Blood after papa test. Women Health. What is a PAP test? When, to whom and why is a smear for cytology prescribed?

Until now, the most common method for screening diagnosis of cervical pathology is the cytological method - cytological smear Papanicolaou test (PAP test)..

Cytological smear PAP is a test for early detection cellular changes on the cervix. The test is performed by cytologically analyzing a small number of cells taken from the cervix and placed on a glass slide for examination under a microscope. The method allows you to detect abnormal (atypical) cells that may indicate the development of the disease.

The cytological technique was developed in the 30s by the Greek pathologist Georg Papanikolaou. Currently, the cytological method for examining cervical smears is recognized classical method and is recommended by WHO to be carried out at least once every 3 years. Considering that the duration of rebirth human papillomavirus infection on average for about 10 years; the main purpose of screening is to diagnose precancer at an early stage.

According to WHO, mass cytological screening across national programs among women aged 25-64 years with an interval of 5 years can reduce mortality from cervical cancer by 84%.

Cytological examination has a sensitivity of approximately 60-80% and a specificity of 60-85%. The main reason for false negative results is human error. Incorrect collection of material for research and the accompanying inflammatory process significantly complicate the interpretation of smears by a cytologist, and sometimes make it completely impossible.

Rules for collecting material for cytological examination:

• Smears should be taken before bimanual examination and extended colposcopy.
• The instruments used must be sterile and dry (water and disinfectant solutions destroy cellular elements).
• Quality cytological smears decreases if less than 24 hours have passed after douching, inserting medications into the vagina and sexual intercourse.
• Material for cytological examination should be taken with special instruments that provide sampling from the vaginal part of the cervix, transition zone and lower third cervical canal.

Cytological examination of Pap smears reveals the following results:
Class 1 - no atypical cells, normal cytological picture.
Class 2 - changes in cellular elements are caused by an inflammatory process in the mucosa.
3rd class - there are single cells with changes in the ratio of the nucleus and cytoplasm, the diagnosis is not clear enough, repeat cytology is required or necessary histological examination biopsy tissue to study the condition of the cervix.
Class 4 - individual cells with signs of malignancy are detected, namely with enlarged nuclei and basophilic cytoplasm, uneven distribution of chromatin.
Class 5 - the smear contains numerous atypical cells.

In 2008, Harold zur Hausen became a laureate Nobel Prize in Physiology and Medicine for the discovery of the connection between the human papillomavirus and cervical cancer. Cytological criteria for human papillomavirus infection have been known for quite some time. These are koilocytes (cells with an extensive clearing zone around the nucleus) and dyskeratocytes (cells with an enlarged dark pyknotic nucleus from the superficial keratinizing layers of multilayered squamous epithelium).

The koilocyte is a specific cell for HPV infection, which is an oxyphilt-stained epithelial cell with clear boundaries and a clearly defined perinuclear clearing zone and numerous vacuoles in the cytoplasm.

More progressive method diagnostics is liquid thin layer cytology. According to research, the sensitivity of the traditional cytological method can range from 34.5 to 89%, the sensitivity of liquid cytology is 71-95%, which is more stable.

To prepare preparations using liquid cytology, a system is used that includes special brushes - cytobrushes, a nephelometer and a centrifuge. Cytobrushes allow you to simultaneously take material from the exo- and endocervix, preventing its loss and drying out. The cervical material is fixed in a stabilizing solution, which allows samples to be stored for 2 years. In a nephelometer, the material is classified by density and differentiated into groups. As a result of centrifugation, preparations are obtained in which the cells are arranged in one layer. Thus, one liquid sample can be used for combined diagnostics - cytology and PCR testing for HPV.

This article will help you understand what a PAP test is and why a woman should do it regularly.

What is a Pap test

PAP test (Papanicolaou test) is an analysis (screening) for precancerous and cancerous diseases of the cervix. It is carried out as follows: the doctor takes a sample of material from the cervical canal of the cervix, the junction of two epithelia and the surface of the cervix. These cells are then analyzed for pathological changes.

How often should you take a PAP test?

A Pap test should be done every two years, once a year or more often - depending on whether the woman is at risk or not. The risk group is women who smoke, women who have several sexual partners and those who have had more than 6 sexual partners in their entire life.

