Cytological analyzes: methodology and interpretation of the results of the study. Oncocytology - a method for early diagnosis of cancer and inflammatory diseases A smear for oncocytology on which day of the cycle

A vaginal cytology smear (Pap smear, Pap test, smear for atypical cells) is a laboratory microscopic examination that allows you to identify abnormalities in the cells of the cervix.

What does a cytology smear show?

In a cytological smear, the size, shape, number and location of cells are evaluated, which makes it possible to diagnose background, precancerous and cancerous diseases of the cervix.

What are the indications for taking a smear for cytology?

This analysis is prescribed to all women from the age of 18 once a year, as well as for:

• pregnancy planning;
• infertility;
• violation of the menstrual cycle;
• genital herpes;
• obesity
• human papillomavirus;
• taking hormonal contraceptives;
• a large number of sexual partners.
• before setting the intrauterine device;

How to prepare for research?

Before visiting a gynecologist for testing, you should:

• refrain from sexual intercourse for 1-2 days;
• do not use vaginal preparations (creams, suppositories, lubricants) and do not douche for 2 days;
• before taking a smear for cytology, it is recommended not to urinate for 2-3 hours;
• It is not recommended to give a smear for cytology in the presence of symptoms such as itching and vaginal discharge.

It is advisable to take a smear for cytology immediately after menstruation, on day 4-5 of the cycle.

How is a smear taken for cytology?

A smear is taken during a gynecological examination with a special disposable small brush from the outer and inner surfaces of the cervix. The procedure for taking a smear is painless and takes 5-10 seconds.

Can there be any discomfort after a smear for cytology?

Since the doctor does a scraping during cell sampling, some may have slight spotting from the vagina for 1-2 days.

How many days to prepare a smear for cytology?

1 business day.

How is the result of a cytology smear evaluated?

A smear is considered normal or negative when all cells are of normal size and shape and there are no abnormal cells.

To describe a smear for cytology, doctors use special terms: dysplasia of 1, 2, 3 degrees, atypia. With dysplasia of the 1st degree, it is necessary to repeat the study after 3-6 months.

What to do if pathological cells are found in a smear for cytology?

In this case, the doctor recommends an additional examination. This may be as simple as repeating a cytology smear some time after the first result. Sometimes a colposcopy with a cervical biopsy is prescribed to clarify the diagnosis, based on the results of which a decision is made on the method of treatment.

For some reason, everyone thinks that oncocytology concerns only the female genital area (cervix, cervical canal). This is probably because the condition of the cervix is ​​the subject of daily study by any cytologist, while a smear for oncocytology can be applied to the glass after scraping or fine needle aspiration biopsy (FNA) from other places. In addition, smears-imprints of the mucous membrane of the larynx, nasopharynx, skin (melanoma), soft tissues can be made. In principle, if an oncological process is suspected, material for research can be obtained from anywhere, however, by different methods. For example, using a fine needle aspiration biopsy. Most often, this is done if there are doubts about the health of the mammary or thyroid gland, where cytological diagnosis plays a major role, because histological verification is provided only during surgery (urgent histology) and after removal of the organ.

Oncocytology

Oncocytology involves microscopic analysis (study of the cellular composition and state of cell organelles) of material suspicious of an oncological process and taken from any available place.

In this regard, patients should not be surprised by smears for oncocytology, prepared not only from scrapings of the female genital organs, but also by fine needle aspiration biopsy (FNA):

• Enlarged regional lymph nodes (cancer of the larynx, nasal cavities and paranasal sinuses, salivary glands, penile cancer, eye tumors, etc.);
• Tumors of the pancreas, liver, gallbladder and extrahepatic bile ducts;
• Seals and nodes of the mammary and thyroid glands.

Identification and diagnosis of a malignant neoplasm of soft tissues, skin, lips, mucous membranes of the mouth and nose, cancer of the rectum or colon, bone tumors often begins with the study of smears-imprints. And then FAB of altered lymph nodes and / or histological diagnostics (histology) is added. For example, if a tumor of the rectum or colon is suspected, cytology is the first stage of diagnosis, but cannot replace histology in any way.

