What can distort the result of the papa test. What is a cytological examination PAP test (Pap test). Indications for repeat smear

Pap smear(PAP test, cervical smear, PAP Smear) is an important screening test for the early diagnosis of cervical cancer. Sometimes it is called “cervical smear for cytology, smear for oncocytology.” This accessible, simple and painless method helps to identify precancerous conditions or the development of a cancerous tumor in the cervix, and begin treatment for early stage and prevent progression of the disease. PAP smears have significantly reduced the incidence and mortality of cervical cancer, especially in developed countries.

Increased risk factors for developing cervical cancer: big number sexual partners, early onset of sexual activity (before 18 years of age), a history of genital warts, bad habits(smoking).

It is recommended to undergo regular preventive examination, at least once a year, for all women who are sexually active, especially if she is diagnosed with a high oncogenic risk human papillomavirus or changes in the mucous membrane are detected during colcoscopy. Next, based on the results of the cervical smear, the doctor will determine how often you will need to repeat this test.

The gynecologist takes a scraping of the cells lining the cervical canal and applies it to a glass slide. Usually 2 preparations are prepared: from the endocervix (the mucous membrane covering the vaginal part of the cervix) and the exocervix (the mucous membrane lining the cervical canal). A special Papanicolaou stain is used to identify atypical cells. The smears are then examined under a microscope to identify possible changes: inflammation, abnormal or cancerous cells.

Preparing for a Pap test. 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 an inflammatory process. 48 hours before taking a PAP smear, you must refrain from sexual intercourse, the use of tampons, the use of any vaginal creams, suppositories and medications, douching and vaginal douches. The smear should be taken before gynecological examination, colposcopy or no earlier than 48 hours after these manipulations. It is also advisable to take a shower instead of a bath 2 days before the Pap test.

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).

Norm. Normally, there are no atypical cells; all cells are of the same shape and size (negative Pap smear).

Cytological smear interpretation, Pap test results. The presence of cells of different shapes and sizes, their pathological position is characterized as a positive Papanicolaou smear. These tests show the presence of atypical cells, which often sounds scary to women who do not 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 necessary treatment And repeat the smear after 3-6 months. With human papillomavirus infection, koilocytosis of cells is often detected. Koilocytes are squamous epithelial cells 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. Around the nucleus there is a clearing zone of the cytoplasm.

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. Diagnosis malignant neoplasm no doubt.

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).

If the cytologist's conclusion indicates mild, moderate, or severe dysplasia (N-PIP and V-PIP), in these cases colposcopy is performed, as well as separate diagnostic curettage of the mucous membrane of the cervical canal and the body of the uterus with histological examination of scrapings.

How much does it cost to have a Pap smear test?
Review of prices for Pap tests in leading laboratories in Moscow(as of August 2014)
— 825 rubles + 250 rubles for taking a smear;
— 1,100 rubles + Taking a smear/scraping: 390 rubles
— 1730 rub.
1545 rub. + 380 rub. for taking the material.
— 1020 rub. + 300 rub. for taking a smear
— 1030 rub. + taking a smear 390 rub.

S.I. Rogovskaya, V.N. Prilepskaya. Prevention of human papillomavirus infection and cervical cancer (Gynecology. Volume 9/N 1/2007::: Topic: PATHOLOGY OF THE CERVIX AND GENITAL INFECTIONS)

A Pap test is a cytology smear that is taken every time a woman is examined by a gynecologist. This analysis has many different names:

• cervical smear;
• cytological smear;
• Pap test.

This is a very simple analysis, which is quite informative. It is taken to identify gynecological diseases.

A cytological smear is taken to identify cellular abnormalities of the cervix, which can later lead to the appearance of cancer cells. At every examination of a woman, such a smear is mandatory, because identifying violations makes it possible to begin the necessary treatment in a timely manner. In addition, a smear allows you to examine the vaginal mucosa for the presence of microbes.

The results of a smear cannot always make a definitive diagnosis; in most cases, additional examinations are required.

The Pap test is taken from more than one sample. There are three such samples:

• Vaginal vaults.
• The outer surface of the cervix.
• Directly from the cervical canal.

It is recommended to carry out this analysis once every 6 months. There are opinions that such analysis is not often necessary, because according to general information, a cell takes 10 years to form a cancerous tumor. But there are cases where cancer developed too quickly. Therefore, it is better not to risk your health.

Pap test based on liquid cytology

The liquid Pap test differs in that the epithelial cells taken from the cervix are placed in a special liquid (liquid medium), which ensures their storage for a long time. This allows for more in-depth testing.

The entire sample is preserved in a liquid medium without losses, which often occur when cell structures are dried in air.

