home Audience 12 Papanicolaou stained smears interpretation. Cytological examination of scrapings of the cervix and cervical canal (Papanicolaou staining, Pap test)

Papanicolaou stained smears interpretation. Cytological examination of scrapings of the cervix and cervical canal (Papanicolaou staining, Pap test)

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 Cancer can be prevented from developing or detected at very 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 cervix is a narrow tube located in the lower part of the uterus, which at its outer end opens 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 minor, spotting bloody issues 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 reveals pathological 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.

Pap test– analysis to detect precancerous and cancerous diseases of the cervix. This study has many synonyms - Pap test, Pap smear, cytological smear. The Papanicolaou test was named after the author, physician and founder of medical cytology, Georgios Papanicolaou.

A Pap test is performed during a gynecological examination for all women over 21 years of age. Using a spatula and endo-brush, the doctor takes samples of cells from the surface of the cervix and cervical canal. The resulting material is applied to a glass slide, fixed with alcohol and sent to the laboratory. Laboratory assistants stain the smear using the method developed by Papanicolaou, study the structure of cells, turning Special attention on typicality, size, degree of maturation, size and structure of nuclei, their relationship with the cytoplasm.

Significance of the study. The Papanicolaou test can detect dysplasia and cervical cancer on initial stages as long as the disease is treatable. Thanks to the mass implementation of dad tests over the past 40 years, it has been possible to reduce the incidence of cervical cancer by 60-70%, and the mortality rate from this type of cancer has decreased by 4 times.

Cervix

Cervix – lower section uterus, which opens at one end into the uterine cavity and the other into the vagina. It is a tube 3-4 cm long, consisting of smooth muscles and fibers connective tissue.
In the cervix they secrete two parts:

exocervix or vaginal part - the lower segment of the cervix, which is in contact with the vagina;
endocervix or cervical canal, which is also called cervical canal- This is a through hole that passes inside the organ.

The cervical canal has two outputs:

internal os opens into the uterine cavity;
external os opens into the vagina.

Cervical mucosa lines the exocervix and the cervical canal. It has two main components:

Epithelium– cells located on the surface of the mucosa;
basement membrane- a thin plate of connective tissue that forms the basis of the mucous membrane.

On different areas the mucous membrane of the cervix is lined two types of epithelium.

Basal– 1 layer of small undifferentiated(immature) cells lying on the basement membrane;
Parabasal– 2-3 rows of cells in which the first signs of maturation appear;
Intermediate– 6-12 rows of moderately differentiated cells;
Superficial– 3-18 rads of cells lying on the surface. They are not prone to keratinization and are constantly sloughed off, replaced by new ones rising from the basal layer.

Indications for a pap test

A smear for cytology must be taken for all women over 21 years of age, regardless of the intensity of sexual activity and the number of partners.

First stroke at the age of 21 or 3 years after the onset of sexual activity.
1 time per year during a routine gynecological examination for all women aged 21 to 64 years.
Once every 2-3 years are taken by women under 65 years of age whose smear test shows no changes in the structure of the epithelial cells of the cervix 3 times in a row. After age 65, the test may be performed less frequently.
Once every 6 months– women of the following categories:

women with menstrual irregularities;
patients with cancer in the family;
women with erosion, dysplasia or other diseases of the cervix;
signs of infection with the human papilloma virus were detected;
to monitor cervical treatment.

Methodology for conducting a pap test

When is the best time to do a PAP test?

To obtain the material, the epithelium is scraped from the surface of the vaginal part of the cervix and from the cervical canal. The best time The period between the 10th and 20th day is considered menstrual cycle. It is not advisable to take the material later than 5 days before the expected menstruation and during menstrual bleeding. During this period, in the mucosa there are physiological changes, which can be mistakenly taken for signs of disease.

To take material, the gynecologist uses disposable instruments:

Eira spatula - for taking a smear from the vaginal part. Its narrow end is inserted into the external pharynx, and the short and wide end is scraped from the vaginal part;
curettes - Volkmann spoons - for taking scrapings from areas that cause suspicion;
endobranche brush - for scraping the epithelium inside the cervical canal.

How is a Pap test performed?

Material for the papal test is taken before extended colposcopy and bimanual examination - palpation (palpation) of the uterus and its appendages. This avoids contamination of the material with talc.

