A cytological (cervical) smear (another name is Papanicolaou analysis, Pap test) is a very simple, quick and completely painless study for the patient. It is carried out during a routine examination on a gynecological chair. For preventive purposes, a smear is performed on almost every woman from the moment she begins sexual activity.
The main purpose of taking a smear is to identify changes in the cells of the cervix that can subsequently develop into cancer. If a woman consults a gynecologist regularly, changes are recorded at the earliest stage, which is characterized by minimal treatment requirements. Also, in addition to diagnosing cellular abnormalities, a smear shows the presence of a number of harmful microorganisms in the vagina and allows you to determine the condition of the mucous membrane. It is worth remembering that the results of a smear sometimes do not allow a final diagnosis to be made and other additional examination methods are required.
A cytological smear is taken, according to the requirements, from three areas of the vaginal mucosa: from its fornix, from the outer surface of the cervix and from the cervical canal. In this case, a special spatula is used. Once collected, each sample is applied to a glass slide and then sent for careful analysis to a cytology laboratory. There, in turn, cytological smears are studied in detail for the presence of the slightest deviations in the structure of the cells. As a rule, this is done using Papanicolaou staining, drying, examination under a microscope, and so on. The combination of the above manipulations provides accurate results.
Many women are concerned about the question of how often they need to repeat the procedure for taking a cytological smear. Doctors' opinions on this issue differ. As you know, in most cases it takes about 10 years for a cell to form a cancerous tumor from slight changes in its structure, so some doctors say there is no need to conduct research often. But, at the same time, in practice there have been cases of rapid development of the disease. Hence, the recommended frequency of taking a smear is once a year or one and a half years.
Cervical cancer (cervical cancer) is the second most common cause of cancer-related death and mortality in women worldwide. The best way to detect cervical cancer is through regular Papanicolaou tests, or Pap smears. (Pap is a shortened version of the name of the doctor who developed the screening test.) The Pap smear is based on a microscopic examination of cells taken from the cervix.
A Pap smear can detect certain viral infections (such as human papillomavirus [HPV]) and other cancer-causing factors. Prompt treatment can stop cervical cancer before it fully develops. A woman may have cervical cancer and not know it because the cancer is often asymptomatic.
Risk factors for cervical cancer:
o Multiple sexual partners (or sexual partners who have multiple partners)
o Beginning of sexual activity at an early age
o Viral infections such as HPV, human immunodeficiency virus (HIV), or herpes simplex virus (HSV)
o Weakened immune system
o Previous history of reproductive system cancer
o Smoking
It is recommended that a woman be screened for cervical cancer annually, starting at age 18, or when she becomes sexually active if under 18. A woman with a negative Pap smear result can be examined less frequently for 3 years if she does not have sexual intercourse during this period.
There is no upper age limit for screening because the incidence of cervical cancer increases with age. Very often, women over the age of 50 are diagnosed with cancer. Even after menopause, a woman should regularly undergo Pap smears.
Many older women believe that they no longer need a Pap smear and think that they are not at risk of developing cervical cancer because of their age because they cannot be sexually active. It is not right. These women need a Pap smear because their risk is higher. Even if a woman's uterus has been removed, she should undergo annual cancer screening if there is a history of abnormal Pap smears or reproductive system cancers.
Complications of the Pap smear
The procedure for taking a Pap smear is not complicated or painful. The only risk is undetected cervical cancer and untimely treatment.
Preparing for a Pap smear
The best time to have a Pap smear is any time without menstrual flow.
In the 2 days before the test, avoid the following as it may mask abnormal cells and lead to false negative smear results:
Sexual intercourse
Douching
Vaginal medications (except those prescribed by a doctor)
Vaginal contraceptives such as contraceptive foams, creams or jellies.
During the Pap smear procedure
Taking a Pap smear is usually part of a gynecological examination and is accompanied by a breast examination, performed by a specialist obstetrician-gynecologist. Taking a smear itself will take only about 1 minute of the total examination time.
The woman will lie on the gynecological chair on her back, her knees are raised and her legs are fixed in stirrups. The doctor will use a small metal or plastic instrument called a speculum to open the vagina so that the walls of the vagina and cervix can be clearly seen.
A sample of mucus and cells will be obtained from the cervix (the part of the uterus that comes out into the vagina) and the lining of the cervical canal (inside the cervix) using a wooden scraper or a small cervical brush.