The sample can be used to conduct additional tests, such as HPV or immunocytochemical studies.

HCP pap test

Human papillomaviruses are often the main cause of cervical cancer. An ordinary Pap test detects about 55% of oncological pathologies. The HCP Pap test is more sensitive to cell changes that lead specifically to cervical cancer.

This test combines two important studies:

1. For human papillomavirus (HPV test).
2. For oncocytology (Pap test).

The combined option allows the patient to be tested for several studies once.

Decoding the results of the papa test

In order to characterize the condition of the uterus, several classes are distinguished:

• 1 class. It says that all cells have a normal shape and size. Norm.
• 2nd grade. There are minor changes in cellular elements. There may be an inflammatory process.
• 3rd grade. In individual cells (in small numbers), changes in the cytoplasm and nucleus are observed. To make a diagnosis, you need to perform a repeat analysis.
• 4th grade. There are cancer cells in the smear.
• 5th grade. The smear contains a large number of modified cells. Diagnosis: Cervical cancer.

Pap test during pregnancy

A Pap test can not only be done during pregnancy, sometimes it is a necessary procedure. At the slightest suspicion of the presence of fungi and infections, the doctor must perform a cytological smear. When detected in time, certain infections are quickly treated and do not have time to harm the fetus.

During the entire pregnancy, a smear is done about three times, and additional examinations may also be prescribed if necessary.

A cytological smear is taken from pregnant women in the same order as from all women. Its technology is not capable of harming health expectant mother and the child.

What else can you find in dad's cervical test results?

With the help of the pap test, they determine not only the presence of cancer cells, they also often detect many different types infections.

• Papillomavirus. This is an infection that causes warts to appear on the cervix and vagina.
• Chlamydia. This infection is the most common and is transmitted sexually. It is very difficult to diagnose, which significantly slows down the treatment process. And this, in turn, threatens to cause complications.
• Gonorrhea. An infection that often causes female infertility.
• Fungus (yeast infection). The growth of fungus in the vagina ultimately leads to an inflammatory process. Symptoms: itching, white discharge with a pungent odor, irritation.
• Trichomoniasis. A sexually transmitted disease that can be completely cured if detected early. Symptoms: itching, pain during urination and sexual intercourse, greenish discharge.

Often, cancer cells or initial changes cannot be traced due to the presence of infections. If an infection is detected during the analysis, then after complete recovery you should do a repeat Pap test.

Pap cytology test is an absolutely harmless test that can be done during pregnancy. It is given to all women over the age of 18, as well as to those who have begun to be sexually active. See your doctor every 6 months. Health comes first!

Doctors regularly take a PAP smear (PAP test) from female patients during routine checkups to check for abnormal cellular changes in the cervix. If left untreated, these changes can lead to cervical cancer. Negative (normal) test results indicate the absence of abnormal cells. This means that you do not need to undergo additional examinations until your next scheduled examination. Positive (abnormal) results indicate a potential problem.

Steps

Part 1

Stay calm. Many women are very worried when they receive a positive test result, but at this stage there is no reason to panic. In most cases, positive results do not indicate cervical cancer. You will need to follow your doctor's instructions and possibly undergo additional testing to determine why the smear showed suspicious changes at the cellular level in the cervix.

Read information about HPV. Most often, abnormal smear results are caused by the human papillomavirus (HPV). This virus is sexually transmitted, and it is so common that most sexually active people will experience this problem at some point.

• There are many various types HPV, some of which can lead to cervical cancer. Many people will never develop this virus and will go away on their own. Having HPV does not mean you have or will ever have cervical cancer.

1. Consider others possible reasons abnormal smear test results. Upon admission birth control pills The smear test may be false positive. Some women may experience cellular changes in the cervix that are not caused by HPV. Hormonal imbalance fungal infections, vaginal sex, using tampons, douche, or vaginal cream 48 hours before a smear test may cause incorrect results.

2. Decipher your test results. There are a range of "positive" or "abnormal" indicators, and some are more important than others. The next step depends on the specific results of the cytological smear.

   • Atypical squamous epithelial cells undefined(ASC-US) are cervical cells that appear abnormal, but they are not necessarily cancerous or precancerous.
   • Squamous intraepithelial lesions are cells that may be precancerous. Their presence is called cervical dysplasia (CIN), which has several degrees: CIN 1 (mild), CIN 2 (moderate) and CIN 3 (severe).
   • Atypical glandular cells are glandular cells (cells that produce mucus in the uterus and cervix) that are an abnormality but are not necessarily cancerous or precancerous.
   • Squamous cell carcinoma cells may indicate that cancer is already present in the cervix or vagina. These cells, along with adenocarcinoma, are one of the most potentially dangerous PAP smear findings.
   • Adenocarcinoma means that cancer may already be present in the glandular cells. Along with squamous cell carcinoma cells, this is one of the most potentially dangerous smear results. It may indicate the presence of cancer of the uterus (endometrial carcinoma), so your doctor may refer you for an endometrial biopsy.