The woman is placed in an examination chair. The doctor examines the cervix using gynecological speculum.
Cleansing the cervix of mucus. carried out if a large amount of secretion prevents scraping.
Material samples are taken from several areas:

In the area of the external pharynx, where precancerous and cancerous cells most often appear;
On visible foci of pathological changes, if any;
From the inner surface of the cervical canal. This procedure is carried out after removing the mucus plug.

The resulting material from each area is applied in an even layer onto separate glass slides, touching all surfaces of the brush. Smears are fixed with fixative solutions containing alcohol. This is necessary to avoid them drying out and deforming.
The glasses are marked (signed), a direction containing brief information about the patient.
In the laboratory, samples are stained to better examine the structural features of the cells. Microscopy of samples is carried out. This evaluates:

cell type;
size;
presence of inclusions in cells;
their degree of maturity;
quantity and structural features cell nuclei;
state of the cytoplasm;
ratio of cytoplasm to nucleus.

The result of the PAP test is usually sent to your doctor within 1-2 weeks. In private laboratories, the waiting time for a Pap test result is 1-3 days.

Pap test based on liquid cytology used in modern laboratories, is considered more informative. The technique allows you to obtain a high-quality cytological preparation and eliminates cell destruction during drying and fixation on a glass slide. If necessary, you can prepare several more drugs if the first one turns out to be unsatisfactory, and conduct additional studies to determine the human papillomavirus or identify markers of proliferation (pathological cell division).

Methodology for conducting a pap test based on liquid cytology:

Use the brush to make 5 rotational movements clockwise in the area of the external pharynx. In this way, it is possible to scrape the entire transformation zone. Another brush is used to collect material from the walls of the cervical canal.
The brush tips are removed and placed in separate bottles with preservative liquid.
The tube is shaken, causing the cells to become liquid.
In the laboratory, the liquid is centrifuged. Preparations are prepared from the resulting cell sediment, stained and examined under a microscope.

How to prepare for the dad test?

The Pap test requires some preparation. 1-2 days before visiting the gynecologist must refrain from:

sexual intercourse;
douching;
vaginal medications– creams, suppositories, spermicidal gels;
washing inside the vagina and vaginal shower;
hot bath.

After these actions, pathological cells may be erased or washed away from the surface of the cervix, which will make the test result unreliable.
Pap test is not performed:

during menstruation;
during inflammatory diseases of the cervix.

What are the possible results of a pap test?

Several systems are used to evaluate the result of the Pap test:

System developed by Papanicolaou in 1954, which classifies changes into 5 classes:

Class I – normal cytological picture, unchanged cells;
Class II - minor cell changes associated with the inflammatory process in the vagina and cervix;
III class- suspicion of malignancy, single cells with an anomaly in the structure of the nucleus and cytoplasm;
Class IV – single cells with obvious malignant changes;
V class – malignant tumor, a large number of cancer cells.

System proposed by the US National Cancer Institute in 1988. It was revised in 2001 and is now widely used in all countries.

NILM– absence of signs of malignancy and epithelial damage;
ASCUS– atypical squamous epithelial cells of undetermined nature. They may indicate inflammation, but neoplasia (a precancerous condition that can transform into a malignant tumor) cannot be ruled out;
ASC-H– atypical squamous epithelial cells. Damage to the squamous epithelium cannot be excluded high degree severity – NSIL;
LSIL– damage to the squamous epithelium of low severity. Indicate mild dysplasia or infection with human papillomavirus;
HSIL– damage to the squamous epithelium of high severity. May indicate moderate or high-grade dysplasia, rarely carcinoma in situ;
A.G.C.– atypical glandular cells, atypical cells glandular epithelium cervical canal;
AGUS– abnormal glandular cells of undetermined significance;
Carcinomain situ– the beginning of the formation of a cancerous tumor, the cells do not go beyond the basement membrane;
High-Grade SIL squamous cell carcinoma- a large number of malignant cells, which indicates cancer based on squamous epithelium;
Adenocarcinoma– cancer based on columnar epithelium.

Pap test result options

I. Normal result. If the conclusion contains the following terms: NILM(negative for intraepithelial lesion or malignancy), negative result, class I – this means that the woman is healthy and no changed cells have been detected. There are no serious disorders in the cervix: inflammation, dysplasia, cervical cancer. Signs indicating candidiasis and bacterial vaginosis are acceptable.
The material may contain:

unchanged squamous epithelial cells;
columnar and metaplastic epithelial cells;
leukocytes in small quantities;
bacteria in small quantities.