It should be noted that some organs are not subjected to histological analysis until the operation, after all, you can’t cut off a piece of tissue in the mammary or thyroid gland and send it for research. In such cases, the main hope is cytology, and here it is important not to make a mistake and not create a risk of removing an organ that could be saved by other methods.

A smear for oncocytology during a preventive gynecological examination or in order to detect oncological pathology (squamous cell carcinoma of the vulva, cervix and vagina) is taken by a gynecologist or midwife, applied to a glass slide and transferred to a cytological laboratory for staining (according to Romanovsky-Giemsa, Pappenheim, Papanicolaou) and research. It will take no more than an hour to prepare the preparation (the smear must first be dried and then painted). Viewing will also take no more time if the preparations are of high quality. In a word, cytology requires glasses, pre-prepared paint, immersion oil, a good microscope, eyes and knowledge of a doctor.

The analysis is performed by a cytologist, but in other cases, smears during screening after professional examinations are trusted by an experienced laboratory assistant who is familiar with variants of the norm (the norm is a cytogram without features). However, the slightest doubt is the basis for transferring the smear to the doctor, who will make the final decision (refer to a specialist, offer a histological examination, if possible). We will return to gynecological smears for oncocytology a little lower, but for now I would like to acquaint the reader with what oncocytology is in general and how it differs from histology.

Cytology and histology - one science or different?

What is the difference between cytology and histology? I would like to raise this issue due to the fact that many people in non-medical professions do not see the differences between these two areas and consider cytological diagnostics to be a section included in histological analysis.

The cytogram shows the structure and condition of the cell and its organelles. Clinical cytology (and its important branch - oncocytology) is one of the sections of clinical laboratory diagnostics, aimed at searching for pathological processes, including tumors, that change the state of cells. To evaluate the cytological preparation, there is a special scheme that the doctor adheres to:

• Smear background;
• Assessment of the state of cells and cytoplasm;
• Calculation of the nuclear-plasma index (NCI);
• The state of the nucleus (shape, size, state of the nuclear membrane and chromatin, the presence and characteristics of the nucleoli);
• The presence of mitoses and the height of mitotic activity.

Cytology is of two types:

1. Simple cytological examination, including taking a smear, applying it to a glass slide, drying and staining according to Romanovsky, Pappenheim or Papanicolaou (depending on the dyes and methods used by the laboratory) and viewing the smear under a microscope, first at low magnification (x400), and then at high magnification (x1000) with immersion;
2. Liquid oncocytology, opening up new perspectives, allowing the doctor to most accurately determine the state of the cell, its nucleus and cytoplasm. Liquid oncocytology is, first of all, the use of modern high-tech equipment (Cytospin) for isolating, evenly distributing cells on glass, preserving their structure, which provides the doctor with easy identification of cellular material after staining micropreparations in special automatic devices. Liquid oncocytology, of course, gives a fairly high reliability and accuracy of the results, but significantly increases the cost of cytological analysis.

Oncocytological diagnostics is carried out by a cytologist and, of course, in order to see all this, he uses immersion and a high magnification of the microscope, otherwise it is simply impossible to notice the changes taking place in the nucleus. Describing the smear, establishing its type (simple, inflammatory, reactive), the doctor simultaneously deciphers the smear. Due to the fact that cytology is more descriptive than establishing an accurate diagnosis, the doctor can afford to write the diagnosis under a question mark (this is not accepted in histology, the pathologist gives an unambiguous answer).

As for histology, this science studies tissues, which, during the preparation of preparations (biopsy, autopsy), are dissected into thin layers using special equipment - a microtome.

The preparation of a histological preparation (fixation, wiring, pouring, cutting, staining) is a rather laborious process, requiring not only a highly qualified laboratory assistant, but also a long time. Histology (a series of preparations) is "viewed" by pathologists and the final diagnosis is established. Currently, traditional histology is increasingly being replaced by a new, more progressive direction - immunohistochemistry, which expands the possibilities of histopathological microscopic examination of affected tissues.

