A cytological smear (in other words, a Papanicolaou smear, Pap test) is an indicator of precancerous and cancerous diseases, various infections in the female genital area. Taking a Pap smear is a simple and painless, although unpleasant, procedure.
You can take a Pap test at any time when you are not menstruating. Shortly before the test, you should avoid sexual intercourse, douching, the use of vaginal medications and contraceptives.
How is a cytological examination performed? The smear is taken by an obstetrician-gynecologist during a gynecological examination, when the woman lies in a gynecological chair with her knees raised and her legs fixed.
During the examination, the doctor uses a special mirror to open the vagina, which makes it possible to see the vagina and cervix. The doctor uses a small cervical brush to collect mucus and cells for analysis.
A smear is usually taken from the surface, from the cervical canal and vaginal vaults. The taken sample is applied in an even layer to a special piece of glass, fixed and sent to the laboratory for research. While taking a smear, a woman should try to relax, then the whole procedure will be painless. If any painful sensations, you must immediately inform your doctor about this.
In medical practice, cellular changes are assessed using the method of the Greek physician Georgios Papanikolaou. A cytological examination of the smear is carried out. This method identifies several stages of development of pathological processes:
- Normal cytological picture, no abnormal cells.
- The cells of the internal genital organs are slightly changed as a result of inflammatory processes. Although this is considered normal, the doctor should give recommendations for a more thorough examination to determine the causes of inflammation and further treatment.
- There is a small group of cells whose nuclei are subject to abnormalities.
- Cells with enlarged cell nuclei, altered cytoplasm, and chromosomal aberrations are detected. But even with such malignant cell changes, only a suspicion of cancer is expressed.
At the final (fifth) stage, an accurate diagnosis is already made due to the large number of cancer cells in the smear.
What does the transcript show?
What does the transcript of the analysis show?
Negative test results indicate a healthy cervix, while positive test results indicate an unhealthy cervix and the presence of some kind of anomaly.
Positive Pap test results are given by yeast, gonorrhea, chlamydia, trichomoniasis, and human papillomavirus (HPV), which also contributes to the development of genital warts.
Having HPV indicates a very high risk of developing cervical cancer. When the infection has cleared, the cytological examination should be repeated. This test cannot determine the condition of the uterus, the fallopian tubes, ovaries.
When cervical cancer begins to progress, vaginal discharge, blood, pain during intercourse appear, discomfort is felt in the lower abdomen, back pain and swelling of the legs occur, and menstruation becomes heavy.
If cancer is suspected, colposcopy and biopsy are performed. Although the cervix does not have pain receptors, a biopsy is considered an operation and is performed under general anesthesia in the hospital or on an outpatient basis without the use of anesthesia.
It cannot be carried out only in two cases: the blood clotting process is disrupted, and there is acute inflammation. If cancer is detected in a timely manner, then during a biopsy all the modified tissue can be removed entirely.
While taking a piece of tissue for analysis, it is quite possible to introduce an infection. Complications of biopsy include bleeding both during the operation itself and in the postoperative period. As a result of surgery, scars may form on the uterus. It must be clearly understood that not all abnormal cells are malignant and eventually turn into cancer cells.
Women need to know how often they need to be examined by a gynecologist and have a smear test to check for infections and cancer. Doctors cannot reach a consensus on this issue.
In most cases, cancer takes a very long time to develop; it can take about 10 years from the beginning to the final stage. But there are times when cancer develops quickly. Therefore, the optimal frequency of taking a smear is once every 1.5 years. It should be noted that the older a woman is, the more likely she is to get cancer. But after 50 years, the diagnosis of cervical cancer is made especially often. Even after removal of the uterus or the onset of menopause, it is necessary to do a Pap smear.
The following categories of women are at risk of developing cervical cancer:
- frequently changing sexual partners;
- those who began early sexual activity;
- smokers;
- with a weakened immune system;
- having viral infections such as HIV, HPV, HSV.
If the diagnosis of cervical cancer is confirmed by biopsy, treatment should be started immediately. It should be noted that cancer, including cervical cancer, ranks second in the world in the number of deaths after cardiovascular diseases.
In the United States, computer systems PAPNET and AutoPap have recently been used to double-check Pap smears and detect cytologist errors. You need to start taking care of the health of the sexual sphere, as well as the body as a whole, from a young age.
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:
- We went through an internal organ transplant and had other manipulations that negatively affected the body’s immune capabilities.
- In the prenatal period, they received a certain dose of diethylstilbestrol, a synthetic substitute female hormone, which was popular in the 70s.
- Are HIV-infected.
- 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 all reproductive organs were 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 has become chronic . 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 is a common disease among the female 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:
- negative– the cells have standard parameters, a precancerous condition does not exist;
- 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 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 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:
- The biopsy confirms the norm. This means that there are no errors in the structure of the cervix, the patient is prescribed a second PAP test after a year.
- CIN I. Errors are present, but they are insignificant and often self-destruct without medical assistance. Female representatives are offered to repeat the PAP test in six months/perform colposcopy + biopsy.
- 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.
PAP test or Papanicolaou test- a study to determine the health of the cervix. The method was invented in the mid-50s. 20th century by the Greek physician Papanikolaou, after which it became widely used in medicine. The main purpose of testing is to prevent cervical cancer. This method, also known as “cervical cytology” (from the Latin “cito” - cell), reveals at the initial stage pathology in the cellular structure, which can develop into cancer.
Several years may pass from the onset of pathological abnormalities in the cellular structure to the formation of cancer. A cytology smear reveals these abnormalities.
Cytological smear - preparation and procedure.
