When do you need to take a smear for cytology and how is the collection done? Cytology of a smear from the cervical canal interpretation Cytology interpretation of the results

The number of diseases of the female reproductive system is increasing every time. When a woman visits a gynecologist, the doctor takes samples to determine the nature of the microflora. To determine cancer, a smear is taken for cytology. All women must undergo the study once a year.

Cytology smear: description and significance of the procedure

Cytology smear - diagnosis of changes in the cells of the cervix and vagina

Cytological examination is a highly informative and reliable diagnostic method, thanks to which you can obtain information about the condition and possible changes in.

A cytological smear or Pap smear is a microscopic examination that helps identify possible pathologies of the cervix. This is a simple, painless procedure. For study, cells are taken from the surface of the neck. This non-invasive diagnostic method allows you to identify the causative agents of some.

With the help of cytological examination, atypical cells indicating dysplasia can be identified. Dysplasia is usually understood as a change in the structure of all layers of the cervical epithelium. This disease can lead to the development of a cervical tumor.

This study is mandatory for diagnosing possible changes in the structure of the cervix, as well as choosing an effective treatment method.

Typically, a malignant process begins to develop from the lower layers of the epithelium. Over time it progresses. As a result, if a scraping was taken from the surface layer, then a diagnosis can be made when the disease is at the last stage.

Unlike a histological examination, during which a single tissue sample is examined, for a cytological examination all the cells waste from the cervix are taken. When a precancerous condition is detected, invasive research methods are prescribed to clarify the diagnosis.

Purpose of analysis

A smear is taken for cytology in the following cases:

• Planned pregnancy
• Cervical erosion
• Vaginal discharge
• Irregular periods
• Condylomas
• Herpetic rashes in the vagina
• Change of sexual partners
• Obesity

A cytological examination is prescribed before the installation of an intrauterine device, as well as during long-term use of hormonal drugs.For prevention purposes, women should undergo a cytology smear annually. The study is prescribed as soon as the girl begins to be sexually active.

Procedure: preparation and execution

A smear for cytological examination should be taken after the end of menstruation. The procedure is not performed during inflammatory processes in the body and during menstruation. If a woman has undergone a gynecological examination or colposcopy, then a PAP test is performed no earlier than 2 days after these manipulations.

2 days before the study, it is necessary to exclude sexual activity, you cannot douche and use vaginal suppositories and creams.

The procedure for collecting a smear for cytological examination is carried out as follows:

• the woman sits in a gynecological chair and the gynecologist inserts a special device into the vagina to access the cervical canal
• taken with a special spatula or cytological brush from the cervical canal, into the vagina and
• After the examination, the doctor takes a smear precisely on the suspicious and inflamed area
• Next, the material is applied to a glass slide and sent to the laboratory.

The duration of the procedure does not exceed 15 minutes including a gynecological examination.The laboratory technician stains the resulting material using the Papanicolaou method. Based on the reaction of cells with dyes, a conclusion is made about a possible inflammatory process or a precancerous condition.

In addition to the PAP test, liquid cytological testing is performed.

The interpretation here is deeper: it is placed in a special solution, where it is examined under a microscope. Carrying out a liquid test simultaneously with a regular smear for cytology allows you to achieve reliable results.

Interesting video - Cytological studies in gynecology.

After a smear, in rare cases, a woman experiences discomfort. Sometimes after the procedure you may experience spotting and pain in the lower abdomen. These symptoms disappear after a few hours. In these cases, you should use personal hygiene products. To avoid pain and discomfort, you should abstain from sexual activity for a while.

However, if after taking a smear you experience bleeding, abdominal pain, or a fever, you should immediately call an ambulance. Such a reaction can occur when scraping is performed incorrectly or when there is an advanced inflammatory process of the mucous membrane.

How long does a smear take and interpretation of the results?

The examination is performed under a microscope and results can be obtained 1 day after taking a smear. During the study, the shape and size of the cells are determined, and based on this, a precancerous or cancerous condition can be diagnosed. If the result is of poor quality, then the collection of material for research must be repeated.

