Does the presence of spindle cells in a pap smear always indicate cancer or can they be present with moderate or severe dyskariosis? Ie cin3?

Not always cancer. Spindle cells (sc) have bilateral tapering poles (like a football); their presence on pap smear indicates issues ranging from benign reactive or reparative changes, artifactual/normal squamous cell shape, to rare malignancies (carcinosarcoma, metastatic desmoplastic melanoma). Sc morphology is seen in connective tissue. Pap grade (high or low intraepithelial lesions, cin 1-3) is more tellig. N.