could do the job. However, after one negative smear, I was sent back to 3 year screening, only for it to become CIN3 this year, necessitating treatment.

Only you can decide whether to have treatment or not. I would advise to have a serious chat with your doctors. The important thing is to arm yourself with as much knowledge you can get. I think for the fact it’s CIN3, I would seriously think about having treatment, especially since you have HPV too. A LLETZ is much more accurate than smears and colposcopies for detecting CIN. Yes, there are risks associated with the procedure, but it is rare to have them - I never did with the 2. Also, it shouldn’t affect you having children, but you would be kept a closer eye on, as it may cause a premature birth - I’ve had 2 prematures at 8 and 7 months before my diagnosis and they’re healthy! 

Thanks for your response! I will consult with the doctor. Am starting to wonder if I have CGIN or something more sinister given that colposcopies cant pick it up. 

So you never actually had a biopsy taken at colposcop? I dont know how they can advise lletz without confirming that. I had abnormal smear, then 2 colposcopies, 1st time consultant thought it all looked totally fine but took biopsies anyway which showed cin1, they decided to bring me back for a repeat colposcopy and took 3 biopsies from slightly different area on cervix, this time came back cin2 so I've just had lletz treatment for this. Anyway my point is both times the consultant said she could see nothing, my cervix looked healthy but thankfully  biopsy showed there is cin2 that needed treatment. I think you should insist on getting a biopsy to get further information . 


Frustrating time for you... I had a borderline endocervical smear result and the colposcopist thought it was higher grade upon inspection but took one biopsy which showed inflammation only. I think it is possible for the lab to read results incorrectly or for the "clinical impression" to be wrong so maybe pester them to take biopsies and possibly an ECC? I am going back for another Colposcopy in December because I wasn't happy to wait another 6 months. 

Good luck :) x

Thanks for getting back to me.  I've been speaking to the new Doctor, who suggests that we do a LLETZ and hysteroscopy and D&C.  His concern is that I've had 4 abnormal pap smears since June (indicating CIN1 or CIN 2/3).  I'm so confused.  I've never even had a biopsy and now it feels like I'm going straight from 0 to nuclear, getting a LLETZ and a hysteroscopy and a D&C.  The new doctor is concerned that the PAPs may be picking up some dysplasia in the uterus, given that the colposcopy looks totally clear.  Let me discuss with him your advise about doing a biopsy first before rushing into any of this.  

I'd like to post an update as it may help others. I am glad I did the lletz as it turned out to indeed be cin3 (clear margins thankfully). So if anyone else is in this situation of clear colposcopy but recurrent abnormal paps, then be sure you also do the lletz.