Papanicolaou smear (PAP test) or smear for oncocytology

The founder of Russian gynecology, Professor Vladimir Fedorovich Snegirev, often said:

“What did I see the most? Cancer. What do I know least? Cancer."

Many decades have passed, but cancer of the uterus, ovaries and mammary glands continues to claim the lives of many Russian women. The fact is that tissues that are subject to the greatest hormonal changes during the menstrual cycle are most prone to malignant degeneration.

• A special place among various types of cancer of the female genital organs is occupied by

cervical cancer . Among all cancers in women, cervical cancer ranks second after breast cancer. Its specificity is that it often develops against the background of benign processes. Refusal of preventive examinations, early onset of sexual activity, sexually transmitted diseases, abortions, and bad habits are factors contributing to the development of cervical diseases. Therefore, experts are increasingly talking about the epidemic of cervical cancer that is sweeping the modern world.

Such simple and accessible diagnostic methods: Papanicolaou smear and colposcopy - make it possible to detect initial precancerous changes and carry out simple and effective treatment at an early stage.

That is why, if every woman finds the opportunity to undergo such an examination every year, deaths from cervical cancer will be prevented.

Papanicolaou smear = oncocytology is a simple, effective test for identifying abnormalities in the structure of cervical cells.

The test was developed in 1943, but even today this test is used to detect abnormalities in cells at the precancerous stage. With the help of the right plan for further action, all deviations can be successfully cured!!!.

What are the causes of abnormal Pap smear results?

When there is an infection such as thrush, trichomonas, chlamydia, or gonococcus, the cells in the cervix become inflamed and appear abnormal. Once the infection is treated, the Pap smear usually returns to normal.

A common cause of abnormal Pap smears is human papillomavirus. The virus may be present in the cervix and may also cause genital warts in the external genital area. There are many types of human papillomavirus, some of which are associated with an increased risk of cervical cancer. Therefore, women who have been diagnosed with human papillomavirus are at risk for developing cervical cancer.

Cancer cells are the most modified abnormal cells found in a Pap smear. In preinvasive cancer, only the superficial cells are affected. Invasive cervical cancer means that the disease has spread beyond the surface layer of cells.

How to Prepare for a Pap Test

It is recommended to take the test no earlier than on the 5th day of the menstrual cycle and no later than 5 days before the start of menstruation. On the eve and on the day of the study, do not douche the vagina, and 2-3 days before, avoid the use of fat-containing vaginal preparations (suppositories, creams, vaginal tablets). During menstruation, as well as earlier than 24-48 hours after sexual intercourse, intravaginal ultrasound and colposcopy, a smear is not taken!

To eliminate the risk of developing this serious disease, take care of your health, make an appointment with a gynecologist at CITILAB and perform a Pap test based on the liquid cytology method - 90-69-502 - Cytological examination of scrapings of the cervix, cervical canal, vagina with staining Papanicolaou (material taken in liquid transport medium).

Be healthy!

Author:

Baktyshev Alexey Ilyich, General Practitioner (family doctor), Ultrasound Doctor, Chief Physician

What is done if the Pap smear is abnormal?

The plan of action depends on the degree of cellular changes described by the cytologist. If the changes are associated with inflammation, the smear is usually repeated several months later. If necessary, appropriate treatment can be prescribed. Smears in which low-grade abnormalities are detected can be repeated after a few months with a follow-up colposcopy. High degree deviations are always an indication for colposcopy. Patients with abnormal smears are advised to use condoms or abstain from sexual intercourse until the examination is completed.

Cytological examination according to Papanicolaou 1 sample (scraping c/k+sh/m)

Papanicolaou smear, or Pap test

is a test that can help identify precancerous or cancerous cells in the vagina and cervix.
The main difference from a standard cytological examination is the additional fixation of the material with alcohol during glass preparation, which increases the accuracy of the analysis. The Pap test makes
it possible to quite effectively detect precancerous changes in the epithelium - cervical intraepithelial neoplasia of varying degrees of severity.

This type of study is mandatory for women over 30 years of age, especially those who have previously or are currently found to have high oncogenic risk human papillomaviruses, 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.