The cell sample is evenly distributed over the glass slide and secured with a fixative. This sample is sent to a laboratory for careful examination under a microscope. If a doctor uses a new type of Pap smear called a ThinPrep test, the sample is washed into a jar and sent to a laboratory for examination.
A cytologist (a specialist who looks at the elements of a smear and interprets the results of a Pap smear) reviews both types of tests.
During the smear test, a woman may experience some discomfort. Most women either feel nothing at all or feel pressure. A relaxed posture will help completely avoid discomfort. The woman should breathe slowly and concentrate on relaxing her stomach and legs.
The Pap smear should not be painful. If a woman experiences pain during the test, she should bring this to the doctor's attention.
After the Pap smear procedure
The time it takes to receive your smear results varies from clinic to clinic, your doctor will tell you when to come get your results.
Negative or normal test results mean that the cervix appears healthy and is of a healthy shape and size.
Positive or abnormal smear results mean that something is unusual in the sample, with abnormal cells of varying sizes and shapes found.
An abnormal Pap smear result does not always mean cancer. The cells sometimes appear abnormal but are not cancerous. The woman will have to return to the clinic for follow-up examination.
Remember that abnormal cells do not always become cancerous, but some factors (such as HPV detection) are more dangerous than others.
Cervical infections may result in positive test results. Yeast, trichomoniasis, chlamydia, or gonorrheal infection can cause inflammation in the cells of the cervix. Once the infection is treated, the Pap smear result usually returns to normal.
Human papillomavirus (HPV) can also make a smear test positive. This virus can live on the cervix or vagina and causes genital warts. Many types of HPV have been identified, and some are associated with cervical cancer. If a woman has HPV, she has a higher risk of developing cervical cancer.
The smear test may be positive because it shows changes that could develop into cervical cancer.
If a woman has an abnormal repeat Pap smear result, smears should be taken by a doctor every 4 to 6 months for 2 years until 3 consecutive negative tests are obtained.
If a positive Pap test is due to an infection, the underlying cause must be treated. PAP - The test should be repeated within 2-3 months because cervical cancer may be hidden by infection.
Although the Pap smear is the best method for early detection of cervical cancer, it is not perfect because even the best laboratories may miss some cellular changes; a woman should have a pap smear every year.
Recently, 2 computerized systems (PAPNET and AutoPap) have been approved in the United States for the detection of abnormal Pap smear cells. To ensure the accuracy of the tests, they use computer technology to double-check Pap smears, in which abnormal cells may not be detected by the cytologist. These tests are more expensive than the cost of a normal Pap smear, but they may be useful if a woman is at high risk of developing cervical cancer. Talk to your doctor about these methods.
Interpretation of smear results
Only a specialist doctor can correctly interpret the results of a smear. In modern practice, assessment of changes in cells using the so-called Papanicolaou technique is widespread, when five stages of pathology development are distinguished.
Stage 1: there are no cells with any abnormalities, a normal cytological picture is observed. This stage is typical for completely healthy women.
Stage 2: there are slight changes in the structure of cells, however, due to the inflammatory process of the internal genital organs. This stage is also the norm, but at the same time, the doctor will definitely recommend you a more thorough examination to identify the causes of inflammation and eliminate them.
Stage 3: there are cells with abnormalities in the structure of the nuclei, but their number is extremely small. In this situation, it is necessary to take a second smear or conduct a special histological examination of the changed tissue.
Stage 4 - individual cells with clearly malignant changes (such as increased mass of cell nuclei, changes in chromosomes and cytoplasm) can be detected. However, this only gives reason to suspect the disease, and not to make a final diagnosis.
Stage 5 - a large number of typical cancer cells are observed in the smears.
The reliability of vaginal cytological smears (Pap test) is high when it comes to changes in the cervix. However, this test does not say anything about the condition of the uterus, ovaries or fallopian tubes. And in 20-30% of cases, the Pap test gives false negative results. A guarantee of reliable interpretation of data is provided only by a comprehensive examination (colposcopy of the cervix, biopsy of the mucous membrane, etc.).
Most laboratories in the United States use a standard set of terms called the Bethesda classification (cervicovaginal cytology diagnosis) to report or interpret Pap smear results. By Bethesda classification Pap smear samples that do not have abnormal cells are interpreted as “negative for an intraepithelial or malignant lesion” (ie, women do not have cancer).