Cytological smear results:

• At the first stage of the PAP test, the result is negative. Normally, there are no atypical cells.
• Subsequent stages are assessed as positive. At the second stage, morphological changes in cells and an inflammatory process are observed. This stage requires careful examination to identify the causes of inflammation. Usually identified.
• At stage 3, single epithelial cells with structural abnormalities are detected. Some cells have enlarged nuclei, indicating development. In the future, this can lead to a malignant process. In this case, the woman must take a second smear, have a biopsy and undergo a histological examination. The diagnosis is made only after additional examination.
• Stage 4 is urgent. The smear reveals cells that resemble malignant ones. Additional examination involves colposcopy and biopsy with sampling of a suspicious area.
• At stage 5, a large number of cancer cells are detected in the smear, and this indicates an oncological disease. The woman should urgently contact an oncologist for further treatment.

It should be remembered that based on a cytology smear one cannot draw a conclusion about the condition of the uterus or. Therefore, it is recommended to go through.By constantly undergoing a preventive examination and taking a smear for cytological examination, the likelihood of developing serious diseases is significantly reduced.

Content

A smear for cytology, traditional or liquid, is one of the most important parts of the screening diagnosis of precancer and cervical cancer. The introduction of the method into cytological screening programs has made it possible in many countries to reduce mortality from cervical cancer.

Due to the high level of information content, simplicity and ease of implementation, safety for the patient, a cytology smear or Pap test is widely used in mass preventive examinations, and has established itself as an indispensable way to detect patients with background and precancerous diseases of the cervix.

Cytology smear allows identifying patients in the pre-symptomatic phase of cancer or dysplasia, apply gentle treatment methods in a short time, and do not disrupt reproductive plans.

A smear for cytology has low sensitivity, so the ideal option for diagnostic examination of a patient for background and precancerous pathologies is a combination of several methods:

• colposcopy;
• biopsies with histological examination of tissue;
• PCR for human papillomaviruses or its improved version Digene test.

The complex methodology ensures 100% accuracy of results with high-quality material taken and its correct assessment.

It is known that the cause of cervical cancer is at least 15 types of human papillomavirus, and two of them - 16 and 18 - initiate the tumor in 70% of cases. Therefore, diagnosis of cervical diseases should include a smear from the cervical canal for HPV. If a virus is detected in a smear, appropriate therapy is carried out, which significantly reduces the risk of developing precancerous pathologies.

The advantage of a combined examination, which includes not only a cytology smear, but also an HPV test, is the possibility of preventing the formation of adenocarcinoma - a malignant tumor that is not detected by the cytological method.

Timing and indications for the test

As a rule, young women undergo their first smear for cytology at the age of 18. However, such analysis often begins at age 21. The frequency and timing of the smear do not depend on the intensity of the girl’s sexual life.

Frequency of smear test:

• from 18 years of age (21 years) to 64 years of age, a smear test should be performed once a year;
• patients over 65 years old undergo analysis once every 3 years, provided there are no atypical cells previously;
• Once every six months, a smear should be performed in case of menstrual irregularities, the presence of HPV, grade 1 dysplasia and ectopia complicated by infections, while monitoring the treatment of cervical pathologies.

The most appropriate time to perform cytology is the middle of the menstrual cycle. The period before menstruation, as well as after it, is undesirable for a smear due to specific hormonal changes in the cervix.

Readiness times depend on the workload of the laboratory, as well as on the type of structure: public or private. As a rule, in government institutions, the cytology result is ready in 7-14 days, and in private institutions - after 1-3 days.

Features of the smear cytology procedure

The material is considered adequate for research if the cytologist detects in it cells of the cervical canal, the vaginal part of the cervix and the transition zone of transformation: flat epithelium, intermediate and metaplastic, cylindrical in the endocervix, single erythrocytes.

A smear must be obtained from the transformation zone - the area most susceptible to malignant changes. A smear is considered inadequate if there are no columnar epithelial cells, a large number of erythrocytes, leukocytes, or a poor number of cells. If the cytology smear is too thick or thin, the effectiveness decreases sharply.

The procedure for taking a smear consists of several stages and has its own peculiarities.

