Cytological analysis: how the PAP test is performed and why it is needed. Pap test with interpretation of cytological smear examination

The basis for early diagnosis of cervical cancer is the Pap smear ( PAP test). A smear is a scraping of the uterine tissue and examination of the cells under a microscope. Like all human organs, the uterus consists of different layers of cells. The outer surface consists of epithelium; they are constantly replaced with new ones. During the process of maturation and replacement, cells move along the surface, where they are sometimes deposited and can be taken for analysis. The widespread use of simple cytological examination has reduced the incidence of cervical cancer by 2 times. The Pap test is also informative in some other cases. For example, when examining any discharge (urine, feces, sputum, etc.), it is possible to recognize cancer of the bladder, stomach, and lungs. However, the Pap test is most often used in gynecology.

The founder of medical cytology, Georgios Papnikolaou, discovered that malignant tumor cells enter the vaginal secretion. Accordingly, the study of this secretion for pathological cells has become the basis for the early diagnosis of tumors.

A PAP test is mandatory for all women during a gynecological examination, starting from the age of 21, annually. Thanks to the introduction of this test into the work of gynecologists, the incidence of cancer among women was reduced by 60-70%. To obtain the material, the doctor scrapes the epithelium from the surface of the cervix and cervical canal. The analysis is best carried out on days 10-20 of the cycle. In the laboratory, samples are stained for better study. The type of cells, their size, number and structural features, etc. are assessed. The result is usually ready in 1-3 days. The smear may be positive or negative. If the result is negative, there are no atypical cells; the cells have the same size and shape. A positive result reveals cells of different shape and size, and their location is not normal. The smear results indicate what changes were detected:

ASC-US– abnormal cells of the surface epithelium, their appearance is associated with dysplasia, papilloma virus, chlamydia and other infections, atrophy of the mucosa during menopause. It is recommended to be tested to detect the human papillomavirus (HPV), which is one of the main causes of cervical cancer.

LSIL– squamous cell lesions of low severity. The causes may be dysplasia, papilloma virus. The risk of cancer is low. It is recommended to conduct an HPV test and colposcopy.

ASC-H– abnormal epithelial cells. Reasons for detecting cells: precancerous changes, initial form of cancer. Extended colposcopy is recommended.

HSIL– high-grade squamous cell lesions. These lesions can develop into cancer cells. Causes: high-grade dysplasia, cervical cancer. Colposcopy or biopsy recommended .

A.G.C.– abnormal glandular cells. Causes: high-grade dysplasia, endometrial cancer, cervical cancer. HPV analysis, colposcopy, and endometrial curettage are recommended.

AIS– squamous cell carcinoma, cells typical of cervical cancer. Causes: cervical cancer, high-grade dysplasia. Diagnostic curettage and diagnostic excision (removal of a section of mucous membrane) are recommended.

Benign glandular changes– wandering cells of connective tissue. Their detection may be evidence of endometrial cancer or precancerous changes. For women who have not reached menopause and do not have other adverse symptoms, benign glandular cells are considered normal. Diagnostic curettage is recommended.

Despite all the information and high significance of the PAP test, its results depend on the quality of the material taken and some other factors. Therefore, the results may be erroneous.

False positive Pap test– the result indicates the presence of dysplasia, although the woman is healthy. This result may be due to previous inflammatory or infectious diseases of the genital organs, erosion, or hormonal disorders. A repeat Pap test and colposcopy are recommended.

False negative Pap test– indicates the absence of the disease, although it is present. The reason may be incorrect sampling of material for analysis, or a laboratory error. It is recommended to perform a colposcopy in addition to the PAP test.

Possible pathologies in the conclusion of a Pap test:

- inflammatory process - inflammation caused by infection must be treated, after which a repeat PAP test is prescribed. If the examination reveals a papilloma virus, the patient undergoes long-term treatment under the constant supervision of the attending physician.

- atypical epithelial cells - moderate changes, deviations from the norm, but not yet cancer cells. Most often, atypical cells disappear on their own. If dysplasia is detected, treatment is carried out.

— high-level epithelial pathology is a serious cell pathology, but not yet cancer. Only in 1-2% of cases of such a conclusion cancer is detected during biopsy. Further examination, colposcopy, biopsy is required.

— epithelial neoplasia is a serious form of pathology of epithelial cells. A thorough examination and immediate treatment are required.

- cancer in situ - the development of cancer cells in a limited area, without spreading to other areas.

Thus, the Pap test helps to identify not only cancerous and precancerous conditions. During the analysis, inflammation, infections, and cervical atrophy can be detected. Modern cytological examination is one of the most effective methods for diagnosing neoplasms.

general information

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

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 the start of sexual activity or at the age of 21 years (whichever occurs 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 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 class - individual cells with obvious signs of malignancy; Class 5 - a large number of typical cancer cells. The diagnosis of a malignant neoplasm is beyond doubt.