Samples with cellular abnormalities are classified into the following categories (as specified by the National Cancer Institute):
ASC (atypical squamous cells): Squamous cells are thin, flat cells that form the surface of the cervix. The Bethesda system divides this category into the following 2 groups:
ASC-US (atypical squamous cells of undetermined significance): The squamous cells do not appear completely normal, but doctors are not sure if the changes mean cancer. Sometimes these changes are associated with HPV infection. ACS-US is considered a soft anomaly.
ASC-H (atypical squamous cells; squamous intraepithelial lesions cannot be ruled out): The cells are not normal, but doctors are not sure if the changes mean cancer. ASC-H often indicates a precancerous condition.
AGC (atypical glandular cells): Glandular cells are mucus-producing cells found in the endocervical canal (in the center of the cervix) or in the lining of the uterus. The glandular cells are not normal, but doctors are not sure what the cellular changes mean.
AIS (endocervical adenocarcinoma): precancerous cells in glandular tissue.
LSIL (low grade squamous intraepithelial lesions): Low grade means there are some early changes in cell size and shape. The word lesion refers to an area of abnormal tissue. Intraepithelial refers to the layer of cells that form the surface of the cervix. LSILs are considered minor abnormalities resulting from HPV infection.
HSIL (high-grade squamous intraepithelial lesions): High-grade means that there are more noticeable changes in the size and shape of the abnormal (precancerous) cells, that is, the cells are very different from normal cells. HSILs are characterized by more severe abnormalities and have a higher likelihood of cancer progression.
When to Seek Medical Help
Early stages of cervical precancer and cancer often have no signs or symptoms. Therefore, it is very important to have regular Pap smears. Symptoms usually appear when the cancer has progressed and become difficult to stop.
If you experience the following symptoms, consult your doctor immediately:
- Unusual vaginal discharge
- Blood stains or light bleeding outside of your normal period
- Bleeding or pain during sex
These symptoms do not clearly indicate cancer; other factors may cause these symptoms, but testing is necessary to determine the cause.
If the Pap smear result is normal, the woman will continue with routine screening.
If her Pap smear result is atypical (could not be classified as normal or abnormal), a repeat smear should be done after 4 months. If the repeat test is abnormal, the doctor will do a colposcopy. During this test, the doctor looks at the cervix through a colposcope (a special microscope) instrument, looking for an explanation for the abnormality in the Pap smear. It doesn't hurt at all and has no side effects. It is possible to perform this procedure during pregnancy.
If there are abnormal cells on the cervix, the doctor will perform a biopsy (taking a tissue sample to look at under a microscope).
If a woman's smear result is abnormal, a colposcopy and biopsy should be performed immediately. A biopsy is the only way to determine whether a precancerous condition is cancerous or not.
Several types of biopsies are performed under different types of anesthesia.
To treat precancerous tissue or very early stage cancer, the doctor may remove the abnormal tissue entirely during a biopsy.
If the biopsy and Pap smear results are normal, the Pap smear should be performed again after 4 months.
If the biopsy is normal but the Pap test is abnormal, the doctor will repeat the colposcopy and biopsy.
If the biopsy results in intraepithelial neoplasia or cancer, treatment for cervical cancer should be started immediately.
1. All women who are sexually active or over 19 years of age are recommended to undergo a gynecological examination once a year with a cytological analysis of the Papanicolaou smear (Pap test). After receiving a negative result twice, you can undergo this test less frequently - once every three years, until you reach age sixty-five.
2. If you use hormonal contraceptives or have had genital herpes, it is recommended to undergo the following test - a Pap test twice a year.
3. Infertility, uterine bleeding, overweight (obesity), genital herpes, genital warts, frequent changes of sexual partners, taking estrogen hormones are factors for more frequent cytological smears.
A Pap smear, Papanicolaou test, or Pap test is a diagnostic procedure in which a doctor checks a woman's cervix for the presence of cancerous or precancerous cells.
A Pap smear involves collecting cells from the cervix, the lower, narrow end of the uterus that sits on top of the vagina.