Indications:

• cervical cancer screening.

Preparation
In women of reproductive age, it is advisable to take a smear for examination no earlier than the 5th day from the start of the menstrual cycle or no later than 5 days before the expected start of menstruation.

24 hours before collection, you must stop using vaginal medications, spermicides, lubricants, and avoid sexual intercourse. You should not douche the day before your smear test.

If there is a visual pathology on the cervix, a smear should be taken regardless of the above factors.

*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

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).

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. The results of these tests show the presence of abnormal cells, which often sounds scary to women who don't 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 the necessary treatment and repeat the smear after 3-6 months. With human papillomavirus infection, koilocytosis of cells is often detected. Koilocytes are 3 cells of squamous epithelium 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. There is clearing of the cytoplasm around the nucleus.

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.

Bethesda Classification
When classifying according to the Bethesda System (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.
The protocol for a standardized cytological report consists of the following sections:

1. Quality of the drug:

• adequate;
• inadequate.

2. Cytogram/description:

• epithelial cells within normal limits are replaced by negative ones for intraepithelial pathology or malignancy;
• the detected pathological changes in the epithelium are described.

3. Cytogram/features: main categories of pathological changes in the epithelium: a) atypical squamous cells (ASC):

• ASC-US of undetermined significance - 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-CIN 1 (dysplasia I-lung), papillomavirus infection-HPV;
• high grade squamous intraepithelial lesions (HSIL);
• CIN 2 (dysplasia II-moderate), CIN 3 (dysplasia III-severe), cancer in situ;
• squamous cell carcinoma.

b) atypical glandular cells (AGS):

• without additional characteristics;
• cells suspicious for invasion;
• endocervical adenocarcinoma in situ; - adenocarcinoma.

4. Cytogram/other types: other non-neoplastic changes (if detected).
5. Additional clarifications: the specific infectious agent is indicated (if detected).

What is colposcopy?

A colposcope is an instrument, much like a microscope, that allows the doctor to examine the external genital area (vulva), vagina, and cervix under magnification, so that areas of change can be more easily detected. The patient is placed on a gynecological chair and a gynecological speculum is inserted into the vagina. The doctor lubricates the cervix with special solutions, which make it easier to see cellular abnormalities. The colposcope itself does not touch the patient. Colposcopy is not performed during menstruation. 24 hours before colposcopy, the patient should not douche, use vaginal gels, ointments or tampons, because this may affect the accuracy of the study.

Analysis of a smear for oncocytology has greater diagnostic quality when carried out by colposcopic targeted examination of cervical tissue.

How is a Pap test performed and interpreted?

For the study, a scraping is taken from the surface of the cervix and cervical canal, as well as from the transformation zone, in which most often, up to 80%, the pathological process occurs, which is an advantage of the study using liquid cytology.

Cytological classification according to Papanicolaou:

• 1st class - normal cells;
• 2nd class - change in cell shape caused by an inflammatory process in the vagina and/or cervix;
• 3rd class - there are single cells with an abnormality of the nuclei and cytoplasm (suspicion of a malignant neoplasm);
• grade 4 - individual cells suspicious for malignancy are present;
• Class 5 - a large number of typical cancer cells are present.

What is done if cellular changes are detected during colposcopy?

If cellular abnormalities are detected, the doctor may do a biopsy. A biopsy is the removal of a small piece of tissue from the changed area. A woman may feel a sharp prick or discomfort (some women may not feel anything at all). There may be some light bloody or spotting discharge from the genital tract for several days after the biopsy. The tissue sample is sent to a histology laboratory, where it is examined by a specialist under a microscope in all sections.

Who is the Pap test recommended for?

Most often, cervical cancer occurs in women aged 45-55 years, postmenopausal women, and over the age of 65 years. However, there is evidence of an increase in incidence among women under 30 years of age. Moreover, in 18% of this age group, after screening, the disease is detected at a late stage, when treatment may not be as effective.