II. Pathological result, positive or unsatisfactory, class II-V. The conclusion must indicate exactly what changes were found in the material.
1. ASC-US – atypical squamous epithelial cells of undetermined significance. Their appearance may be caused by:

dysplasia;
infection with human papillomavirus (HPV);
chlamydia and other sexually transmitted infections;
atrophy of the mucosa during menopause.

Recommended:

undergo testing to detect papillomavirus (HPV test);
Take the Pap test again in 1 year.

2.LSIL – low-grade squamous intraepithelial lesions. A moderate number of atypical cells on the surface of the cervix. This means that some squamous epithelial cells of the cervix have atypical features. The risk of developing cervical cancer is low.
Causes:

dysplasia;
papillomavirus infection.

Recommended:

carry out an HPV test,
colposcopy, if HPV is detected,
carry out PAP in a year.

3.ASC-H– . The epithelial cells on the surface of the cervix are abnormal. To exclude malignant process more research is needed. In 1% of women with ASC-H are detected early forms cancers that respond well to treatment.
Causes:

precancerous changes – grade 2-3 dysplasia;
rarely, initial form of cancer.

Recommended:

mandatory extended colposcopy.

4.HSIL –. A large number of atypical cells indicating the 2nd and 3rd degree of dysplasia. In 2% of women with HSIL detects cancer. Without treatment, in 7% of women, dysplasia transforms into cancer within 5 years.
Causes:

high-grade dysplasia;
rarely, cervical cancer.

Recommended:

if the examination reveals first-degree dysplasia, then a pap test and colposcopy are performed every 6 months for 2 years;
women over 25 years of age should immediately undergo diagnostic excision - removal of a section of the mucous membrane of the cervix.

5.AGC– . Changed atypical cells from the cervical canal or from the endometrium - inner shell uterus.
Causes:

dysplasia 1-3 degrees;
cervical cancer;
endometrial cancer.

Recommended:

colposcopy;
collecting material by scraping the mucous membrane of the cervical canal;
HPV test;
women over 35 years of age with irregular bleeding - collection of material by curettage of the endometrium.

6. AIS(adenocarcinoma in situ) or squamous cell carcinoma. The analysis reveals cells typical of cervical cancer.
Causes:

high-grade dysplasia;
cervical cancer

Recommended:

colposcopy;
diagnostic curettage cervical canal;
endometrial scraping for diagnostic study;
diagnostic excision – removal of a section of mucous membrane.

7. Benign glandular changes. The material contains normal, unchanged cells of the glandular epithelium - endometrial cells, endometrial stromal cells, histiocytes (wandering connective tissue cells).
Causes:

endometrial hyperplasia – precancerous changes in the endometrium;
endometrial cancer;
in the absence of symptoms ( irregular menstruation, bloody vaginal discharge not related to menstrual bleeding) in women who have not reached menopause, Benign glandular changes are considered a normal variant.

Recommended:

diagnostic endometrial curettage for women who have reached menopause or have symptoms of endometrial hyperplasia;
There is no need for further testing in women who have not reached menopause and have no symptoms.

Inadequate drug. This phrase in the conclusion suggests that the material was taken incorrectly. There are not enough epithelial cells in the scraping, there is no columnar epithelium from the cervical canal, the smear is contaminated with blood or is dry. In this case, the woman needs to take the Pap test again in 2-4 months.
What to do if you get a “bad” Pap test result?
Depending on the woman’s age and the nature of the changes, the doctor can choose one of the options.

Repeat Pap test after 3 months. If it turns out to be negative (without pathological changes), then repeat Pap tests after 6 months, 1 year, 2 years. If the result is positive, perform a colposcopy.
Perform a colposcopy. If extended colposcopy does not reveal any changes, then repeat the Pap test after 6 or 12 months. If colposcopy reveals foci of changes, then a biopsy is performed. If the result of colposcopy is questionable, anti-inflammatory or estrogen is administered. hormonal treatment, and after that a repeat colposcopy.
Take a test to detect human papillomavirus (HPV). If oncogenic types of the virus are detected, colposcopy is performed. If there are none, repeat Pap test after 6 months.