Early detection of cervical cancer using a Pap test gives a woman a high chance of successful treatment. In addition, using a smear test, you can identify changes in the cells of the cervix that may lead to the development of cancer in the future. Finding abnormal cells early with a Pap smear is the first step in stopping the development of cervical cancer.
The content of the article:Why is a Pap test done?
A Pap test can detect cervical cancer at an early stage, therefore dramatically increasing a woman’s chances of successful treatment
The Pap test is used to detect cervical cancer or precancerous lesions. This procedure is usually performed during. For women over thirty, a smear may be taken at the same time as a test for human papillomavirus (HPV), a common sexually transmitted infection that can cause cervical cancer in some women.
Who should get a Pap smear?
A woman and her doctor can decide when it is time to start Pap tests and how often the procedure should be done.
How often should you have a Pap test?
For women between the ages of 21 and 65, doctors recommend repeating a Pap test every three years.
Women aged 30 years and older can be tested once every five years, provided that the procedure is coupled with a test for human papillomavirus.
If a woman is at increased risk of developing cancer, her doctor may recommend more frequent Pap tests. In this case, the frequency of testing will depend on age.
Increased risk factors for developing cervical cancer may include the following.
- diagnosis of cervical cancer or detection of precancerous cells during a Pap test;
- a woman being under the influence of ethylstilbestrol and before your own birth;
- infection with human papillomavirus;
- an immune system weakened by organ transplants, chemotherapy, or regular use of corticosteroids.
You can read more about the risks of developing cancer.
Who can stop having a Pap test?
After a hysterectomy not related to cancer treatment, a woman may stop having regular Pap tests.
In some situations, a woman and her doctor may decide to stop performing Pap tests. Such situations may include the following.
Hysterectomy
After complete, that is, surgical removal of the uterus, including the cervix, a woman should ask her doctor whether she needs to continue regular smear tests. If the hysterectomy was performed for reasons other than cancer, such as fibroids, your doctor may not require Pap tests. But if a patient has had a hysterectomy because cancerous or precancerous lesions were found on the cervix, the doctor may recommend continuing to have regular pap smears.
Age
Typically, doctors will consider stopping a woman from having smear tests after age 65 if her previous tests for cervical cancer are negative, meaning they do not indicate cancer. A woman should discuss this issue with her doctor and make a decision together based on her individual risk factors. If the patient continues to be sexually active and does so with multiple partners, the doctor may recommend continuing to have Pap smears.
What are the risks associated with a Pap test?
By and large, medicine does not know the risks associated with the Pap test. However, there are significant risks for those women who do not undergo this procedure. The most that a woman can detect is a small discharge immediately after taking a smear. Moderate to heavy bleeding after a Pap test is not normal.
That is, the Pap test is a safe way to check for cervical cancer. However, its results may be mixed. When taking a smear, false negative results are possible, that is, situations when the smear does not show the presence of abnormalities that actually exist.
A false negative result does not mean that medical personnel made a mistake. Factors that can lead to a false negative result include the following:
- collection of insufficient number of cells;
- a small number of abnormal cells in the area being examined;
- hiding abnormal cells by blood or inflamed cells.
It is important!
Even in situations where abnormal cells cannot be identified the first time, time will be on the woman’s side. Cervical cancer takes several years to develop, and if one test fails to detect cancer, it is more likely to happen next time.
How to prepare for a Pap smear?
To ensure the most effective Pap test, a woman can follow the recommendations below:
- Avoid sexual activity, douching, vaginal medications, spermicidal foams, creams or jellies for two days before the procedure. All of the above can clear or hide abnormal cells;
- Try not to schedule a Pap test during your menstrual cycle. A smear can be taken, but it is better not to perform the procedure at this time, if possible.
What to expect from a Pap test?
What happens during a Pap test?
Using a speculum, the doctor dilates the vagina to gain free access to the cervix
The Pap test is usually performed in a doctor's office and takes just a few minutes. A woman can ask her doctor whether she needs to undress completely or just from the waist down.
The patient lies on her back with her legs bent. During the procedure, the body body is placed on the table, and the feet remain on special supporting stands.
The doctor carefully inserts an instrument called a speculum into the vagina. This device holds the walls of the vagina away from each other to allow the doctor to see the cervix clearly. Insertion of speculum may cause a sensation of pressure in the pelvic area.
The doctor then takes a sample of cervical cells using a soft brush or flat object called a spatula or spatula. As a rule, this procedure does not cause pain.