Gynecological oncocytology (cervix)

A smear during a gynecological examination is performed using a cytobrush, and then the material is placed on the glass (for liquid oncocytology, a removable cytobrush is used, which, together with the material, is immersed in a bottle with a special medium). Oncocytology of the cervix, as a rule, is not limited to one smear (vaginal portion of the cervix), since there is a need to study the epithelium of the cervical (cervical) canal. This happens because the most problematic area in relation to the oncological process is the junction zone (transformation zone)- the place of transition of the stratified squamous epithelium of the vaginal part of the cervix (ectocervix) into a single-layer prismatic (cylindrical) epithelium of the cervical canal (endocervix). Of course, it is unacceptable to “blurt out” both smears on one glass during diagnosis (this is possible only during a physical examination), because they can mix and the smear will be inadequate.

In a smear from the cervix of a young healthy woman, one can see cells of the superficial and intermediate layer (in various ratios) of a non-keratinizing four-layer squamous epithelium growing from a basal cell, which is normally deep and does not fall into the smear, as well as cells of the prismatic epithelium of the cervical canal.

Differentiation and maturation of the epithelial layers occurs under the influence of sex hormones (phase I of the cycle - estrogens, phase II - progesterone), therefore smears in healthy women in different phases of the menstrual cycle are different. They also differ during pregnancy, in pre- and postmenopause, after radiation and chemotherapy exposure. For example, the presence of more than 10% of surface cells in a smear of an elderly woman makes us wary, because their appearance, in addition to inflammation, leukoplakia, vaginal dermatosis, may indicate the development of a tumor of the genital organs, breast, adrenal glands. That is why in the direction of a smear for oncocytology it is always indicated:

• The age of the woman;
• Cycle phase or gestational age;
• The presence of an intrauterine device;
• Gynecological operations (removal of the uterus, ovaries);
• Radiation and chemotherapy treatment (reaction of the epithelium to these types of therapeutic effects).

If necessary (if the hormonal type of smear does not correspond to age and clinical data), the doctor conducts a hormonal assessment of vaginal preparations.

Issues of cervical carcinogenesis

human papillomavirus

Issues of cervical carcinogenesis are often associated with the penetration into the body of a chronic resistant infection such as high-risk human papillomavirus (HPV). The human papillomavirus (HPV) can only be detected by indirect signs (koilocytes, multinucleated cells, parakeratosis), and even then, after the virus has activated, it left the nucleus of the basal cell of the transition zone into its cytoplasm and "moved" to more superficial epithelial layers . The conclusion “mucosal epithelium with signs of papillomavirus infection” deserves special attention, because HPV, for the time being “sitting quietly”, can lead to the development of a precancerous, and then a malignant process.

Thus, the identification and study of this DNA virus is very important in oncocytology, since it belongs to the factors of malignant transformation of stratified squamous epithelium cells into cervical precancer - dysplasia (CIN), non-invasive cancer in situ, and, finally, into invasive tumor diseases.

Unfortunately, in a smear for oncocytology in women without dysplasia, but with high-risk HPV, the detection of a dangerous virus does not even reach 10%. True, with dysplasia, this figure increases to 72%.

It should be noted that the signs of HPV infection in the smear are most noticeable in mild to moderate dysplasia, but practically do not appear in severe CIN, so other methods of investigation are required to identify the virus.

Dysplasia

A cytological diagnosis of dysplasia (CIN I, II, III) or cancer in situ is already considered bad oncocytology (the term is not entirely correct, more correctly - “bad cytogram”).

Dysplasia is a morphological concept. Its essence is reduced to disruption of normal stratification in the stratified squamous epithelium and the release of basal and parabasal cells at different levels of the layer of cells (cells of the lower layers that do not appear in the smear of a young healthy woman normally) with characteristic changes in the nucleus and high mitotic activity.