Incorrect Pap test result

The sensitivity of the pap test ranges from 70-95%. The cause of errors may be improper collection and recording of the material, insufficient qualifications of the laboratory assistant, or processes occurring in the uterus.

False positive result Pap test– the analysis indicates that there is dysplasia, although the woman is healthy. The cause may be previous inflammatory and infectious diseases genital organs, erosion in the healing (regeneration) stage, hormonal disorders. These processes produce cells that may have unusual shapes. To exclude errors, a colposcopy or a repeat Pap test is performed.
False negative Pap test result– there is a disease, but the test results are within the normal range. This is possible if the doctor did the scraping incorrectly and the smear did not include epithelial cells from the foci of the disease, or if atypical cells were not found in the laboratory. This option is possible, but there is no need to be afraid. If visible changes appear on the cervix, the doctor will prescribe a colposcopy and biopsy. Even if foci of dysplasia go unnoticed, it will take 2-20 years until they turn into a malignant tumor, and the pathology will be detected during the next PAP test.

What diseases can be detected by this study?
Pap test is a diagnostic procedure designed to detect precancerous and cancerous diseases of the cervix. The examination may also reveal signs of inflammation, infection, or atrophy of the cervix.

Infections.Bacterial and viral infections are indicated by:

squamous epithelial cells of undetermined significance ASC-US;
presence of bacteria in the material;
changes in cell structure caused by the presence of a virus.

Identified changes do not allow an accurate diagnosis to be made, but only indicate possible diseases.

Inflammatory atypia is the appearance of cells with minor abnormalities ( thin shells, enlarged nuclei), which is caused by inflammation;
Squamous metaplasia - replacement of columnar epithelium with multilayered squamous epithelium;
Hyperkeratosis – keratinization of stratified squamous epithelium;
Parakeratosis - increased keratinization or complete absence keratinization process;
Reserve cell hyperplasia is an increase in the volume of reserve cells.

Human papillomavirus infection. The appearance of most atypical cells is associated with the human papillomavirus. Its presence in the body is indicated by:

Atypical squamous epithelial cells of undetermined significance ASC-US;
Low-grade squamous intraepithelial lesions LSIL – disorders in squamous epithelial cells;
Atypical squamous epithelial cells do not rule out HSIL - ASC-H;

Neoplasia or dysplasia of the cervix denoted by the abbreviation CIN (cervical intraepithelial neoplasia) - these are pathological changes in the cervical mucosa that occur when infected with the human papillomavirus. The virus damages the genetic material in the cell nuclei, which causes the appearance of atypical cells and increases the risk of developing malignant cells. Mild dysplasia can regress (heal) on its own, but about 20% eventually progress to a more severe stage.

Carcinoma in situ(in situ) – cervical cancer on early stage development. Cancer tumor is a collection of epithelial cells. It does not penetrate the basement membrane and underlying tissues and does not form metastases. It responds well to treatment. They talk about the development of the oncological process:

High grade squamous intraepithelial lesions HSIL;
Cells characteristic of cervical cancer - carcinoma in situ .

Adenocarcinoma – cervical cancer, which originates from the columnar epithelium - cells of the cervical canal. Adenocarcinoma is indicated by:

Atypical glandular cells AGC;
Adenocarcinoma cells in situ AIS.

Squamous cell carcinoma – a type of cervical cancer that is formed on the basis of squamous epithelial cells. The analysis reveals:

Carcinoma in situ – AIS;
Atypical squamous epithelial cells do not rule out HSIL - ASC-H;
High grade squamous intraepithelial lesions – HSIL;
Atypical glandular cells – A.G.C.

Cervical cancer or endometrial cancer– a malignant tumor of the inner lining of the uterus. Oncology is indicated by:

Atypical glandular cells AGC;
Atypical squamous epithelial cells do not rule out HSIL - ASC-H;
High grade squamous intraepithelial lesions – HSIL;
Cells characteristic of cervical cancer - AIS.

Benign glandular changes– endometriosis. They say about this disease:

Benign endometrial cells;
Endometrial stromal cells;
Histiocytes are connective tissue cells.

The Pap test does not provide an accurate diagnosis. It is used to identify a group of women with signs of dysplasia and cancer who need additional examination and treatment.