What happens after taking a Pap test?
Once the smear is taken, the woman can continue her day without restrictions.
Depending on the type of test performed, the doctor may place the cells collected during the procedure in a container filled with a special liquid (liquid Pap test) or on a glass slide (smear cytology).
The samples are sent to a laboratory where they are examined under a microscope to look for characteristics in the cells that signal cancer or precancerous conditions.
After completing the procedure, a woman should ask her doctor when the results will be ready.
Pap test results
A Pap test can alert your doctor to the presence of suspicious cells that need further examination.
Negative result
If the Pap test found only normal cells, the doctor will tell the woman the result is negative.
In this case, no further treatment and no further diagnostic procedures will be needed until the woman comes for her next gynecological examination.
Positive result
If the Pap test reveals unusual cells, the doctor will tell the patient that the result is positive. A positive result does not mean that a woman has cancer. What a positive result indicates depends on the type of cells that were found.
Below are terms that the doctor may use, as well as the next steps for the woman and her medical team.
Squamous cell atypia of undetermined significance
Squamous cells are thin and literally flat cells that are found on the surface of a healthy cervix. In this case, the Pap test revealed a slight abnormality of these cells, but the changes do not clearly indicate the presence of a precancerous condition.
With a liquid test, your doctor may retest a sample to check for viruses in your body that are known to promote cancer. One such virus is the human papillomavirus (HPV).
If there are no such viruses, then the abnormal cells detected by the test will not be a big problem. If there are viruses, the woman will have to undergo further tests.
Squamous intraepithelial lesions
This term is used to identify that cells obtained from a Pap test may be precancerous.
When the degree of cell change is low, the shape, size and other characteristics of the cells suggest that if precancerous lesions are present, it may take several years for them to become cancerous.
If the degree of cell changes is high, there is a high chance that these lesions may develop into cancer much earlier. In this case, additional diagnostics will be required.
Atypia of glandular cells
Glandular cells produce mucus and are located at the opening of the cervix, as well as in the uterus itself. Atypical glandular cells may have slight abnormalities, but it is almost always difficult to tell whether they are cancerous.
Further testing will be required to determine the source of these cells and their significance.
Squamous cell carcinoma or adenocarcinoma
This means that the cells obtained from the Pap test look so abnormal that the pathologist is almost certain that they are cancerous.
Squamous cell carcinoma is characterized by cancer arising in the squamous epithelium of the vagina or cervix. Adenocarcinoma is characterized by the presence of cancer in glandular cells. If such cells are found, the doctor will recommend further evaluation.
If the Pap test results are positive, which means bad, your doctor may suggest a procedure called colposcopy, which uses a special instrument with a magnifying glass (colposcope) to examine the tissue of the cervix, vagina, and vulva.
The doctor may also take a tissue sample (perform a biopsy) from any area that seems suspicious. The tissue sample is then sent to a laboratory for analysis and an accurate diagnosis.
Hello! Good analysis. At the end of the PAP test there is almost always a conclusion. Different countries use different cytological classifications. The most common classification is Bethesda (Bethesda) of different years of approval (The Bethesda System, TBS). Conclusion “NILM” - Negative for intraepithelial lesion or malignancy - indicates the absence of intracellular lesion or malignancy, that is, the cells are not changed, there is no oncological alertness. According to another classification, this conclusion sounds like “a cytogram without features.” That is, everything is fine with you. Based on the results of the HPV test. You have not been diagnosed with HPV infection, since the total diagnostic titer in women should be more than 500 (and you only have more than 50 and less than 500), and you also do not have HPV types 16 and 18. There may be other types in small quantities. But this is not fatal, even if you get an analysis where, for example, other types will be found. Human papillomavirus (HPV)- a very common infection. 