Depending on the depth of the lesion, there are mild (CIN I), moderate (CIN II), severe (CIN III) degrees of dysplasia. From severe dysplasia in a smear for oncocytology, it is almost impossible to distinguish a preinvasive form of cancer (cancer in situ). Cancer that has not left the basal layer (cr in situ) can be difficult to differentiate from CIN III in histological analysis, but the pathologist always sees an invasion, if it exists, and the fragment of the neck in which it occurs has got into the preparation. When identifying the degree of dysplasia, the cytologist takes the following criteria as a basis:

• Weak degree (CIN I) puts in the case of detection in smears of a young healthy woman 1/3 of basal type cells in the absence of signs of inflammation. Of course, mild dysplasia will not develop into a malignant tumor overnight, but in 10% of patients in less than 10 years it will reach a severe degree and in 1% it will transform into invasive cancer. If, nevertheless, there are signs of inflammation, then when deciphering the smear, the doctor notes: “Inflammatory type of smear, dyskaryosis (changes in the core)”;
• Moderate the degree of dysplasia (2/3 of the field is occupied by cells of the basal layer) should be distinguished from the cytological picture in menopause (to exclude overdiagnosis of CIN II), but on the other hand, the identification of such cells with dyskaryosis in reproductive age gives every reason to make a diagnosis: CIN II or write: "The changes found are consistent with moderate dysplasia." Such dysplasia develops into invasive cancer in 5% of cases;
• Oncocytology of the cervix captures well expressed (heavy) degree of dysplasia. The doctor in this case writes in the affirmative (CIN III) and urgently sends the woman for further examination and treatment (the risk of developing cancer under such circumstances is 12%).

cervical dysplasia

Oncocytology of the cervix shows not only the inflammatory process and dysplastic changes in the stratified squamous epithelium. With the help of cytological analysis, it is possible to identify other neoplastic processes and malignant tumors in this area (squamous cell carcinoma, glandular hyperplasia with atypia according to dysplasia type I, II, III, adenocarcinoma of the cervix of various degrees of differentiation, leiomyosarcoma, etc.), and according to statistics, the coincidence of the cytological interpretation smear and histology findings are noted in 96% of cases.

Inflammation

Although the task of the cytologist is not to view the smear on the flora, nevertheless, the doctor pays attention to it, since the flora often explains the cause of inflammation and reactive changes in the epithelium. The inflammatory process in the cervix can be caused by any microflora, therefore, nonspecific and specific inflammation are distinguished.

Nonspecific inflammation happens:

• acute(up to 10 days) - the smear is characterized by the presence of a large number of neutrophilic leukocytes;
• subacute and chronic when in a smear, in addition to leukocytes, lymphocytes, histiocytes, macrophages, including multinuclear ones, appear. It should be noted that simply the accumulation of leukocytes cannot be perceived as inflammation.

The cytological picture of specific inflammation is determined by the influence of specific pathogens that enter the body and begin their development in the genital organs of the new host. It can be:

Thus, inflammation can be caused by the presence of various pathogens of a bacterial and viral nature, of which there are about 40 species (only a few of them are given as an example above).

table: norms of smear results for women, V - material from the vagina, C - cervical canal (cervix), U - urethra

As for the conditionally pathogenic bacterial flora and leukocytes, the whole point here is their number in each phase of the cycle. For example, if the cytologist clearly sees an inflammatory type of smear, and the cycle is coming to an end or has just begun, then the presence of a large number of leukocytes cannot be considered as a sign of inflammation, because the smear was taken from a non-sterile zone and such reactivity only indicates that menstruation will begin soon ( or just ended). The same picture is observed during the period of ovulation, when the mucous plug leaves (there are many leukocytes, but they are small, dark, immersed in mucus). However, with a truly atrophic smear, which is typical for elderly women, the presence of a large number of surface cells and even a small flora already indicates an inflammatory process.

Video: a smear for oncocytology and how to take it correctly

Why is an analysis for oncocytology taken?

A smear for oncocytology, what is it, why is it taken and what are the indications for diagnosis? This analysis helps to determine cervical cancer, as well as the diseases preceding it, at the earliest possible time.

Every woman should take a smear for cytology and oncocytology at least once a year. And sometimes even more often. Women suffering from genital herpes, HIV, with identified oncogenic types of papillomatosis, in case of early onset of sexual activity and the presence of several partners in it, with long-term use of hormonal contraceptives, should be especially responsible for this annual procedure. After all, it is these diseases and factors that provoke cervical pathologies.