The material is collected during an examination by a gynecologist. The procedure is completely painless and lasts a few seconds. The doctor inserts a disposable gynecological speculum, removes discharge with a cotton swab, and scrapes from the cervical canal and the outer surface of the cervix with a special brush. The resulting material is sent to the laboratory for examination by a cytologist, who determines the cellular composition of the material. This information is returned in documented form to your treating doctor.
The procedure is carried out a few days after completion menstrual cycle.
- Vaginal medications.
- Spermicidal (chemical) contraceptives.
- Lubricating gels.
It is worth holding off on taking a Pap test if you have itching or unusual vaginal discharge. Such symptoms signal an infection that requires treatment.
How often is a Pap test performed?
- It is advisable to take the first test after the start of sexual activity.
- Subsequently, 1 time per year during planned gynecological examinations(regardless of the frequency of sexual contacts or their complete absence).
- If your tests are normal for 3 years in a row, you need to take cytology once every 3 years
Risk factors for the development of cancer:
- Early onset of sexual activity
- Having multiple sexual partners
- Past or present presence of sexually transmitted diseases (herpes or papillomas).
- Positive HIV status.
- Smoking
If a pathology is detected, the doctor will prescribe additional tests: a daijin test, examination for viral and bacterial infections, repeated PAP testing and colposcopy.
Colposcopy is a method in which a gynecologist examines the cervix under a microscope. During the procedure, the gynecologist will detect the pathological area where the altered cells are located and decide whether a biopsy is necessary for an accurate diagnosis.
Depending on the final result, the specialist may recommend further observation or treatment of the pathologically altered area of the organ.
Cervical cancer does not occur suddenly. This disease gradually arises from various precancerous pathologies and progresses very slowly over several years. Therefore, if the pathology is detected early, the chances of a complete recovery are very high. This is especially true for numerous precancerous diseases, which today are very treatable with the use of the latest methods and technology.
Cytological examination cervical smear (PAP test)- This modern way early diagnosis of precancerous changes at the cellular level.
As a screening test, this test can reduce the incidence of cervical cancer by 84%.
Why is a cytology test performed?
The study is carried out primarily to make sure that the cervix is healthy.
As a rule, in 90% of cases the test confirms the absence of diseases.
In 10% of women, various pathologies are identified that can be treated with the outcome of complete recovery.
Simple outpatient treatment for precancerous changes prevents the development of a serious disease.
Provided that a woman is regularly tested, her risk of developing cervical cancer is virtually eliminated.
Indications for analysis.
Preventive examinations and screening studies.
Suspicion of atypical processes (dysplasia) of the cervical epithelium.
All women over 35 years of age at least once a year.
Women from risk groups.
Risk factors for developing cervical cancer include
the presence of oncogenic human papillomaviruses (HPV) in the body;
chlamydial and herpes infection;
chronic inflammatory gynecological diseases;
frequent change of sexual partners;
early onset of sexual activity;
hereditary factor (cervical cancer in close relatives);
long-term use of hormonal contraceptives;
frequent multiple births;
How is biomaterial taken for analysis?
Cytological material from the mucous membrane of the cervix is taken by scraping. Scrapings are carried out with special brushes from various parts of the cervix and placed on a glass slide.
To ensure that foreign tissue does not get in during the material collection process, special mirrors of a special shape are used when taking the material.
The doctor quickly applies the biomaterial to the glass to prevent drying, then the material is immersed in a special solution and sent to the laboratory.
A cytological examination of the cervical smear is also called a PAP test after the scientist George Papincolau.
In the laboratory, a laboratory assistant stains a smear in several stages using the Papincolau method, after which he evaluates the degree of maturation of the cytoplasm of epithelial cells and identifies the presence of atypical ones.
In very rare cases, the material taken may be found to be inappropriate. Then the laboratory will simply ask you to repeat the sample.
When can a distorted analysis result occur?
First of all, a distorted result can be obtained if the woman did not prepare for the analysis properly.
the biomaterial for analysis was taken during menstruation and blood is present in the smear;
there are sperm in the smear;
the presence of foreign impurities was detected in the smear: spermicidal creams, lubricant for condoms, lubricant gel for ultrasound;
The doctor conducted a palpation study before taking the analysis, so the biomaterial is contaminated with talc.
As for girls under 20 years of age, false positive changes may be detected in them due to hormonal changes.
How to prepare for an oncocytology test?
Compliance with several fundamental rules for preparing for analysis is a necessary condition for obtaining reliable results.
biomaterial is taken no earlier than the 5th day of the menstrual cycle. In any case, the bleeding should stop completely.
The analysis is carried out no later than 5 days before the expected date of the next menstruation.
The test is performed no earlier than 24 hours after sexual contact.
If a woman used lubricants, introduced medications, creams into the vagina, douched with various solutions, used tampons, then at least 48, and preferably 72, hours should pass from the moment of such manipulations.
The same period of time should pass after an ultrasound examination with a vaginal sensor.
There is a small chance of a negative cytology result in cases of altered conditions of the cervical epithelium, so regular tests once a year are necessary.
Classification of cytology analysis results
1 class. No abnormal cells were found in the smear; the cytological situation was normal.
2nd grade. Inflammations of various etiologies lead to disruption of the cell structure.
3rd grade. Single changed cells were found. In this case, the diagnosis needs to be clarified, so a repeat cytological examination or a biopsy of the changed areas followed by cytology is usually performed.
4th grade. Individual atypical cells with signs of malignancy were found.
5th grade. The analysis contains a large number of atypical cells.
Currently, a more modern and progressive research method is liquid-based thin-layer cytology. This is, of course, a more expensive and therefore expensive diagnostic method, but at the same time more sensitive.
Sensitivity rates for traditional cytology range from 35 to 89%, while sensitivity rates for liquid-based cytology range from 71 to 95%. Such criteria allow you to take a cytology test less often - once every two to three years.