1. The gynecologist performs two-handed palpation of the uterus, cervix and ovaries.
2. For the most accurate cytology result, colposcopy should be performed. With multiple magnification, the cervix is ​​examined for pathological inclusions. After this, the doctor treats the surface with a vinegar solution and evaluates the result. If there is persistent white staining (acetowhite epithelium), a smear for cytology is taken specifically from these places. This is also done when the neck is lubricated with iodine and there is no brown coloration (iodine-negative reaction). A smear is taken from unstained areas, since this reaction of the integumentary epithelium is considered a pathology.
3. Instruments must be dry and sterile, preferably in individual packaging. Water and disinfectant solutions can destroy cell samples, which will adversely affect the cytology result. When taking a smear, specialists use special instruments: Cervix-Brash, Papette cytobrushes, modified Eyre spatulas.
4. A smear for examination is taken from the surface of the cervix and the visible part of the canal, including the transformation zone, which is clearly identified during colposcopy. In addition, a smear is taken from the outer surface using a spatula, and a scraping is performed from the cervical canal with a cytobrush.
5. The selected material is either applied to glass (in classical cytology) or immersed in a transport fluid (liquid-based cytology).
6. Test tubes and glasses are labeled.

During the manipulation, a woman may feel slight discomfort. After a smear for cytology, brown discharge from the genital tract is noted throughout the day.

Pregnant women over 22 weeks gestation Cytology is performed strictly according to indications, since the procedure can cause complications.

Goals and objectives

A cytology smear allows you to identify a precancerous pathology of the cervix - epithelial dysplasia, in which the risk of developing pre-invasive cancer is 20 times higher. The transition of stages 2 and 3 of dysplasia to pre-invasive cancer (in situ) lasts from 3 to 8 years, and after 10-15 years microinvasive cervical cancer develops.

The most common pathologies detected by smear cytology are:

• ectopia of columnar epithelium;
• hyperkeratosis, parakeratosis - disorders of keratinization of squamous epithelium;
• glandular hyperplasia;
• chronic cervicitis;
• various stages of dysplasia and cancer.

Cytology makes it possible to identify a dysplastic process in the epithelium of the cervix, which prevents the formation of cancer if treated in a timely manner. Cervical dysplasia is asymptomatic at stages 1 and 2, so an annual cytology smear contributes to the early detection of a dangerous pathology.

Stage 3 dysplasia and pre-invasive cancer are most often recorded in women who do not visit a gynecologist for 5 years in a row and do not undergo a cytology smear.

When analyzing the results of a smear for cytology, it is important to evaluate all diagnostic studies, in particular histology or biopsy.

Liquid cytology method

The traditional smear cytology has several limitations that lead to a false negative result (within 2-50%), while the main source of errors in screening and evaluation of results is poor-quality collection, processing of the resulting material and the qualifications of the laboratory technician.

Therefore, the classic smear cytology has been replaced by a new method - liquid cytology. This method was developed in 1996 in the USA. Its essence lies in immersing material from the surface of the cervix and cervical canal not onto a glass slide, but into a liquid accumulation medium. A single-layer preparation is prepared from the resulting suspension using an automatic device, which leads to increased efficiency in assessing the results. When performing a classic smear for cytology, the specimen consists of several layers of cells, which makes a correct assessment difficult, and the true picture may be distorted.

An important feature of the liquid cytology technique is the collection of material obtained by smear from the cervix into a special medium that promotes the preservation of cells, which increases the effectiveness of the study. The structure of cellular elements and their immunohistological characteristics are completely preserved. This allows you to process the resulting smear with special reagents and carry out immunocytochemical reactions and hybridization.

After removing the cells from the liquid medium, staining is carried out. Staining is performed in the same ways as with a traditional smear for cytology, for example, using the Pappenheim method.

Decoding

For the development of many pathological phenomena in the area of ​​the integumentary epithelium of the cervix, the peculiarities of the anatomy of the organ are of decisive importance. In particular, the relationship between the layers of the epithelium of the cervical canal and the vaginal portion of the cervix plays a role.

As a rule, all atypical processes, and then malignancy, occur in the area of ​​transition of the stratified squamous epithelium, which forms the surface of the cervix, into the cylindrical canal lining the inside. Columnar epithelium is otherwise called prismatic or glandular, since its main function is the production of protective mucous secretion for the formation of a plug. The area of ​​transition from one type of tissue to another is called the transition zone or transformation zone. A smear for cytology should be taken, including this area.