Screening (taking a PAP test) is prescribed from the moment of sexual activity. Up to 30 years of age, this is a mono test, and after 30 years of age, an additional test for highly oncogenic human papillomavirus (HPV) is also prescribed. Until the age of 30, such an analysis is not necessary, since the human papillomavirus at this age occurs in every third woman who is sexually active. And often it leaves the body on its own without causing oncogenic effects. But after 30 years, HPV testing is very important, since, together with risk factors, it is the No. 1 cause of cervical cancer. Vaccination of girls who are not sexually active (aged 11-14 years) is also effective against the human papillomavirus.

Taking a Pap test once is not enough. Only if a woman carries out such screening regularly can reliable conclusions be drawn about her health status. This is especially important if the Pap test shows the presence of pathology. In this case, it is easier for the doctor to prescribe the correct treatment regimen precisely if the results of previous screenings are available, since the dynamics of the disease are clearly visible. Therefore, such screening - the conclusion of a PAP test to detect precancerous and cancerous diseases of the cervix - is systematic and regular. Back in the 70s, in many European countries, the Pap test was introduced as a regular and mandatory analysis. The results of this decision led to the fact that the incidence of cervical cancer was reduced to 70%.

It is necessary to take such an analysis in the first phase menstrual cycle, before the onset of ovulation. It is also necessary to abstain from sexual activity 2 days before the test.

Several days after taking the test, symptoms may appear. bloody issues, a feeling of discomfort (which can also happen when taking a smear) and nagging pain lower abdomen.

If the result of the Pap test is negative, this means that no abnormalities in the structure of cells were detected, no epithelial formations = the woman is healthy. If the PAP test is positive, then each patient must be considered individually. Appointed additional examinations and the appropriate treatment regimen. This is because there are different categories of changes in cells: mild, moderate and severe, cancer. A positive Pap test indicates that there are deviations from the norm, but this is not always an indication for surgery and serious interventions.

Acute inflammatory processes or chronic diseases in gynecology. If they are detected, treatment is prescribed, and then a repeat PAP test.

What else is important to remember

Every woman should be examined by a gynecologist at least once a year. If she is healthy, and there is no history of cervical cancer in her family, then taking a PAP test is also enough to do once a year.

Human papillomavirus, which leads to cancer diseases cervix, sexually transmitted. Therefore, if a woman has bad tests and is regularly bothered by gynecological diseases, then the man should also be examined by an andrologist.

Pap test and pregnancy

During pregnancy, a PAP test can and should be taken to rule out precancerous and cancerous conditions. If more than a year has passed since the preliminary Pap test.

The danger is that the initial forms of cancer are asymptomatic, and it is almost impossible for a doctor to detect them visually. Therefore, a Pap test should be done regularly in order to promptly detect changes in the cells of the cervix and prescribe effective treatment.

Take care of your health regularly and be happy!

This is a test that evaluates the structure of the cells of the cervix. It received its name in honor of the Greek physician Papanikolaou, who first introduced it into medical practice in the 50s of our century. In Russia, this study is also called the Pap test or its other name is “cervical cytology” (from the word “cyto” - cell). A Pap test helps identify various changes in the structure of cervical cells that can lead to the development of cancer. Detection of these changes and their appropriate treatment prevents the development of cancer.

Thus, the main purpose of performing cytology is prevention (i.e. prevention) of cancer. For example, in the USA, where a Pap test is mandatory during preventive examinations by a gynecologist, the incidence and mortality from cervical cancer has decreased by 70% over the past 40 years.

Can a Pap test detect cervical cancer?

Yes. But the main role of the test is to detect changes in cells that usually precede the appearance of cancer. These changes are also called precancerous changes. Several years usually pass from the appearance of abnormalities in the structure of cells to the appearance of cancer. And if in this time interval a Pap test is regularly carried out, which will reveal these disorders, then with the help early treatment it is possible to prevent the development of cancer or to detect it very early early stages. To confirm and clarify the diagnosis of cancer detected by cervical cytology, other additional studies are carried out.

Does the Pap test help detect or prevent cancer in other organs?