3. Inquire about colposcopy. Your doctor may also suggest you have a colposcopy, a procedure that uses a magnifying device called a colposcope to look at the cervix in more detail. If your doctor sees any potential problems, they may also refer you for a cervical biopsy for further testing.

   • If you think you may be pregnant, tell your doctor before your colposcopy. The risk of miscarriage is low, but bleeding may occur after the procedure.
   • Do not insert anything into the vagina (avoid tampons, showers, medications, or sexual contact) for at least 24 hours before your colposcopy.

Part 3

1. Find out if you need any treatment. In most cases, doctors simply recommend regular checkups and Pap smears to keep the situation under control. However, you may need additional examination.

   • Keep in mind that a Pap smear will reveal the presence of certain abnormal cells, but the doctor will not be able to make a diagnosis based on it alone. If he sees a potential problem, he will refer you for a colposcopy or biopsy to find out the cause.

2. Choose the treatment that's right for you. If your doctor recommends removing precancerous cells, there are several treatment options. These procedures may seem scary and painful, but keep in mind that they are performed under anesthesia to make you feel comfortable.

   • Loop electrosurgical excision procedure (LEEP) is a process in which a doctor cuts out abnormal tissue with a small wire under electrical voltage. This procedure is performed in a doctor's office under local anesthesia and takes only a few minutes. This is the most common treatment method.
   • Cryotherapy is another procedure performed in a doctor's office using a cold probe to freeze abnormal cells. This procedure is very quick and does not require anesthesia.
   • Conization is a procedure in which a doctor removes abnormal cells using a scalpel. This procedure requires general anesthesia, so you will have to go to hospital.
   • Laser therapy is a procedure in which a doctor uses a laser to remove abnormal cells. Like conization, this method is performed in a hospital under general anesthesia.

• Get regular checkups and have a smear test, including a Pap smear. This process may seem unpleasant, especially if you have abnormal test results, but this procedure is better protection from cervical cancer.
• The most common cause of cervical cancer is human papillomavirus (HPV). This virus is widespread but often has no symptoms, so don't assume you won't be affected by HPV or cervical cancer if you don't feel any discomfort. Regular examination is very important.
• Stop smoking. In addition to HPV, smoking is another risk factor for cervical cancer.
• Women under 27 years of age should consider getting vaccinated against HPV. The HPV vaccine will not cure the virus or change your smear test result, but it may protect you from future HPV infections and the resulting cervical cancer. The HPV vaccine is a highly controversial issue, so consult your doctor and make an informed decision.
• It's normal to feel worried and upset when you get abnormal test results. Talk to your partner, friend or relative. Talk about your feelings and problems. If you let your emotions out, you may feel better.

SYNONYMS

Pap smear, Pap test, Pap test, Pap smear.

RATIONALE FOR PAP smear

The morphological analysis method is based on the study and evaluation of cellular material.

PURPOSE OF PAP TEST

Identification of morphological features of cells characterizing a specific pathological process.

INDICATIONS FOR PAP smear collection

Screening for cervical cancer (see section “Cervical dysplasia”).

PREPARATION FOR THE STUDY (PAP smear)

During the day before the test, you should not douche or use vaginal medications. It is advisable to abstain from sexual intercourse for 1–2 days before the test. You cannot take material for research during menstruation.

PAP TEST TECHNIQUE AND FOLLOW-UP CARE

Material for research: scraping from the cervical canal and from the surface of the ectocervix. To obtain the material, the following instruments are used: Eyre's spatula (for taking smears from the surface of the ectocervix), Volkmann spoon, screenet, endobranche (for taking endocervical smears, etc.). To obtain optimal cytological results, samples should be taken separately from the ectocervix and endocervix. The material is taken before bimanual examination. After examining the cervix using mirrors without preliminary treatment, lightly scrape the surface of the pathologically changed area or the surface of the ectocervix around the external os. Material is taken from the cervical canal after removal of the mucus plug. From the resulting material, prepare one thin, uniform smear over the entire length of a clean, dry glass slide and fix it by air drying. The dried smear is labeled.

INTERPRETING PAP smear results

CLASSIFICATION OF CERVICAL PAP smears

• First class - no atypical cells, normal cytological picture.
• The second class is a change in the morphology of cellular elements caused by an inflammatory process in the vagina and/or cervix.
• The third class is single cells with abnormalities of the cytoplasm and nuclei.
• The fourth class is individual cells with obvious signs of malignancy: increased nuclear mass, cytoplasmic abnormalities, nuclear changes, chromosomal aberrations.
• Fifth class - a large number of atypical cells are observed in the smear.