75% of people in the world have been exposed to HPV at least once.The virus can infect cells of the mucous membranes and skin of only humans.There are more than 100 different types of HPV.The virus can exist in two forms: outside the cell’s chromosomes or integrated into its genome. In the first case, these are benign types of human papillomavirus, in the second - malignant.The so-called malignant types include 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82. Types 16 and 18 are considered the most dangerous (high risk of cancer). All other types of the virus are benign. Malignant types of the virus are considered high-risk human papillomaviruses because they can develop into precancerous and cancerous cells over time. Benign ones sometimes cause warts and condylomas, sometimes they turn into precancerous formations on the cervix, but they never turn into cervical cancer. These consequences appear in up to 5% of infected people; in other cases, the human papillomavirus does not cause any complications. It is not yet possible to fight the papilloma virus itself, that is, there is no way to completely rid the body of it; only the consequences of infection can be treated. If these are “traces” of a benign infection, that is, condylomas, warts, papillomas, then they are removed using: laser, cryodestruction, or radio wave method.It has been proven that a healthy and strong immune system in some cases is able to cope with HPV on its own.In people under 30 years of age, spontaneous recovery from the virus often occurs within 2 years of infection.The situation is worse for peoplewith weakened immunity. In them, the virus can take root in the body for a long time, becoming invulnerable to the immune system and traditional treatment.A bad prognostic sign is the persistence of the virus in the body for more than 2 years. In this case, we talk about chronic carriage of HPV. Often, when ectopia is detected (which, you wrote, you have), women are sent specifically for HPV testing, since its role in the occurrence of such ectopia has been proven. But apparently this is not the case for you. Perhaps the reason is an imbalance of microflora in the vagina, thrush, or another latent infection. Remove it and everything will be fine. Perhaps the reason is not an infection, but a hormonal imbalance. Then everything will pass with age. Health to you!
Papanicolaou smear, or Pap test- a test that can be used to identify precancerous or cancerous cells in the vagina and cervix. The main difference from a standard cytological examination is the additional fixation of the material with alcohol during glass preparation, which increases the accuracy of the analysis.
The scraping is performed from two points: the cervical canal and the cervix.
Pap-tesT makes it possible to quite effectively detect precancerous changes in the epithelium - cervical intraepithelial neoplasia of varying severity.
This type of study is mandatory for women over 30 years of age, especially those who have previously or are currently found to have high oncogenic risk human papillomaviruses, as well as for women who have areas of altered epithelium detected during colposcopic examination of the cervix.
The number of preparations (glasses) can be from 1 to 3. Most often, it is necessary to examine two preparations - epithelium from the endocervix and exocervix. The material must be collected using special cytobrushes.
Indications:
- cervical cancer screening.
In women of reproductive age, it is advisable to take a smear for examination no earlier than the 5th day from the start of the menstrual cycle or no later than 5 days before the expected start of menstruation.
24 hours before collection, you must stop using vaginal medications, spermicides, lubricants, and avoid sexual intercourse. You should not douche the day before your smear test.
If there is a visual pathology on the cervix, a smear should be taken regardless of the above factors.
*Please note that gynecological tests are taken for children under 16 years of age only in the presence of their parents. Medical offices do not perform cervical scrapings or smears on pregnant women who are 22 weeks or more pregnant because the procedure can cause complications. If necessary, you can contact your doctor to take material.
Interpretation of results
First, the quality of the smear is assessed: high-quality, low-quality. If the quality of the smear is unsatisfactory, the smear must be repeated. The Pap smear can be positive or negative (Pap class I).
Normally, there are no atypical cells; all cells are of the same shape and size (negative Pap smear). The presence of cells of different shapes and sizes, their pathological position is characterized as a positive Papanicolaou smear. The results of these tests show the presence of abnormal cells, which often sounds scary to women who don't understand what it means.
A positive smear result for atypical cells does not mean that you have cancer or a precancerous condition, but only indicates the need for further research. The cause of the appearance of atypical cells may be the presence of inflammation (chlamydia, herpes infection, gonorrhea, trichomoniasis), infection with the human papillomavirus (HPV). These changes are more often characterized as grade II dysplasia. In this case, it is necessary to carry out the necessary treatment and repeat the smear after 3-6 months. With human papillomavirus infection, koilocytosis of cells is often detected. Koilocytes are 3 cells of squamous epithelium of irregular shape, with clear boundaries. Koilocytes vary in size and are usually larger than normal cells. The nuclei are enlarged to varying degrees, the nuclear membrane is uneven and folded. There is clearing of the cytoplasm around the nucleus.
Cytological classification according to Papanicolaou
1st class - normal cytological picture;
2nd class - changes in cell morphology caused by an inflammatory process in the vagina and (or) cervix;
3rd class - single cells with abnormalities of nuclei and cytoplasm (suspicion of malignant neoplasm);
4th class - individual cells with obvious signs of malignancy;
Class 5 - a large number of typical cancer cells. The diagnosis of a malignant neoplasm is beyond doubt.