What to do after a dad test

During the procedure for collecting material for a Pap test, the doctor scrapes off the top layer of the mucous membrane, after which a small abrasion is formed on the cervix. Scanty bloody or dark brown discharge is possible for 3-5 days. This condition does not require treatment or the use of any medications.

To prevent infection of lesions on the cervix, it is recommended to refrain from:

sexual contacts;
douching and vaginal douche;
using tampons.

general information

The Pap test can quite effectively detect precancerous changes in the epithelium - cervical intraepithelial neoplasia varying degrees gravity.

This type of examination is mandatory for women over 30 years of age, especially those who have previously or are currently diagnosed with high-oncogenic risk human papillomavirus, 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. Methodology for preparing a specimen for Papanicolaou cytology.

The biomaterial is taken using a special cervical brush. Immediately after taking the biomaterial, an imprint smear is prepared by touching all surfaces of the cytobrush to the surface of the slide. The probe is disposed of. The prepared smear is dried in air. The glass with the dried smear is placed in a cuvette and fixed with 96% rectified ethyl alcohol for 5 minutes.

Place the finished drug in individual packaging (plastic or paper bag), attach it to the direction with a stapler and send it to the laboratory. It is allowed to store glasses with fixed or dried smears in sealed packaging at a temperature of 2-8 oC for 10 days.

According to international standards, the first Pap test is performed 3 years after becoming sexually active or at age 21 (whichever comes first). Then - once a year. If for 3 years in a row the results of the Pap test do not reveal changes in the structure of the cells of the cervix, the 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 negative.

Preparing for the study

To obtain the most accurate result, a number of conditions must be met before performing a Pap test. It is not recommended to conduct an examination during menstruation, in the presence of any inflammatory process. Recommend that patients, 48 hours before taking a PAP smear, refrain from sexual intercourse, the use of tampons, the use of any vaginal creams, suppositories and medications, douching and vaginal douches. It is also advisable to take a shower instead of a bath 2 days before the Pap test. A smear should be taken before a gynecological examination, colposcopy or no earlier than 48 hours after these manipulations.

Interpretation of results

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.

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 grade - separate cells with clear signs malignancy; Class 5 - a large number of typical cancer cells. The diagnosis of a malignant neoplasm is beyond doubt.

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In modern gynecological practice A Pap test is performed quite often. This is a relatively simple diagnostic procedure, during which specialists can determine the presence of malignant cells in the tissues of the cervix. Of course, patients who have been prescribed a test are looking for any Additional information. What is a PAP study? How to properly prepare for the procedure? How are samples collected? How to decipher the results?

What is a PAP study?

Many women are interested in questions about what such a study is. But first, it’s worth understanding the basic anatomical data.

So, the cervix is a narrow tube, which at its outer end opens into the vagina, thereby communicating with the uterine cavity. The outside of the cervix is covered with stratified squamous epithelium (consists of four layers various cells), and from the inside - columnar epithelium, which is one row of cylindrical cells.

The PAP test in gynecology is used to study the structure of cells that are located both inside and outside the cervix. In fact, this procedure represents a scraping with further cytological examination of the obtained samples.

By the way, this procedure is often called a Papanicolaou smear in honor of the Greek doctor who first began conducting such studies in the 50s of the 20th century. There is another name for the test - “cervical cytology”.

Why do you need a PAP test? Main indications

This study is carried out if cervical cancer is suspected. Moreover, the procedure is also preventive in nature. During the study, it is possible to detect altered cells that are precursors oncological diseases. This technique makes it possible to diagnose precancerous conditions, and this, in turn, makes it possible to prevent the development of dangerous oncological diseases.

In addition, during a Pap test it is sometimes possible to diagnose other pathologies of the cervix, in particular hyperplasia and proliferation of the epithelium.

In the United States and many European countries, this procedure is included in the standard gynecological examination. According to statistics, over the past 50 years, the frequency and number of deaths from cervical cancer in these countries has decreased by 70% thanks to early diagnosis.

How to prepare for research

A PAP smear is a fairly simple procedure, which, however, requires appropriate preparation.