The transformation zone can be located in various places:

• on the surface of the cervix in young women, as well as during pregnancy and after childbirth;
• at the entrance to the cervical canal– in women of the reproductive phase;
• deep in the cervical canal– in women of mature age and menopause.

In 96% of cases, pathological processes occur precisely in the transition area, and in the rest - in the area of ​​the cervical canal.

After staining the smear, the cytologist carefully examines the sample under a microscope. In this case, the specialist evaluates:

• type of identified cells and their affiliation (flat, columnar, intermediate epithelium and metaplastic);
• sizes of cellular elements;
• maturity;
• state of the cytoplasm and nucleus;
• ratio of cytoplasm to nucleus sizes;
• fission intensity.

To decipher a smear for cytology, various classifications are used for the purpose of unification. Evaluation of results using the Papanicolaou system is widely used.

1. The first class of smear means normal.
2. The second class of cytology is characterized by inflammatory changes.
3. The third class is described by the presence in the cytology smear of cells containing atypical nuclei and cytoplasm - dysplasia cannot be excluded.
4. The fourth class means the presence of atypical cells that do not exclude cancer.
5. The fifth class is characterized by large numbers of cancer cells.

One of the popular ones is the Bethesda system. This classification implies 3 types of smears.

1. NILM is the norm, namely the absence of intraepithelial malignant changes in the smear. Cytology has a normal result in terms of dysplasia and cancer, but does not exclude inflammatory, atrophic and other changes, for example, the result may indicate the presence of a large number of leukocytes, trichomonas, yeast, bacteria (cocci), viral changes in epithelial cells.
2. ASCUS - cytology smear has an indeterminate result, atypia of unknown origin is present.
3. ASC-H – atypical squamous epithelial cells are present in the smear, and this finding does not exclude a high degree of dysplasia.
4. LSIL - changes detected in the smear indicate a low degree of intraepithelial changes associated with the human papillomavirus - grade 1 dysplasia (CIN I).
5. HSIL means the presence of high-risk changes or level 2, 3 dysplasia (CIN II, CIN III). In addition, the smear result does not exclude pre-invasive (in situ) or microinvasive cancer.

In addition to dysplasia, smear cytology detects cancerous changes, which are designated AGC, AGUS, carcinoma in situ, squamous cell carcinoma (High-Grade SIL) or glandular (adenocarcinoma).

If the results of a smear for cytology are suspicious The woman undergoes a biopsy to confirm or rule out cancer.

After receiving the histology results, the doctor determines the tactics for further action. Additional tests and examinations are carried out depending on individual situations:

• multislice computed tomography;
• MRI with contrast;
• bone scintiography;
• angiography;
• Ultrasound of the pelvis and abdominal cavity;
• X-ray examinations;
• blood tests for tumor markers;
• diagnostic laparoscopy.

When the initial stages of the tumor are confirmed, or more precisely pre-invasive cancer or stage 3 dysplasia, conization is performed to capture healthy tissue. Techniques such as radio wave conization, laser, and electric loop are used. The removed cone is examined histologically to assess the quality and completeness of the excision. The woman is prescribed a course of immunomodulators and is observed for the purpose of dynamic assessment of the condition of the cervix. If microinvasive cancer or stage 1 is detected, hysterectomy is performed. The second and subsequent stages require not only organ removal, but also chemotherapy and radiation therapy.

Many countries have uniform cytological screening programs. In Russia, at the legislative level, it is customary to examine all women over 18 years of age, with a cytology smear from the cervix and cervical canal.

There should be no formalism in the work of gynecologists assisting in the diagnosis of cervical pathologies; sampling for analysis should be carried out taking into account the identified external changes on the surface of the organ, and the result should be assessed in conjunction with all diagnostic methods. The choice of a clinic for cervical cancer screening should be treated scrupulously, since there are often situations when, after testing, it is not possible to detect initial changes.