Are there any other options for diagnosing cancer? Certainly there is. And more accurate too. But first, in any case, the smear is deciphered for oncocytology, and if it has changes diagnosed as dysplasia, or a benign disease, often serving as a background for cancer, then colposcopy is performed. Colposcopy allows you to view the cervix with high magnification.

You also need to know when it is better to take a smear for oncocytology in order to get a reliable result. It is desirable to do this in the middle of the menstrual cycle. In addition, it is mandatory before colposcopy or some time after it.
It often happens that a smear from the cervix for oncocytology shows inflammation, then you must first carry out treatment, and then repeat the analysis. And it is better to make sure in advance that there is no inflammation, and only then go to take an analysis for atypical cells. Moreover, you need to “prepare” like this if they take an analysis in a paid laboratory. This is for the purpose of absolutely senseless waste of material resources and time.

The most reliable results of a smear analysis for oncocytology can be obtained if the material is examined using the Papanicolaou method, that is, to do a Pap test. In antenatal clinics, the less perfect Leishman technique is used. Usually, women who have previously been diagnosed with dysplasia, when a smear is taken for oncocytology, the diagnostic algorithm is to do a PAP test, usually it takes about 10 days, if negative changes are detected, then do a colposcopy. If not everything is in order there, too, a cervical biopsy may be needed.

Acting according to this scheme, it is possible with a high degree of probability to avoid cervical cancer.

Leukocytes in a smear in the vast majority of cases are a sign of an inflammatory process in the organs of the urogenital tract, both female and male. However, a rare man, especially at a young age, can “boast” that he had a smear taken if everything is in order with the genitourinary system. For men, smears do not belong to mandatory tests during medical examinations. Another thing is women. Probably, those do not exist, which, at least once a year, are not subjected to such manipulations. And this is in the absence of pathology, but if there are problems, then smears are taken as needed.

Norm and pathology

The material from the male urethra is normally not abundant. Solitary leukocytes, transitional epithelium in a smear, single rods - that's all that a healthy man can provide us. The appearance of a large number of leukocytes in a smear of the stronger sex, as a rule, is accompanied by the presence of the culprits of inflammation(, yeast-like fungi of the genus, etc.), which is treated, and then the analysis is taken again to ensure the success of the measures taken.

As for women, an increased number of leukocytes is observed before menstruation and is considered an absolutely natural phenomenon. In addition, the elevated content itself (the norm is up to 30 cells in the field of view) does not apply to reliable indicators, the absence of morphological signs of these cells is considered evidence of the norm of leukocytes. They are “calm”, not destroyed (the nuclei are preserved), there are no signs of phagocytosis. In addition, sometimes the reason for the error of the diagnostician may be incorrectly taken material. An example is a “thick” smear, which is practically not visible due to the fact that the entire field is dotted with clusters of overlapping cells (including leukocytes). Without risking a mistake, in such cases, the woman is offered to take the test again.

Table: Norms for smear results for women

V - material from the vagina, C - cervical canal (cervix), U - urethra

Flora and cytology - what is their difference?

If in men the analysis is taken only from the urethra, then in women there are more objects of study: urethra, vagina, cervix, cervical canal. True, sometimes they take an aspirate from the uterine cavity and also make smears, but this is considered a biopsy material that is viewed by a cytologist. He also draws a conclusion. Aspirates are not taken during routine examinations, this analysis is used exclusively for diagnostic purposes to detect cancerous and precancerous diseases of the main reproductive organ in women. In addition, if the aspirate is filled with formalin, and then applied to the slides and painted, a histological preparation will be obtained, which is considered the last resort in the diagnosis of malignant neoplasms.

Probably, many have heard the expressions: “a smear for flora”, “a smear for cytology”. What does all of this mean? How are they similar and how are they different?

The fact is that in a smear on the flora at high magnification with immersion, the doctor can count the cells, detect trichomonas, yeast, diplococci, gardnerella and other microorganisms, representing a rich biocenosis of the female genital area. But he will not be able to determine the morphological changes in the epithelium, since these are different areas of laboratory diagnostics, where cytology occupies a separate niche. The study of the cellular composition of some material requires, in addition to certain knowledge, also special training. The study of pathological changes in the cell and nucleus theoretically gives very little, here, as they say, a trained eye is needed.