No. This test allows you to evaluate the structure of only the cells of the cervix and no other organs. The neck is a narrow tube located in the lower section the uterus, which opens at its outer end into the vagina. On the outside, it is covered with thin pink epithelium, which appearance resembles the tissue in your mouth. This epithelium consists of 4 layers of cells of different structures and is called “stratified squamous epithelium”.

The inside of the neck is covered with epithelium, consisting of one row of cylindrical cells. Therefore, this epithelium is called “columnar epithelium”. He has bright red color. Cytology of the cervix examines the structure of cells located both outside and inside.

How is cervical cytology performed?

Pap test is performed during gynecological examination. The doctor will ask you to undress and lie down on the gynecological chair. In order to see the cervix, the doctor will insert a special instrument called a speculum into the vagina. After removing vaginal discharge, using a small brush and a wooden spatula, the doctor makes a scraping for examination from the outside and inner surface cervix. This is a completely painless procedure lasting 5-10 seconds.

The cells are applied to special glasses and sent to the laboratory, where they are examined under a microscope by a cytologist. The cytologist determines whether the sent material contains cells with a changed structure or not, and reports this to the gynecologist (usually in the form of a written report). Since the doctor scrapes them off when collecting cells, some women, after cytology, may have extremely slight, spotting bleeding from the genital tract over the next 1-2 days.

Do I need to prepare in any way for a Pap test?

Yes. To collect cytology, come in the first few days after the end of menstruation. 2 days before the PAP test, it is not recommended to use any medications for vaginal use, spermicidal contraceptives, vaginal lubricants, or moisturizers. All this can affect the true picture of the structure of cervical cells.

It is not recommended to conduct a study if there are symptoms such as itching and, which may indicate a possible infection. In this case, it is better to consult a doctor to find out the cause of these symptoms.

How often should cytology be performed?

The first Pap test should be performed immediately after sexual activity begins. Then once a year, during your annual preventive visits to the gynecologist, regardless of whether you are sexually active or not. If for 3 years in a row you have good results Pap test (i.e., you do not detect changes in the structure of the cells of the cervix), then a Pap test is performed once every 2-3 years until the age of 65. After age 65, the Pap test can be discontinued, provided all previous results have been good.

Of course, the frequency of Pap tests may vary. Your doctor may recommend performing this test more frequently if you have had a history of pathological changes cervical cells and/or have risk factors for cancer, such as:

• more than one sexual partner or a partner who has other sexual partners besides you
• early onset of sexual activity (before 18 years of age)
• past or current sexually transmitted diseases (), especially such as genital herpes and papillomas on the genitals
• HIV infection
• smoking

How accurate is the Pap test?

Like any test in medicine, the Pap test is not always 100% accurate. Those. Sometimes the cervical cytology report describes pathological changes, but in fact they are absent. This result is called a false positive. Or, on the contrary, the conclusion of the Pap test is good, while in reality there are disturbances in the structure of the cells. This result is called a false negative.

Most common cause False-positive cervical cytology results are the presence of inflammation in the vagina or cervix. In this situation, if the doctor sees an abnormal Pap test + signs of inflammation, it is usually recommended to carry out a course of anti-inflammatory treatment and repeat the Pap test after its completion.

The reasons for a false negative Pap test may be the following:

• too few cells were on the glass for examination
• presence of infection in the vagina and cervix
• blood in the test
• use of vaginal medications and lubricants 1-2 days before the test

Proper preparation and regular testing (as recommended by your gynecologist) helps reduce the frequency of unreliable Pap test results to a minimum.

A What if the Pap test shows abnormal cells?

In this case, the doctor recommends additional examination. This could be as simple as repeating the Pap test some time after the first result. Sometimes a special test is prescribed - colposcopy. is an examination in which the cervix is ​​examined by a gynecologist under high magnification (usually 7-15 times) using an instrument called a colposcope (similar to large sizes microscope). During such an examination, the doctor can see the area where the pathological changes detected in the Pap test are located.

In addition, during colposcopy, the doctor decides whether you need it to clarify the diagnosis. Depending on the result of the Pap test and colposcopy (with or without a biopsy), your doctor may recommend either simple observation with periodic repetition of cervical cytology, or removal of the detected pathological cells.