Bethesda classification
When classifying according to the Bethesda System (TBS), the following terms may appear in the cytologist’s report:
- ASCUS (atypical squamous cells of undetermined significance) or APNZ (squamous cell atypia of undetermined significance);
- CIN (cervical intraepithelial neoplasia) or CIN (cervical intraepithelial neoplasia) (the term is used as a synonym for cervical dysplasia);
- LSIL (Low-Grade Squamous Intraepitelial Lesions) or N-PIP (low-grade squamous intraepithelial lesion);
- HSIL (High-Grade Squamous Intraepitelial Lesions) or B-PIP (high-grade squamous intraepithelial lesion).
The protocol for a standardized cytological report consists of the following sections:
1. Quality of the drug:
- adequate;
- inadequate.
- epithelial cells within normal limits are replaced by negative ones for intraepithelial pathology or malignancy;
- the detected pathological changes in the epithelium are described.
a) atypical squamous cells (ASC):
- ASC-US of undetermined significance - reactive changes or dysplasia I-weak-CIN-1, most often associated with inflammation;
- not excluding B-PIP (ASC-H);
- low grade squamous intraepithelial lesions (LSIL);
- H-PIP-CIN 1 (dysplasia I-lung), papillomavirus infection-HPV;
- high grade squamous intraepithelial lesions (HSIL);
- CIN 2 (dysplasia II-moderate), CIN 3 (dysplasia III-severe), cancer in situ;
- squamous cell carcinoma.
- without additional characteristics;
- cells suspicious for invasion;
- endocervical adenocarcinoma in situ; - adenocarcinoma.
5. Additional clarifications: the specific infectious agent is indicated (if detected).
[12-048 ] Cytological examination of smears (scrapings) from the surface of the cervix (external uterine pharynx) and cervical canal - Papanicolaou staining (Pap test) (mixed smear)
980 rub.
Order
Cytological examination using a special method of staining the material. Allows you to detect atypical cells in a smear with high sensitivity and diagnose early precancerous changes in the epithelium and cervical cancer.
Synonyms Russian
Papanicolaou smear, Pap test, oncocytology smear.
SynonymsEnglish
Pap smear, Papanicolaou Smear; Cervical Smear; Cervical Oncocytology.
Research method
Cytological method.
What biomaterial can be used for research?
A smear mixed from the cervical canal and the surface of the cervix.
General information about the study
Cervical cancer (CC) ranks third in prevalence among all malignant tumors in women (after breast cancer and colon cancer). The incidence of invasive cervical cancer in the world is 15-25 per 100,000 women. Cervical neoplasms occur mainly in middle-aged women (35-55 years), are rarely diagnosed under 20 years of age, and in 20% of cases are detected over the age of 65 years.
The 5-year survival rate for localized (local, in situ) cervical cancer is 88%, while the survival rate for advanced cancer does not exceed 13%.
Risk factors for the development of cervical cancer include infection with the human papillomavirus (oncogenic serotypes HPV16, HPV18, HPV31, HPV33, HPV45, etc.), smoking, chlamydial or herpes infection, chronic inflammatory gynecological diseases, long-term use of contraceptives, repeated childbirth, cases cervical cancer in the family, early onset of sexual activity, frequent change of sexual partners, insufficient dietary intake of vitamins A and , immunodeficiencies and HIV infection.
According to international recommendations, all women should be screened (pre-symptomatic examination) for cervical cancer 3 years after the start of sexual activity, but no later than 21 years of age. Beginning at age 30, patients who have had 3 consecutive negative cervical smear results can be screened every 2 to 3 years. Women with risk factors (human papillomavirus infection, immunodeficiency conditions) should continue annual screening. Women 65 years of age and older with 3 or more normal cervical smear results in the past 10 years may not participate in screening. For survivors of cervical cancer who have a papillomavirus infection or a weakened immune system, it is advisable to continue screening. Women who have had their uterus and cervix removed may not have this test unless the surgery was performed because of cancer or a precancerous condition of the cervix. Those who have had surgery on the uterus only, without removing the cervix, should continue to participate in screening.