Every day in Russia about a thousand people die from cancer, and in the world this number is more than 20 thousand. It is sad to realize that many patients could have been saved if the diagnosis had been made in the early stages. Therefore, timely detection of cancer is one of the most important tasks of medicine. One of the ways to diagnose cancer and precancerous conditions was discovered in the middle of the twentieth century: it is enough to “ask” the cells of our body.

What does the term “cytology analysis” mean?

As many people know from school courses, cytology is the science that studies the cells of the body. Cytological examination, in turn, makes it possible to detect abnormalities in the condition, structure and functioning of cells and, based on these data, make a diagnosis or monitor the course of the disease, and determine the success of treatment. The cells will “tell” about many problems in the tissues being studied: inflammation, bacteria, infections and various neoplasms.

Cytology analysis has the following advantages:

• high accuracy;
• minimal degree of interference in the body;
• does not require any special preparation;
• low cost of research;
• quick results.

The main disadvantage of cell research is the need to collect material directly from the affected areas of the body. This creates certain difficulties in cases where the location of the inflammation or tumor is unknown, although the symptoms indicate the presence of such a pathology in the patient.

When is a cytological examination prescribed?

As we have found out, cytology analysis is indispensable primarily in identifying tumors and precancerous conditions, but it also allows us to identify many inflammatory, infectious and autoimmune diseases. Therefore, it is successfully used in many areas of medicine: oncology, gynecology, surgery.

Cytological examination is prescribed in the following cases:

• for the prevention of diseases. For example, gynecologists recommend taking a cytology test annually for the timely detection of tumors, inflammation and infections;
• for diagnostics. Cytological examination allows us to identify the nature of the pathology, determine the presence of tumors and their nature, and detect concomitant diseases. An analysis for diagnostic purposes is prescribed by a doctor to confirm or refute a preliminary diagnosis;
• for control. During the course of therapy, the patient is prescribed a cytological examination to monitor the dynamics of the disease, make changes to the treatment plan if necessary, and also confirm recovery. For cancer patients, periodic cytology tests help identify relapses.

What biomaterial is being studied?

Since our entire body consists of cells, almost any biomaterial can be used for cytological research. However, as already mentioned, in order to obtain an accurate result, the material must be obtained from the suspected focus of the disease, that is, it must contain affected cells.

Thus, depending on which organ is being examined, the following types of biomaterials are the object of analysis:

• exfoliative- urine, sputum, blood, washing water, scrapings from the cervix, from the surface of ulcers and wounds, glandular secretions, excreta, transudates, exudates, etc.;
• punctates, that is, biomaterials obtained through puncture of the thyroid gland, lymph nodes, mammary gland, skin, joints, pleural cavity, etc.;
• surgical material. This group includes impressions and scrapings from removed tissue, as well as from various incisions obtained during surgery.

How is cytology analysis performed?

So, a cytological examination begins with taking biomaterial using one of the above methods. In traditional cytology, the resulting sample is immediately transferred to glass, dried or fixed with a special substance and transferred to the laboratory. Unfortunately, such treatment leads to cell damage, and as a result, frequent false negative results. The emergence of liquid cytology, a research method in which biomaterial is immediately placed in a special preservative solution, helped change the approach. This not only helps keep the cells intact, but also significantly increases the shelf life of the samples.

note
Preparation of biomaterial is one of the most important aspects in increasing the accuracy of the study. The accuracy of the traditional cytology method is only 34.5–89%, while liquid-based cytology provides results with an accuracy of up to 98%. Therefore, before analysis, be sure to clarify what method the study is being used.

After fixing the sample or preparing the preparation using the liquid method, smears are usually stained in one of the following ways:

• Papanicolaou test (PAP test) - the most common coloring method in the world. Effective in detecting cancer and viral diseases (for example, HPV).
• according to Romanovsky - in Russia it is most often used in the Leishman modification. As a result of this staining, the cell nucleus is more clearly visible, which makes it possible to identify bacteria and protozoa.

The resulting sample is then examined under a microscope. During the examination, the doctor identifies anomalies in the number, structure and location of cells and records the data obtained in the conclusion. For example, for a PAP test, type 1–5 of cell changes is indicated, where 1 means normal, that is, the absence of pathologies, and 5 means the presence of a large number of cancer cells in the epithelium.