In order to prevent and timely detect cervical cancer, screening should be carried out regularly. Previously, it was recommended to carry out such preventive measures at least once a year, but modern achievements allow for an increase in this period. The components of screening are a variety of tests, among which the most popular is the Pap test.

The modern cervical cancer screening program in Russia - every woman should know this!

Innovations in the aspect of testing to identify the disease in question were published in the journal Obstetrics & Gynecology in November last year. The author of the article is the American College of Obstetricians and Gynecologists, which described algorithm, principles of cervical cancer screening.

The age of a female representative directly affects the indications for screening:

1. Survived transplant surgery internal organs, had other manipulations that negatively affected the immune capabilities of the body.
2. In the prenatal period, they received a certain dose of diethylstilbestrol, a synthetic substitute female hormone, which was popular in the 70s.
3. Are HIV-infected.
4. In the anamnesis there is information about the treatment of moderate, severe forms of dysplasia, cancer.

• From 30 to 65 years of age, it is recommended to undergo a Pap test + HPV test every five years. If there is no possibility of testing to detect the human papillomavirus, you can get by with just a PAP test, which is not welcome among doctors. This examination must be carried out every three years.
• After the age of 65, female representatives do not need to undergo screening. If before reaching this age there was dysplasia (moderate, severe) or adenocarcinoma, the need for screening will be relevant for 20 years.
• After surgical treatment, during which everything reproductive organs have been eliminated, there is no need to screen the cervix.

Vaccination against the papilloma virus does not affect the frequency of screening.

The human papillomavirus is widely known among women due to its frequent diagnosis in one or another patient, but often it does not cause cancer.

Danger arises in situations where HPV acquired chronic form . If available in female body cells that can degenerate into cancer, it takes years to establish invasive cancer.

Double testing every five years is beneficial balancing between the timely elimination of low-frequency manifestations of cancer and relatively dangerous medical procedures(for example, taking a substance for study). The innovations state that screening, as a surgical procedure, is needed in the presence of highly oncogenic groups of human papillomavirus.

Although there is no longer a need for an annual Pap test, Visits to the gynecologist should not be ignored . In addition to the disease in question, there are many other diseases that need to be eliminated in a timely manner.

Pap test as a test for cervical cancer - results, interpretation of the Pap test

The relevance of regular preventive measures in terms of the disease in question lies in the high chances of its elimination if detected on early stages. Cervical cancer - frequent illness among representatives of the female part of the population aged 16 to 53 years. Thanks to regular developments that improve the screening system, timely detection of this disease is not a problem.

The disease in question arises against the background of epithelial transformations, which are of a pre-tumor nature. Such changes in the matter of the cervix are called dysplasias (CIN). Often the disease develops in the area where flat and glandular matter meet. The first covers the external component of the cervix, the second covers the cervical opening.

If measures are not taken to eliminate dysplasia, the latter will go from mild to moderate, from moderate to severe. This phenomenon requires monitoring by a gynecological oncologist. Through a screening program, it is possible to detect and eliminate these changes before cancer begins.

The effectiveness of screening is directly proportional to its regularity. One of the most productive components of this procedure is the PAP test. The latter involves preliminary taking from the patient sample of cellular substance on the surface of the cervix, which is carried out during a gynecological examination.

For this procedure, the doctor uses a vaginal speculum, a glass slide, medical brushes, and a spatula. Using a medical brush, the extracted material is placed on the glass, after which it is delivered to the laboratory.

Thanks to the staining of cells with various dyes, it is possible to trace the transformations that have occurred in the nuclei and cytoplasms of microcells. Initially, the laboratory studies the nature of the changes: malignant, infectious, progressive. Then the analysis of those phenomena that exist is carried out.