In practical work, it is advisable to use modern standardized reports of the main types of this classification or cytological reports corresponding to certain histological diagnoses.

In 1989, the Working Group National Institute Cancer, which met in Bethesda (Maryland, USA), proposed a two-stage system for assessing the results of cytological examination, later called the “Maryland” or “Bethesda” system. Similarities clinical manifestations, the results of cytological and molecular biological studies, as well as the same treatment tactics, made it possible to combine koilocytosis (see section “Hapillomavirus infection of the genital organs”) and CIN I and classify them as a low degree of PIP. For the same reasons, CIN II, III and carcinoma in situ were classified as high-grade PIP. According to the Maryland system, unclassified atypical squamous epithelial cells include cells that do not meet the criteria for changes in one or another degree of malignancy. This category does not include atypical cells that arise from inflammation, atrophy or repair, since according to the Maryland system they are considered benign.

Standardization of cytological examination results facilitates their comparison and reduces the likelihood of diagnostic errors. In addition, during recent years repeat cytological screening techniques are used to improve the efficiency of the cytological method. In particular, three new methods have been approved to improve the information content of Pap smears: computer screening of negative Pap smears, Pap test in solution and autocytology system. When performing a Pap test in solution, smears are taken using brushes and immediately placed in a special solution in a test tube, which is sent to the laboratory, where the smear is prepared. Before placing cells on a glass slide, the solution is shaken and filtered, i.e. One layer of epithelial cells is subjected to microscopy. An increase in the accuracy of cytological diagnostics when performing this technique is achieved by overcoming all the errors associated with the preparation of a smear.

The principle of the autocytological system is the automated computer differential diagnosis of Pap smears. The scanned cells, which have undergone preliminary dispersion and centrifugation in order to separate blood and other components from them, are compared with standards stored in the computer memory for various morphological characteristics. As a result, the reliability of diagnosis significantly increases and the proportion of false negative results of cytological examination decreases.

When establishing a cytological diagnosis of CIN or cancer (class 3–5 Papanicolaou smears or high-grade PIP according to the Maryland system), an in-depth study is necessary - colposcopy and biopsy of the cervix with curettage of the mucous membrane of the cervical canal. In case of an inflammatory type of smear (Papanicolaou smear class 2, low-grade PIP, or the presence of unclassified atypical squamous epithelial cells according to the Maryland system), a repeat examination after sanitation is indicated, as well as HPV typing.

OPERATIONAL CHARACTERISTICS OF PAP smear

The method makes it possible to assess the structure and cellular level of damage to tissues caught in the smear. Cytological criteria are based on the severity of signs of cellular atypia, of which there are more than 80, but only 10 of them are the most constant.

The cytological method is highly reliable - the rate of early cytological diagnosis of precancer and early stages of cervical cancer is approximately 80%. However, method errors, ranging from 5% to 40%, cover both harmless viral proliferation and genuine precursors of cancer. Negative cytological data do not exclude the presence of cervical microcarcinoma, therefore, each patient, when the pathological focus is localized on the vaginal part of the cervix, must undergo a targeted biopsy and curettage of the mucous membrane of the cervical canal.

FACTORS AFFECTING THE RESULT OF PAP smear

• Failure to comply with material collection techniques.
• Technical errors associated with the preparation of the drug.
• Qualification of pathologist.

ALTERNATIVE METHODS

A worthy alternative to cytological screening for countries with low and medium levels of economic development is the VIA screening test (visual inspection with acetic acid - visual assessment of the condition of the ectocervix after treatment with acetic acid) followed by immediate cryodestruction of identified pathological foci. To detect CIN II and more severe cervical lesions, the sensitivity of the VIA screening test is 71% and the specificity is 74%.

In modern gynecological practice, a Papanicolaou 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 of different cells), and the inside is covered with columnar epithelium, which is a single 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 essence, this procedure is a scraping with further cytological examination of the resulting 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 of cancer. 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 the true structure of the 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 the age and general condition of the patient, 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. Occurs inflammatory process. 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 the possible presence of a particular pathology. To make an accurate diagnosis, additional research is necessary.

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 there are no processes of malignant degeneration in the woman’s 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 the samples contain blood, this may distort the results obtained during laboratory testing.
• 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).

Gynecologists recommend that women of reproductive age (from 21 to 49 years old) undergo a PAP test every 2-3 years. Older patients (50-65 years old) should be tested every five years.

• disorderly sex life, women have 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 (examination of the cervix using a special device) and cervical biopsy are performed.

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.