The doctor is engaged in deciphering the analysis in both cases (flora and cytology), we only have to slightly familiarize ourselves with some concepts so that when faced with a similar problem, we do not get scared and do not panic.

Cytological examination

The tasks and functions of cytology are much broader, and therefore its possibilities are wider. The doctor examining the material focuses on the state of epithelial cells in order to identify pathological processes (inflammation, dysplasia, malignant neoplasms) and at the same time notes the flora. Most often, the vaginal portion of the cervix, represented by stratified (four-layer) squamous epithelium (SPE) and the cervical canal, is subject to research. With a correctly taken smear from the cervical canal in the cytological preparation, at the norm, the prismatic (cylindrical) epithelium, single leukocytes and depleted microflora, which could come from the underlying sections (from the vagina, for example), are clearly visible.

It should be noted that the cytological preparation is more informative, since the method of staining (according to Romanovsky-Giemsa, Pappenheim or Papanicolaou) gives a clearer picture. Cells are viewed first at low magnification to assess the general state of the drug, and then at high magnification (with immersion) in order to consider not only the epithelium itself, but also changes in the nucleus characteristic of a particular disease. In a word, the cytologist sees the flora, inflammation, and in most cases its cause and changes that this inflammatory process entailed. As well as indicative signs of infections that present particular difficulties in diagnosis, precancerous and neoplastic conditions of the epithelium.

Video: about a smear for oncocytology

Indirect signs of some STIs in cytology

As for the smear for STIs, it is desirable to examine it as a cytological preparation. A smear taken on the flora and stained with methylene blue is the most important, affordable and cheap, and therefore the most common diagnostic method in gynecology. However, unfortunately, it does not provide the necessary completeness of the picture for the diagnostic search for STDs and their consequences.

In addition to all possible inhabitants that, when infected or disturbed, are visible in a smear on the flora (Trichomonas, yeast, leptothrix), indirect signs of the presence of microorganisms can be found in the test material (cytology), which are very problematic to identify using microscopic methods:

• The appearance of giant multinucleated MPE cells, sometimes of a rather bizarre shape, often with signs of parakeratosis and hyperkeratosis (keratinization), indicates a possible lesion;
• Cells in the form of an "owl's eye" with coarse-grained cytoplasm are characteristic of;
• When it is possible to detect koilocytic atypia (MPE cells with large nuclei and an area of ​​enlightenment around the nucleus);
• Indicative are the bodies of Provachek in the cells of metaplastic epithelium, which are characteristic of and play an important role in screening studies.

Of course, it is impossible to diagnose a herpetic, cytomegalovirus or papillomavirus infection with a cytological analysis, but it can be assumed, and this is already the basis for a further, more in-depth examination in a specific direction (, etc.). Thus, cytology allows you to narrow the range of diagnostic search, avoid unnecessary tests, save time, and promptly start treatment.

How to prepare for the analysis?

Since the simplest and most accessible method for detecting inflammatory processes in the urogenital tract, both in men and women, is a smear on the flora, it is necessary to pay more attention to it and teach the reader to understand a little about the entries on the form.

However, before making a visit to the doctor, Patients should know some simple rules:

1. A couple of days before the test, it is necessary to exclude not only sexual contacts (sometimes spermatozoa can be seen in a female smear), but also all sorts of interventions such as douching, the use of local medications (suppositories, creams, tablets);
2. You should not go for such a study during menstruation, because menstrual blood will interfere with viewing the drug, where the doctor will see it mainly;
3. On the day of the examination, you need to calculate the time so that you urinate for the last time in 2-3 hours, since urine can wash out all the “information”;
4. 7-10 days before the analysis, stop taking pharmaceuticals, especially antibacterial ones, or take a smear only a week after the end of treatment;
5. Another rule that women often ignore is not to use intimate hygiene products. Of course, it is very difficult to refrain from such procedures in general, as experts recommend, but at least you can limit yourself to clean warm water. Men, on the other hand, carry out the last toilet of the external genital organs in the evening on the eve of visiting the doctor.