The test results have several variations:

1. negative– cells have standard parameters, precancerous condition has no place to be;
2. positive– there are errors in the parameter aspect of the tested cells. In this case, you should not panic: the indicated result does not guarantee the presence of cancer. There may be several options regarding an abnormal result. There is an algorithm of actions for one or another result:

• ASCUS. This concept denotes microcells that are non-standard for cervical matter. They often occur against the background of inflammation in the specified part of the body. They can be eliminated by eliminating the inflammatory process. Patients with this result should have a new Pap test after six months. An alternative option is an HPV test or colposcopy;
• ASC-H. One of the options for atypical transformations of cervical cells, which are characterized by a flat shape. To confirm/exclude large-scale damage to microparticles of the cervix, colposcopy + biopsy is required;
• LSIL. Here there are minor errors in the structure of the cervical epithelium. Such defects arise against the background of the spread of HPV, which provokes mild dysplasia. In this case, females should repeat the PAP test (after 5-6 months), or undergo colpospopia + biopsy;
• HSIL. This result means that moderate/severe dysplasia, carcinoma, is present. IN in rare cases Regression of these atypical phenomena may occur, but often such changes favor the formation of cancer. To study the nature of the lesions in more detail, colposcopy with biopsy is needed.

After the biopsy, depending on the results obtained, the doctor determines the further course of action:

1. The biopsy confirms the norm. This means that there are no errors in the structure of the cervix, the patient is prescribed replay PAP test in a year.
2. CIN I. There are errors, but they are insignificant and often self-destruct without medical care. Female representatives are offered to repeat the PAP test in six months/perform colposcopy + biopsy.
3. CIN II/CIN III. The errors are pronounced and require treatment to eliminate them. Medical manipulations in relation to such a deviation are aimed at removing atypical cells in order to prevent them from turning into cancer.

This study received its name from the Greek scientist Georgios Papanikolaou, a pioneer of cytology and early diagnosis cancer. The Pap test helps to identify those cellular changes in the cervical epithelium, which can subsequently lead to cancer, and begin treatment in a timely manner. Today this analysis is used all over the world, and it has already saved the lives of hundreds of thousands of women.

How is a PAP test performed?

The procedure for collecting cell material is painless. It is carried out during an examination in a gynecological chair. First, using a cotton swab, the doctor cleans the surface of the cervix from secretions, then using a special brush, the material for research is taken, which is applied to a glass slide. This piece of glass will go to the laboratory, where it will be studied under a microscope.

How often should a cytological smear be taken for analysis?

The Association for Cervical Pathology and Colposcopy gives the following recommendations in this regard.

All women should begin undergoing cytological examination 3 years after the start of sexual activity, but no later than 21 years.

Women from 21 to 49 years old need to undergo a cytological examination every 3 years, and from 50 to 65 years old - every 5 years. However, there is a category of women with weakened immune systems (HIV-infected, after an organ transplant, after chemotherapy or chronic use of steroids) who should undergo this test annually. Gynecologists also advise women over 30 years of age to normal indicators cytological smears at every three-year examination, do a DNA test for the human papillomavirus.

Women 65 years of age and older who have had three cytology tests negative in the past 10 years may no longer have cytology screening for cervical cancer. However, this does not apply to those who have previously been treated for cervical cancer, carriers of HIV infection or women with weakened immune systems. They need to keep testing.

A special group consists of women who have undergone surgery to remove reproductive organs. After a complete hysterectomy (removal of the uterus along with the cervix), cytological screening is no longer necessary, unless this operation was performed as part of the treatment of cancer or pre-cancer of the cervix. If the amputation affected only the uterus, without removing the cervix (supravaginal amputation), then cytological screening must be continued, adhering to general principles prevention of cervical cancer.

How to prepare for research?

First of all, a cytological smear is not taken during menstruation and when inflammatory processes infectious nature.

In order not to blur the pictures, two days before the study it is not recommended to douche, insert tampons, suppositories or creams into the vagina.

You should also abstain from sexual intercourse two days before visiting a gynecologist.

What the results say

Typically, your doctor will receive your Pap test results within 1–2 weeks. And if atypical cells are found in them, this does not mean a death sentence. An identified deviation from the norm is only a call to be wary and undergo additional examinations. In this case, colposcopy is first prescribed. This is a procedure for examining the vulva, vagina and cervix using a special device - a colposcope, which helps to identify the presence of lesions of the cervical epithelium and determine their nature. And based on this study, the doctor decides whether a cervical biopsy is needed.