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See what a “Pap smear” is in other dictionaries:

Georgios Papanikolaou (Greek Γεώργιος Παπανικολάου, May 13, 1883 (18830513), Kymi, Euboea 1962) Greek scientist, physician, pioneer of cytology and early diagnosis of cancer. Papanicolaou test (Pap smear), today... ... Wikipedia

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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 advances allow this period to be increased. 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.
During the prenatal period, they received a certain dose of diethylstilbestrol, a synthetic female hormone substitute that 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 there are cells in a woman's body 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 in the 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 the inflammatory process. Patients with this result should have a new Pap test after six months. An alternative option is an HPV test or colposcopy;
ASC-H. One of the options for atypical transformations of cervical cells, which are characterized by a flat shape. To confirm/exclude large-scale damage to microparticles of the cervix, colposcopy + biopsy is required;
LSIL. Here there are minor errors in the structure of the cervical epithelium. Such defects arise against the background of the spread of HPV, which provokes mild dysplasia. In this case, females should repeat the PAP test (after 5-6 months), or undergo colpospopia + biopsy;
HSIL. This result means that moderate/severe dysplasia, carcinoma, is present. In 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.

Description

Material under study See description

The Papanicolaou staining method is a specially developed method that allows the greatest degree of reliability to identify early precancerous diseases of the cervix.

Cervical cancer ranks third in the structure of malignant neoplasms of the reproductive system. Until 1992, the incidence of cervical cancer was decreasing, but now there is a tendency for this pathology to increase again. The development of the tumor occurs gradually, over several years, so preventive examinations of women using the cytological method are very important.

Currently, when conducting screening programs to detect cervical cancer, precancerous and background conditions, Papanicolaou staining of cellular material is used - the Pap test. The Papanicolaou staining method allows one to assess the degree of maturation of the cytoplasm and stains nuclei with atypia well. The term “atypia” has different interpretations in different countries: in central Europe it is defined as malignancy, in WHO nomenclature it is defined as “less than dysplastic intraepithelial changes.”

Carrying out a Pap test has a number of features. An important point is to correctly take the material and fix it. The cellular material is taken with brushes of a special configuration in “mirrors” to avoid the ingress of foreign material. The transfer of material should occur quickly, without drying out; rapid fixation of the wet smear in 96% ethanol is required. Papanicolaou staining of smears goes through a number of stages, then the cellular material enclosed in the balm is subjected to cytological analysis.

Material to be examined: scrapings from the endocervix, exocervix, as well as mixed scrapings applied to a glass slide.

Literature

Kulakov V.I. and others. “Modern approaches to the diagnosis of papillomavirus infection of the female genitals and their significance for screening for cervical cancer. Gynecology". 2000; 1 (2): 4 - 8.

Preparation

No special preparation is required for the study. Please note that gynecological tests are taken for children under 16 years of age only in the presence of their parents. Medical offices do not perform cervical scrapings or smears on pregnant women who are 22 weeks or more pregnant because the procedure can cause complications. If necessary, you can contact your doctor to take material.

Interpretation of results

Interpretation of research results contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. The doctor makes an accurate diagnosis using both the results of this examination and the necessary information from other sources: medical history, results of other examinations, etc.

The protocol for a standardized cytological report, based on the Bethesda classification (revision 2001), as well as on a standardized cytological description according to the Order of the Ministry of Health, consists of the following sections:

quality of the drug: - adequate; - inadequate.
cytogram/description: - epithelial cells within normal limits replaced by - negative for intraepithelial pathology or malignancy; - or describe the detected pathological changes in the epithelium.
cytogram/features: main categories of pathological changes in the epithelium: a) atypical squamous cells (ASC) - PCNS (ASC-US) - undetermined - reactive changes or dysplasia I-weak-CIN-1, most often associated with inflammation; - not excluding B-PIP (ASC-H); - Low grade squamous intraepithelial lesions (LSIL): - H-PIP (ASC-H) - CIN 1 (dysplasia I - mild), human papillomavirus infection - HPV. - high degree of squamous intraepithelial lesions (HSIL): - B-PIP (ASC-B) - CIN 2 (dysplasia II - moderate), CIN 3 (dysplasia III - severe), cancer in situ. - squamous cell carcinoma; b) atypical glandular cells (AGS)
cytogram/other types: other non-neoplastic changes (if detected);
additional clarifications: the specific infectious agent is indicated (if detected).

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 for 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:

For human papillomavirus (HPV test).
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 the health of the expectant mother and child.

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

With the help of the pap test, not only the presence of cancer cells is determined, but many different types of infections are also often detected.

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!