An adult patient has a Pap smear showing LSIL. What is the appropriate next step in management?

• A. Repeat Pap smear in 6 months
• B. Endometrial biopsy
• C. Colposcopy with directed cervical biopsy
• D. HPV typing

Answer: (C)

When Pap smear shows LSIL, the goal is to assess for cervical intraepithelial neoplasia and rule out higher-grade disease or cancer. LSIL often reflects HPV-related changes, but imaging and histology are needed to determine severity. Colposcopy provides a magnified view of the cervix with directed application of acetic acid and, crucially, allows targeted biopsies of any abnormal areas. This histologic assessment is essential to identify CIN2/3 or invasive cancer and to guide appropriate treatment, such as excisional procedures if high-grade disease is found. Repeating the Pap smear later misses the opportunity to evaluate or treat a potentially significant lesion now, and endometrial biopsy is not indicated for a cervical cytology finding. HPV typing alone does not establish histologic diagnosis or assess lesion severity; it complements but does not replace colposcopic evaluation.