Cytological examination of material from the cervix and external uterine pharynx, stained using the Papanicolaou method in compliance with the test methodology and conditions of preparation for analysis, allows for high sensitivity and reliability to identify atypical cells in the material, precancerous conditions (dysplasia, intraepithelial neoplasia of the cervix). Most often, biomaterial is examined using a special cytobrush from two points (epithelium of the endocervix and exocervix) and fixed on a glass slide with 96% alcohol. The smear should contain material from the transformation zone, since about 90% of neoplastic conditions come from the junction of squamous and columnar epithelium and only 10% from columnar epithelium. This study may also reveal signs of infection, pathology of the endocervix and endometrium.
Screening and early diagnosis of precancerous conditions and initial stages of cervical cancer allow timely effective treatment and prevention of dangerous consequences.
What is the research used for?
- For screening and diagnosis of precancerous diseases of the cervix.
- For screening and diagnosis of cervical cancer.
When is the study scheduled?
- With periodic examination of girls and women 3 years after the start of sexual activity, but no later than 21 years (it is recommended to take an analysis annually and at least every 3 years).
- Every 2-3 years from age 30 until age 65 with three consecutive negative results.
- Every year if you have human papillomavirus (HPV), or if your immune system is weakened by transplantation, chemotherapy, or long-term use of steroid hormones.
What do the results mean?
Taking into account the classification according to the Bethesda system" The 2001 BethesdaSystemterminology"
1. Quantity of material
- The material is complete (adequate) – a smear of good quality, containing a sufficient number of appropriate cell types, is considered a complete material.
- The material is insufficiently complete (insufficiently adequate) - the material does not contain endocervical cells and/or metaplastic cells, squamous epithelial cells are present in sufficient quantities, or the cellular composition is poor.
- The material is defective (inadequate) – it is impossible to judge from the material the presence or absence of pathological changes in the cervix.
2. Interpretation of results
- Negative Pap test – epithelial cells within normal limits, cytogram corresponds to age and normal.
- Benign changes - the presence of non-tumor cells, signs of inflammation (increased number of leukocytes), infections (a significant number of cocci, rods). It is possible to detect infectious agents (indicating the causative agent), for example trichomonas, yeast.
- Changes in squamous epithelial cells (require increased attention, additional examination and, if precancer or cancer is detected, treatment):
- Atypical squamous cells of undetermined significance (ASC-US)
- Atypical squamous cells cannot exclude, HSIL ASC-H
- Squamous intraepithelial lesion (SIL)
- Low grade squamous intraepithelial lesion (LSIL)
- High grade squamous intraepithelial lesion (HSIL)
- Cervical intraepithelial neoplasia grade 1, 2 or 3, CIN 1, 2, 3
- Carcinoma in situ (CIS)
- Squamous cell carcinoma - invasive cancer
- Changes in glandular cells (require increased attention, additional examination and, if precancer or cancer is detected, treatment):
- Atypical glandular cells (AGC)
- Atypical glandular cells, favor neoplastic, AGC, favor neoplastic)
- Adenocarcinoma
If minimal changes or atypical cells of unknown significance are detected, it is recommended to conduct testing for oncogenic serotypes of the human papillomavirus.
What can influence the result?
In girls under 20 years of age, false-positive results are possible due to the presence of changes in the epithelium against the background of transient hormonal disorders.
Important Notes
- In case of acute infection, it is advisable to obtain material for the purpose of examination and identification of the etiological agent; after treatment, but not earlier than 2 months, cytological control is necessary.
- There is a possibility of a negative test result if there are changes in the epithelium in the cervix, so it is important to undergo regular repeated examinations.
Who orders the study?
Gynecologist, oncologist.
Literature
- Apgar BS, Zoschnick L, Wright TC (November 2003). "The 2001 Bethesda System terminology". Am Fam Physician 68(10):1992-8.PMID 14655809.
- Arbyn M. et al. (2010). "European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition – Summary Document". Annals of Oncology 21(3):448–458.
- American College of Obstetricians and Gynecologists, "ACOG Committee Opinion No. 483: Primary and Preventive Care: Periodic Assessments," 2011, Obstet Gynecol, 2011, 117(4):1008-15. PubMed 21422880.
- Novik V.I. Epidemiology of cervical cancer, risk factors, screening.
Loading...