A Pap test is recommended for all women of reproductive age starting at age 21. It is recommended to perform it every two years, necessarily in the presence of gynecological pathologies of a viral nature (genital warts, genital herpes), long-term use of contraceptive and hormonal drugs, the appearance of atypical discharge from the genital tract, or infertility. If the results are negative, a Pap test is performed once every three years.

The purpose of the Pap test is to detect cancer in situ, that is, stage 0 cancer. This helps to prescribe effective “saving” treatment, reduce its duration, and avoid complications.

What to do if the biopsy indicates abnormalities?

Medical recommendations will depend on the histological report. At the “For Birth” clinic, experienced doctors who are experts in cervical pathology will prescribe appropriate treatment and a follow-up plan with repeat Pap smears at certain intervals. It is possible that procedures using electrowave therapy or laser therapy will be prescribed to remove the changed cells.

Dear women, remember that undergoing a cervical examination procedure once a year COLPOSCOPY WITH ONCOCYTOLOGY will relieve you of fears of cervical cancer!!!
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What does the study show?

Microscopic examination of biological material from the cervix is ​​performed on a glass slide. Cytological examination allows you to assess the condition of cells, their structure, detect anomalies in the structure of the nucleus and cytoplasm and the division process. It is based on these characteristics that the cytologist makes a conclusion about the presence or absence of atypia. In addition, the test informs about the activity of pathogens of infectious diseases and the activity of inflammatory processes. A large number of leukocytes signals that pathogenic microorganisms are present in the diagnosed location, which methodically destroy the anatomical and physiological structures of the female reproductive system.

Advantages:

• high diagnostic accuracy;
• harmlessness, ease of manipulation;
• no need for medical training or hospitalization;
• the ability to get results quickly.
• cheap research

Flaws:

1. a large percentage of false negative responses, up to 50% of cases, changes are not detected in the smear
2. the need to comply with requirements for the collection and transportation of tests
3. need to visit a gynecologist

It should be noted that the oncocytology method is very low-sensitivity (a lot of missed pathology), but very highly specific (if atypia is detected, then it definitely exists). In this regard, you should not double-check one smear with another; you can get a false negative test and underestimate the situation and waste time. If atypia is detected, it is necessary to conduct an in-depth diagnosis from a specialist.

Table with recommendations for different age categories for performing a Pap smear

3.Do pathological changes in the cells of the cervix cause any symptoms?

No, changes in cells are usually not associated with poor health or other noticeable symptoms. The human papillomavirus, which is most often associated with abnormal Pap test results, also usually does not cause any obvious symptoms.

But if the cause of an abnormal test result is another sexually transmitted infection, the following may occur:

• Vaginal discharge that is not typical for you. The amount, color, smell, or texture of the discharge may change.
• Pain, burning or itching in the pelvic or genital area when urinating or having sex.
• Sores, blisters, rashes, or warts on or around the genitals.

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Why is a Pap smear performed?

A cytological examination is carried out to identify abnormalities in the structure of the cells of the cervix and vagina. In order to detect malignant tumors in time, you should not neglect the diagnostic procedure, if only because health should always come first.

Do not forget that cancer can progress over a short period of time, and this can lead to its metastasis and inoperability of the tumor. This is why it is so important for women to have a smear, which helps diagnose any pathological changes in the structure of cells at an early stage of the disease, and also enables patients to begin timely treatment.

2.What increases the risk of an abnormal test result?

According to statistics, the risk of becoming infected with the human papillomavirus is higher in those people who have more than one sexual partner (or a partner who, in turn, has other sexual partners). There is also a risk of infection associated with having sex without a condom, especially if the first condition is present. And the risk of HPV infection automatically increases the risk that after the next smear from the cervix, the test results will show a deviation from the norm.

In addition, smoking and disorders of the immune system increase the chance of developing abnormal cells in the cervix.

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Price of Pap test in gynecology

The price of a Pap test in gynecology is set only by private laboratories and can range from 1200-1800 rubles. In public clinics/polyclinics/hospitals such studies are carried out free of charge.

We recommend reading about why cervical erosion occurs. From the article you will learn about the causes of cervical erosion, why and after what time it can appear again.