After following these tips, a person goes to an appointment, where they will take a smear, paint and look under a microscope. The doctor will take care of the decoding, and the patient will receive a conclusion in his hands, and he will probably be interested to know what all these numbers and words mean.

Video: preparing for a smear

What can be seen in a male urethral smear?

Probably, the reader has guessed that the analysis of men is unlikely to leave pleasant memories, because the object of study is not so accessible to them, so there will really be unpleasant sensations that may not leave the person for several more hours. Sometimes, in order to avoid this, the doctor prescribes a prostate massage to the patient, which is carried out a few days before the procedure per rectum, that is, through the rectum.

However, if the burning sensation and soreness in the penis continues to remind of itself for several days, and these phenomena have also been added similar to, a trip to the doctor is inevitable. But if everything went well, then maybe men will be reassured by the fact that everything looks much simpler in their smear taken from the urethra, unless, of course, normal analysis:

• The norm of leukocytes is up to 5 cells in the field of view;
• The flora is made up of single sticks;
• The general background dilutes the urethral epithelium (mostly transitional) - approximately 5-7 (up to 10) cells;
• A small amount of mucus, which does not play any role;
• Sometimes a smear may contain opportunistic flora in single specimens (streptococci, staphylococci, enterococci), however, in order to differentiate it, it is necessary to stain the smear according to Gram.

In the case of an inflammatory process, the smear changes:

1. A large number of leukocytes appear in the smear, sometimes not countable;
2. Coccal or cocco-bacillary flora displaces rod;
3. The preparation contains microbes that caused inflammation (trichomonas, gonococci, yeast, etc.);
4. It is hardly possible to see microorganisms such as chlamydia, urea- and mycoplasmas under a microscope, just like distinguishing pathogenic diplococci that cause gonorrhea from enterococci lying in pairs or a chain of Enterococcus faecalis (enterococci too) from streptococci, therefore, in such cases, to clarify the species pathogen, the study is supplemented by a cultural method or the almost universal and popular nowadays PCR (polymerase chain reaction);
5. With rare exceptions, in a man's smear, you can find E. coli (a flagrant violation of hygiene rules!), Beneficial in the intestines, but causing cystitis, getting into the urethra of a man. For its differentiation, additional laboratory research methods are also needed.

They do the same with female smears, since the found diplococci may not be Neisseria at all and do not cause gonorrhea. By the way, E. coli (Escherichia coli), enterococcus (Enterococcus faecalis), staphylococci with streptococci and other microorganisms in female smears are much more common, due to the structure of the female genital organs.

Ecosystem of the female urogenital tract

Leukocytes in a smear taken in gynecology, even for flora, even for cytology, are not the only cells present in the preparation. In addition, they act only as a consequence or reaction to events occurring in the ecosystem (hormonal fluctuations, inflammation). For example, their increase in different phases of the cycle is due to hormonal influence, therefore, when taking material, the date of the last menstruation is indicated in the referral form.

The diagnostic criterion of the inflammatory process is considered not only a large amount of Le, "escaping" to the place of "military operations", but also the state of their nuclei. When leukocytes react, they try to absorb the “enemy”, phagocytize, but they themselves begin to break down. Destroyed cells are called neutrophilic leukocytes, however, this phenomenon is not indicated in the decoding of the analysis. A large number of neutrophilic leukocytes, together with abundant cocco-bacillary or coccal flora, serves as the basis for confirming the presence of an inflammatory process.

The ecosystem of the female genital organs includes microorganisms that occupy certain niches, which are: the epithelium of the vagina, cervix, cervical canal, rich in endocervical glands. These anatomical formations provide conditions for the vital activity of certain microorganisms. Some of the inhabitants are mandatory (obligate), while others come from outside due to certain circumstances and cause various inflammatory reactions of the epithelium.

In addition, the balance in the ecosystem can be disturbed by various factors that negatively affect the woman's body (both internal and external), which lead to the fact that microbes living in small numbers begin to displace natural inhabitants representing rod flora and occupy the dominant position. An example of this is the colonization of the vaginal environment with gardnerella, which for a number of reasons displaces lactobacilli (Doderlein sticks). The result of such a "war" is widely known.

