A diagnostic method that allows you to study the structure of cells, including the mucous membrane, as well as to detect the presence or absence of pathological processes, is called cytology. The main objective of this type of research is to identify oncological pathology, bacterial or viral infection. Cervical cytology is a common type of examination in gynecological practice.
General information
Another name for this type of analysis is the PAP test or Pap smear, named after the Greek Aesculapius, thanks to whom this type of research appeared in the fifties of the last century. The analysis allows you to identify violations in the structure of cells, i.e., precancerous processes that occur before the formation of cervical cancer. Years pass from the appearance of changes in the cellular structure to the oncopathology, therefore regular analyzes are necessary. Cytology of the cervix helps to detect the problem in the early stages, prescribe treatment in a timely manner andprevent the development of the disease. With the help of the PAP test, the structure of only the cells of the cervix is analyzed, which is lined on the outside with a pink epithelium that has several layers. One row of cylindrical cells covers the inner surface of the cervix. This epithelium is endowed with a rich red tint. Cells are subject to research both from the inside and from the outside.
Indications and contraindications for cytological examination
This type of study is considered mandatory when visiting a gynecologist for all the fair sex from the age of 18. In addition, a cervical cytology smear is indicated for:
- menstrual irregularities;
- before IUD insertion;
- HIV diagnostics;
- infertility;
- taking hormonal contraceptives;
- obesity, metabolic syndrome;
- human papillomavirus;
- genital herpes.
Contraindications for cytological examination are:
- menstruation;
- pregnancy;
- virginity.
Underage girls who have sex, a smear for cervical cytology is taken in the presence of official representatives. After delivery, the biomaterial can be donated at least three months later, when the tone of the uterus and the birth canal are fully restored.
Performing cytology
The doctor takes a smear during the examination of the patient from the inner and outer surface of the cervix, using for thispurpose of a special spatula. The manipulation is painless and takes no more than ten seconds. In some cases, slight bloody spotting is possible within two days. The biomaterial is applied to a glass slide. Laboratory assistants evaluate the quality of the smear and the cells, which must be of a certain size, shape, as well as the ratio between the nucleus and the cell. For this, various fixatives and dyes are used, which make it possible to more accurately diagnose precancerous changes. In addition to them, deciphering the cytology of the cervix may show changes of a different nature associated with:
- using contraception;
- viral infections;
- inflammatory processes.
Results will be ready in a day. Signs of abnormal cells:
- anomalies in the cytoplasm;
- increased core;
- changing the color and shape of the core.
When they are detected, the doctor recommends additional types of examinations, since cytology does not allow to determine the depth of the lesion, as well as to distinguish dysplasia from carcinoma.
Interpretation of histology results
Bethesda classifications are used to communicate to doctors the data obtained during the histological examination. According to this systematization, squamous intraepithelial disorders are distinguished:
- LISIL – low.
- HSIL is high.
- Invasive (spreading) cancer.
LISIL includes the following changes:
- associated with HPVhuman papillomas);
- intraepithelial cancer – cr in situ;
- severe dysplasia - CIN III;
- moderate – CIN II;
- weak – CIN I.
Notation in the form of terms:
- ASCUS - used for changes between reactive state and dysplasia that are difficult to differentiate.
- NILM - combines reactive and benign changes, as well as the norm.
If the conclusion says that "The cytogram is within the normal range", then this indicates the absence of pathological changes in the cervix. If reactive changes of unknown origin are detected, then additional types of analyzes are needed. The presence of the terms ASC-US or ASC-H in the conclusion implies a dynamic observation of a woman, as well as a further examination.
Preparing for analysis
General recommendations before submitting biomaterial for cervical cytology:
- 3 hours before the procedure, do not urinate;
- for two days - refrain from intimacy, douche and do not use vaginal products.
During the period of menstruation, a smear is not taken, it is given immediately after menstruation. Cytology is also undesirable in the presence of itching or vaginal discharge. A smear taken during pregnancy shows a distorted result. In the presence of an infectious process in the acute phase, the biomaterial is taken to study changes in the epithelium. The control study is repeated after two months after treatment. A false positive cervical cytology result may be due to the following reasons:
- onbiomaterial got blood;
- use of vaginal products before the test;
- not enough cells on slide;
- presence of infectious processes in the cervix and vagina.
Properly carried out preparatory measures reduce the frequency of unreliable results to a minimum. In the presence of visual pathology on the neck, the biomaterial is taken regardless of the above factors.
How often is a Pap test done?
The first time it should be done after the start of an intimate life. Further - annually, with preventive gynecological examinations. In the absence, according to the results of deciphering the cytology of the cervix, violations in the structure of cells in a row for three years, the test is recommended to be done every three years. Cytology is not performed after 65 years of age, provided that all previous results were good. This scheme is used if the couple has no other sexual partners. With risk factors or in case of detection of pathological changes in the cellular structure of the cervix, the doctor individually prescribes the frequency of cytology. Risk factors include:
- smoking;
- early onset of sexual relations;
- several sexual partners from both a woman and a man;
- HIV;
- existing or past sexually transmitted diseases.
