D

A Pap smear that reads “carcinoma in situ” is equivalent to a high-grade squamous intraepithelial lesion (HSIL). Current guidelines recommend immediate colposcopic evaluation with directed biopsy to confirm the cytologic impression and map the lesion before any excisional therapy is planned; treatment decisions (e.g., conization) are based on the biopsy result, not on cytology alone [Lindeque, 2005, PMID 16150393; Knutzen, 1977, PMID 905909].