The norm in a gynecological smear

The microscopic creatures that live in the genital tract of a woman are diverse, but the norms still exist, although sometimes it is very difficult to determine their boundaries, but we will still try to do it. Thus, in a smear taken in gynecology, you can find:

• Leukocytes, the norm of which in the urethra is up to 10 cells per field of view, in the cervix and its canal - up to 30 cells. During pregnancy, these indicators change upwards;
• The type of epithelium in the smear depends on the place where the material was taken: the urethra, the neck, the vagina are lined with stratified squamous epithelium (SSE), which we will get in the preparation. A smear from the cervical canal will be represented by a cylindrical (prismatic) epithelium. The number of cells changes in different phases of the cycle; in general, it is generally accepted that, at the norm, their content should not exceed 10 units. However, all this is very conditional, since for accurate diagnosis it is necessary to take into account morphological changes in cellular structures(nucleus, cytoplasm, the presence of "naked nuclei"), that is, to conduct a cytological analysis;
• Mucus in the preparation is considered an obligatory, but moderate, component, because the glands of the cervical canal and vagina secrete it. The mucus looks interesting in the ovulatory phase of the menstrual cycle, it crystallizes and forms patterns similar to the leaves of a plant, which are called the "fern symptom" (cytology);
• A normal smear, as a rule, is represented by rod flora (lactobacilli) and single cocci.

Conditionally pathogenic flora is not always the norm

In addition to lactobacilli - the main representatives of the normal microflora of the genital tract, which are entrusted with the important function of "self-purification of the vaginal environment", other opportunistic microorganisms can be found in a smear in small quantities:

All these representatives of the microflora can live without disturbing anyone, or cause inflammation under certain conditions. By the way, even lactobacilli in excess and in abundant bacterial flora can provoke an inflammatory process - lactobacillus, manifested by itching, burning, discharge. The disease, of course, is not fatal, but very painful.

Pathogenic "guests"

The presence of pathogenic microorganisms, transmitted mainly through sexual contact, almost always causes trouble. Local inflammation caused by the pathogen can spread to other organs and systems and (often) become chronic if not treated in time.

This phenomenon is especially dangerous during pregnancy, since many pathogens can have a very negative effect on the fetus, so a bad smear during pregnancy is a guide to action, moreover, immediate. What microorganisms can threaten the human reproductive system through sexual transmission? Probably, we will not surprise anyone by naming them, but once again it still does not hurt to recall the danger posed by microscopic creatures.

gonococcus - the causative agent of gonorrhea

Thus, the pathogenic microflora of the genital tract includes:

What is the degree of purity?

A smear for the degree of purity of the vagina is taken as a regular smear for the flora, but is evaluated somewhat differently. In gynecology, the IV degree of purity is distinguished:

I degree- a rather rare phenomenon, the smear is clean, only rod flora, single leukocytes and squamous epithelial cells in optimal quantities;

II degree- among the sticks, single cocci can “slip” or other non-pathogenic microorganisms can also be mixed in single copies, this degree is the most common among gynecologically healthy women;

table: standards for assessing the cleanliness of the vagina

III degree- it is characterized by conditionally pathogenic flora and yeast-like fungi, which tend to actively reproduce. This may indicate the development of an inflammatory reaction to the presence of an excessive number of opportunistic microorganisms. This analysis involves an additional examination of the woman;

IV degree- signs of an obvious inflammatory process: abundant coccal or cocco-bacillary (mixed) flora, the presence of Trichomonas, gonococci or other pathogenic microorganisms is possible. In such cases, additional laboratory tests (bacteriological, PCR, etc.) are prescribed to search for the pathogen and further treatment.

A smear on the flora, although it is considered a simple method, but has great potential. The first step in the laboratory diagnosis of diseases of the urogenital tract, sometimes, immediately solves the problem and allows you to immediately begin therapeutic measures, the quality of which will subsequently be controlled by the smear itself, therefore it is not recommended to avoid such an accessible procedure. It does not require a lot of expenses, and the answer will not have to wait long.