And here is more information about when a cervical biopsy is performed for erosion.

The Pap test is the only reliable method for the early diagnosis of cervical cancer and the precancerous state of the cells of this organ. Regular examination allows you to avoid terrible consequences, because for many years cervical cancer is asymptomatic and it is impossible to diagnose it without such laboratory testing of biomaterial.

Interpretation of Pap test results

The interpretation of the Pap test results is given by laboratory specialists and the doctor can immediately clarify the diagnosis for his patient.

Norm in analysis

If during a laboratory test no changed cells were detected in the smear, this means that the woman is healthy and does not have dysplasia, cervical cancer or an inflammatory process. It is assumed that signs of progressive candidiasis (fungal disease - thrush) or vaginosis of bacterial origin may be detected.

Under normal conditions, biological material contains:

• columnar, metaplastic epithelium;
• a small amount of bacteria;
• squamous epithelial cells without signs of changes;
• a small number of leukocytes.

Papanicolaou stain result “passed”: how to understand

If data is received from the laboratory with the mark “Papanicolaou staining result “completed,” then this only means that the study has been completed and its data have been sent to the gynecologist who sent the biological material.

Negative result

If only normal cells are found in the smear, the doctor will inform the patient that the test was negative. In this case, no treatment is required, no additional diagnostic measures are carried out.

The next control Pap test will be performed no earlier than 1 year later, unless there are diseases for which the test is performed more often.

Transformation zone cells are present

If transformation zone cells are present, the doctor will report a positive Pap test result. This does not indicate the presence of cancer cells, because changes at the cellular level can vary in extent, severity and level of abnormality.

Squamous cell atypia of undetermined significance

This term means that the test has revealed an abnormality in the development/structure of squamous epithelial cells - they are located on the surface of the cervix. Changes of this type may not indicate a malignant nature of their appearance, in which case the doctor will need to conduct several more studies.

Most often, squamous cell atypia of undetermined significance ends with a diagnosis of human papillomavirus.

Squamous intraepithelial lesions

The term means that changes in the cells of the smear may indicate a precancerous condition. If the severity of the changes is low, then the doctor can assume that several years will pass before the full development of cancer - you can have time to take therapeutic measures that will serve as prevention and stop the process of cell malignancy.

If the changes are too pronounced, then the rate of development of cancer will be high - treatment must be started immediately.

Atypia of glandular cells

Glandular cells are “responsible” for the production of mucus; they are located at the inlet of the cervix and directly in the body of the hollow organ. Their atypical structure and size do not mean the presence of a malignant process. But such results are a reason to conduct a more extensive examination of the woman.

Squamous cell carcinoma, or adenocarcinoma

Squamous cell carcinoma is a pronounced cellular abnormality that clearly indicates the presence of a malignant process in the tissues of the cervix. If such cells are detected, the doctor prescribes an additional examination for the patient:

• examination of the cervix and vaginal walls using a colposcope;
• collection of a fragment of cervical tissue for histological examination in the laboratory.

The last research method is called a biopsy, which allows you to accurately diagnose cancer.

Erroneous Pap test result

Pap test results may be erroneous:

• false positive - indicates cervical dysplasia, although it is absent;
• false negative - the test results are normal, although the disease is clearly present and is diagnosed by a doctor.

In the first case, the reason for obtaining an erroneous result may be the regenerative stage of cervical erosion (regeneration, tissue healing), inflammatory diseases of the reproductive system, and hormonal disorders. A false negative result may be due to incorrect collection of biological material or improper transportation to the laboratory.

Complications after a cervical PAP test and risks from the procedure

After a PAP test of the cervix, the following complications are possible:

• slight bleeding from the vagina - this is considered the conditional norm, the doctor simply warns about this possibility;
• infection at the site of collection of biological material is diagnosed extremely rarely, because the procedure is carried out with sterile instruments.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

The Pap test is considered a safe procedure, so there are no risks. But the absence of such a study means a risk of late diagnosis of cervical cancer, when treatment is either impossible or extremely difficult to implement and may result in remission rather than complete recovery.