Cytological sampling is carried out in the first few days after the end of menstruation - this is the only way to count on reliable results.
Two days before the procedure, doctors recommend stopping the use of intravaginal medications. The use of vaginal lubricants and spermicidal contraceptives is contraindicated. All these means can distort information about true structure cells of the uterine cervix.
Also, scraping should not be performed if the patient has signs of an inflammatory/infectious disease of the genital organs, for example, itching, uncharacteristic vaginal discharge. In such cases, you first need to determine the cause of the symptoms and undergo a full course of treatment. Only after complete recovery can the procedure be performed.

Sample collection rules

You already know what a Pap test is and how to prepare for it. But for many patients, the features of the procedure itself are also important.

In fact, the test technique is quite simple. During the procedure, the doctor uses a spatula to scrape cells from the surface of the cervix. These samples are marked on the slide with the letter “Ш” (material from the cervix). Next, the same procedure is performed to obtain cells from the cervical canal. For this purpose, a special brush is used, and the letter “C” is used to designate samples.

Glass slides with tissue samples should be fixed as soon as possible using 96% alcohol or Nikiforov’s mixture (consists of 96% alcohol and ether). The resulting preparations are kept in the fixative from 10-15 minutes to 24 hours.

If it is not possible to fix the samples, they are dried in air. The resulting materials are subsequently stained and examined under a microscope. The preparations are suitable for painting within 3-7 days from the moment of collection.

Decoding the results

The interpretation of the Pap test largely depends on age and general condition patients, so this should be done by the attending physician. Depending on the data obtained, five types are distinguished, each of which corresponds to a particular state of the reproductive system.

TypeI. The results correspond to the norm; no pathological features were found in the studied material.
TypeII. An inflammatory process takes place. Possible hyperplasia and proliferation of glandular epithelium.
TypeIII. Suspicion of cervical dysplasia.
TypeIV. Suspicion of cancer.
TypeV. There is a high chance of having cervical cancer.

Of course, such results only provide information about possible availability one or another pathology. For the ruling accurate diagnosis more research is needed.

Main causes of false results

Many patients are interested in information not only about what a Pap test is - they ask questions about the reliability of the results. Like most diagnostic procedures, this study It is not always one hundred percent accurate.

Sometimes the test gives false-negative (pathological cells are present, but were not identified during the study) or false-positive results (oncological markers were identified during diagnosis, although in fact the processes malignant degeneration there are no women in the reproductive system). The reasons for receiving false data may vary.

Sometimes, during sample collection, too few cells fall onto the laboratory glass. There is simply not enough material to conduct a full-fledged study.
Results may be affected by infectious as well as inflammatory diseases vagina and cervix.
If samples are contaminated with blood, this may interfere with the results obtained during laboratory research results.
The test may be unreliable due to the use of vaginal medications and lubricants. Sexual intercourse is also unacceptable 1-2 days before the procedure.

Every woman should have a Pap smear from time to time. Cell samples should be taken for the first time three years after the start of sexual activity (or when the patient reaches 21 years of age).

Women reproductive age(from 21 to 49 years old) gynecologists recommend undergoing a PAP test every 2-3 years. Older patients (50-65 years old) should be tested every five years.

promiscuity, women having more than one sexual partner;
early onset of sexual relations (before 18 years of age);
the patient's medical history contains information about sexually transmitted infections (including genital herpes and human papillomavirus);
HIV infection;
smoking and other bad habits.

What to do if a woman has malignant cells?

As already mentioned, PAP tests in gynecology are used primarily to detect pathological cells. If a positive result was obtained during diagnosis, the patient is prescribed additional studies.

First, the Pap test is repeated to eliminate the possibility of a false positive result. Subsequently, colposcopy is performed (examination of the cervix using special device) and cervical biopsy.

This diagnostic procedure is intended for the timely detection of a malignant process. If cancer was detected at an early stage, then the patient has a chance of recovery.

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.

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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

Pap test is used to detect cervical cancer or precancerous conditions. 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.

Factors increased risk The development of 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 a hysterectomy was performed for reasons other than cancer diseases, for example, due to fibroids, the doctor may cancel the mandatory 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's smear tests after age 65 if her previous cervical cancer screenings have been negative. negative results, that is, they did 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 active sex life, and does this with several partners, the doctor may recommend continuing to take 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. Average and heavy bleeding after a Pap test are not normal.

That is, Pap test - safe way screening 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 staff 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, the next time it will happen with a larger share probabilities.

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 expands the vagina to obtain Free access to the cervix

The Pap test is usually performed in a doctor's office and takes only 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.