Liquid-based cytology
The study of cervical scrapings provides an opportunity to identify cancerous and precancerous changes in cells. If a tumor is foundcells are subjected to histological examination. Liquid cytology is a modern method of preparing a preparation in a liquid medium from a cell suspension. The benefits of liquid cervical cytology are as follows:
- more accurate result;
- liquid medium preserves cells for a long period (up to six months);
- molecular biological and morphological properties of cells are preserved;
- storage is carried out in a special solution that prevents them from drying out;
- the quality of the biomaterial is better, since the presence of destroyed cells, mucus, various elements of inflammation and blood is minimized.
So, a cytological examination of a smear taken from the cervix makes it possible to detect the pathology of the epithelium and analyze the state of the mucous membrane. However, there are some limitations in the application of this method. Of the shortcomings, the impossibility should be noted:
- determining the process of inflammation;
- assessment of the cell environment in the biomaterial.
Cervical cytology decoding
Liquid-based cytology results are interpreted depending on the data obtained during the examination of the sample:
- adequate - the composition of the cells is indicated;
- not adequate enough - reasons are described;
- unsatisfactory - unable to assess process and reflect cause.
The cell structure is described in detail in the cytological characteristics. Benign changes are:
- radiation - occur after exposure to x-rays;
- degenerative - indicate damage to the epithelium;
- reparative - reflect the restoration of the epithelium;
- an increase in the volume of cell nuclei - the likelihood of an oncological process;
- dyskeratosis - keratinization is disturbed, plaques have formed;
- hyperkeratosis - excessive keratinization;
- parakeratosis - in the stratum corneum there are cell nuclei that should not be normal;
- bacterial vaginosis - changes in the vaginal microflora.
Abnormal changes in the squamous epithelium are described according to the Bethesda classification:
- ASC-US - Unclear atypical changes detected.
- ASC-H - atypical changes.
- LSIL - low grade intracellular changes.
- HSIL - high degree of change.
- CIS – intraepithelial carcinoma in situ. Cancer in the initial stage, in the area of the surface epithelium.
- AG-US - atypical changes of an unclear nature in the glandular epithelium.
- AIS is a carcinoma in situ that develops inside the cervical canal.
Additionally, information about detected bacterial cells, fungi, etc.
Inflammation cytogram
These are changes in the smear that indicate the presence of inflammation in the cervix. Cytology helps to identify them, since in the process of this study the composition of the resulting preparation is analyzed. Studying and installing:
- the presence of microbes in cells that can provoke an inflammatory process;
- located in the chromatin nucleus;
- quantitative composition of blood cells;
- reactive changes;
- shape of epithelial cells.
The above indicators are analyzed in all layers of the epithelial layer. After receiving a cytogram of inflammation, a smear is again taken to study the microflora and determine its sensitivity to antibiotics. After a course of antibiotic therapy, the doctor prescribes a second analysis.
Cervical cytology results
An inflammation cytogram is one of the most common and harmless conclusions. Research results may contain information about koilocytes. These cells appear when a woman is infected with the human papillomavirus. Additional tests are ordered to confirm infection. Leukoplakia or hyperkeratosis of the cervix also reflects the cytogram. It is possible to suspect this pathological condition even during the taking of the biomaterial. The presence of atypical cells, which are characterized by irregular sizes and shapes, rapid and random division, is also detected using cytology. When they are detected, a reanalysis is made, which is necessary to eliminate the error. If such cells are found again during a second examination, then this indicates a precancerous condition of the cervix.
Cervical cancer
This is a fairly common worldwide disease among the female population. The growth of a tumor of a malignant nature of the cervix with the transition tothe germinating common form proceeds for a long period. The transition of epithelial cells to a severe degree of disturbance lasts about 10–15 years. With the help of early recognition, it is possible to detect a precancerous condition. In this case, biological material taken from the inner and outer surface of the cervix is subjected to cytological examination. In contrast to the standard technique, cervical fluid cytology, especially for early diagnosis, is considered the gold standard. Causes of cervical cancer:
- frequent delivery;
- weakened immune system;
- smoking;
- past infection (chlamydia);
- change of sexual partners;
- age over 40;
- long-term use of hormonal contraceptives;
- occasional examinations;
- insufficient content of vitamins C and A in the body.
Most often this disease occurs at the junction of the stratified epithelium of the cervix into the epithelium of the cervical canal. It is important to remember that additional types of examinations are needed to confirm and clarify cervical cancer. Cytology is primarily aimed at detecting cell changes.
Cytological diagnostics
Analysis of smears from the cervix helps to identify signs, if any, of various abnormal processes:
- precancerous;
- tumor;
- reactive.
And besides, analyze the state of the mucous membrane. If the interpretation of the resultsother types of examinations showed that there are viral, parasitic or bacterial infections, then using cytological analysis, signs of damage are assessed, as well as metaplasia, proliferation, and transformation of cervical cells. Cytology also helps to identify the cause of epithelial disorders:
- Abnormal processes associated with mechanical or radiation effects on the cervix, taking hormonal medications.
- Conditions that provoke the formation of dysplasia and neoplasms of the cervix.
- Presence of inflammation and approximate definition of pathogens.
Based on the foregoing, we can conclude: both in the presence of visible changes during examination of the mucosa, and with a visually normal cervix, an analysis is shown - cytology of the cervix. Decoding will demonstrate deviations or norms. In addition, this study is important in the dynamic monitoring of women who have been identified unclear atypical transformations of squamous cells.