The conclusion at the bottom of the analysis form is usually formed using the generally accepted Bethesda terminology system, in which each indicator is indicated by an abbreviation. The system is a global standard and will be understandable to doctors in most countries.

How long does it take a microbiologist to perform an analysis?

As already mentioned, cytology analysis is carried out quite quickly: as a rule, the period is up to five days. In some cases (depending on the method and the biomaterial being studied), the result can be obtained the very next day.

At the same time, the study itself does not last long, but the clinic may delay the receipt of the analysis form by the patient for up to a week or more (this usually happens if the hospital does not have its own laboratory - this is also worth paying attention to when choosing a diagnostic center).

How to read the cytology results form

Most patients, having received test results in their hands, strive to study them on their own, without waiting for consultation with a specialist. Of course, you shouldn't do that.

We will provide only a list of basic values ​​​​according to Bethesda:

We provided a transcript of the Pap test above.

Remember that interpretation of the cytology test results should be carried out by an experienced specialist, taking into account data from other studies. Self-diagnosis and, especially, self-medication are absolutely unacceptable, because your life and health are at stake.

Cytology analysis is a simple, quick and inexpensive way to examine the body for cancer, inflammatory processes and infections. However, its accuracy greatly depends on the training of the medical workers taking the biomaterial, the research method and the quality of the equipment in the laboratory.

Thursday, 03/01/2018

Editorial opinion

You should not treat the appointment of a cytological analysis as a confirmation of the diagnosis, you should not worry ahead of time, avoid the procedure, and even more so, try to develop a course of treatment yourself. If for some reason you do not want to go to the hospital to donate biomaterial, pay attention to the service of sampling at the patient’s home - many laboratories and diagnostic centers now offer this.

The main reason for performing cytology of a smear from the cervix is ​​to establish the presence of a pathological process, which is accompanied by the appearance of modified cells.

Such processes include precancerous conditions, the appearance of benign or malignant neoplasms. This procedure is characterized by complete painlessness and speed.

Cervical cytology - what is it?

A cytological smear for morphologically changed cells is also called PCR analysis. It increases the chance of detecting atypical cancer cells; they indicate the onset of the oncological process. Also, this type of analysis determines with great certainty the presence of pathological microflora.

Early diagnosis of cancer makes it possible to preserve the health and sometimes even the life of a woman. This is due to the fact that the early stage is asymptomatic, and when the clinical picture of the disease makes itself felt, the disease is difficult to treat even with surgical intervention. Delayed diagnosis sometimes negate the use of radiation or chemotherapy.

Another advantage of early diagnosis of cancer is the ability to preserve the integrity of the genital organs and the possibility of the reproductive function of the body.

To prevent the development of undesirable consequences, it is necessary to undergo an annual examination by a gynecologist and undergo this type of analysis.

Sometimes this type of test may be called a PAP test.

Indications for cervical cytology

In addition to detecting modified cellular structures and determining a precancerous condition, this type of analysis can be used as a method for additional diagnostics of intracellular changes.

He is appointed:

This type of analysis is also prescribed:

• Before a planned pregnancy.
• With frequent labor processes.
• If the birth occurred at an early age (the woman giving birth was under 18 years old).
• Before the onset of menopause.
• Before inserting a contraceptive device.
• If a woman has not contacted an antenatal clinic for more than 3 years.
• If a visual examination of the cervix using a vaginal speculum raises doubts about the health of this organ.
• With a positive test for HIV infection.
• With genetic burden (illness of close relatives with cancer).

If a cytological examination suspects the presence of a tumor, the patient must undergo this type of examination at least twice a year.

Unscheduled cervical cytology

During colposcopy, two smears are usually taken:

1. The material is collected directly from the cervical canal.
2. A vaginal smear allows you to determine the presence of pathogenic microflora.

In some cases, an unscheduled appointment of this type of study occurs. It occurs in the following cases:

What does cytology show?

The result of cervical cytology can be divided into positive and negative:

• Positive analysis indicates that atypically altered cellular inclusions were found in the cervical tissue. They have a changed morphological structure, shape, and can be observed in different quantities.
• If the result is negative cellular changes are not detected, this is an indicator of normality.

Changes in cell structure are divided into 5 stages:

Material for cervical cytology

Oncological diseases of the cervix (90% of all cases) affect the stratified epithelium; much less often, the glandular layer is involved in the pathological process.

In this regard, the following material is collected:

How to prepare for cervical cytology?

To achieve the reliability of the analysis, it is necessary to carry out a number of preparation activities before carrying out this procedure.

To do this you need:

How is cervical cytology performed?

To carry out this procedure, only a sterile instrument is used.

For this purpose the following is used:

Material is collected for cytological examination by a gynecologist.

For this:

1. The woman lies down on the gynecological chair, having previously removed her underwear to the waist.
2. For complete visualization, a vaginal speculum is inserted.
3. A sterile brush is inserted into the lumen of the cervical canal, approximately 2 cm, to collect endocervical tissue. The taken material is placed on a special glass slide, which is assigned a specific code or number.
4. Using an Eyre spatula, scraping is performed in the area of ​​​​the transition of cylindrical to squamous epithelium. The contents are also placed on glass and labeled.
5. To take material from the ectocervix site, you need to take a new sterile spatula. The biomaterial is placed on a separate glass slide.
6. After this, the smears are treated with a special solution, dried, and sent for further laboratory examination under a microscope.

To conduct this type of research it is sufficient 15-20 minutes.

Main indicators of cervical cytology

The cytological smear is subjected to microscopic examination.

This determines:

• The presence of pathogenic microflora.
• The number of red blood cells and leukocytes.
• Condition of the columnar epithelium.

If the number and shape of cells does not cause abnormalities, the study is considered negative, which is the norm.

Deciphering cervical cytology

When deciphering a cytological analysis, the following is considered to be the norm:

Pathological changes are detected if the following deviations are observed in the smear:

• An increase in acidity over 5.0.
• , Neisser gonococci, fungi of the genus candida, papillomavirus indicates the presence of an infectious pathology.
• The detection of several types of lactobacilli at once, against the background of an increase in acidity to 7.0, or if it becomes alkaline, may indicate the initial form of dysplasia. The degree of vaginal cleanliness can move into the third or fourth category.
• The complete absence of lactobacilli, the development of an alkaline environment, with a high concentration of columnar and squamous epithelial cells raise the suspicion of the probable development of a cervical form of uterine cancer. Such changes are most often observed against the background of an increased content of leukocytes, with large amounts of mucus, and a change in vaginal cleanliness to the fifth degree.

• The volume of the core increases significantly.
• Its configuration and coloring are disrupted.
• Morphological abnormalities appear in the cytoplasm.

It should be noted that even significant deviations do not always provide grounds for making a diagnosis indicating the development of an oncological process.

To achieve a reliable diagnosis, prescribe:

• Repeated cervical cytology.
• in combination with a biopsy.
• Diagnostic curettage.
• Complete blood test using tumor markers.

When the analysis shows that morphological changes have occurred in the cells, with a violation of their structure, this result is considered positive. In this case, a repeat type of analysis is prescribed in combination with additional types of research.

What to do if you receive a positive cervical cytology test result

When undergoing this type of study, a positive result is quite common. But this does not always mean that a woman develops cancer.

Very often, a positive result may indicate the presence of an infectious process, which can occur as a result of diseases of the genital area, or vaginal dysbiosis.

After treatment for sexually transmitted infections, repeated cytological analysis usually returns to normal.

If atypical cells, or, are found in the analysis results, this is also indirect evidence of the development of a malignant neoplasm. This happens because cervical cytology is not designed to detect the stage of the cancer process. It can only indicate the emergence of risk factors for this disease.

To establish a final diagnosis and exclude oncopathology, colposcopy, biopsy, and histology are required. A diagnostic curettage is required.

In addition to the above studies, the woman is prescribed anti-inflammatory therapy followed by cauterization of the affected areas. If the disease is viral, it is recommended that both partners undergo a full course of therapy. This will prevent re-infection.

After all treatment measures, it is recommended to undergo an annual cytological examination for the presence of cervical cancer.

Cervical cytology and pregnancy

This test is taken three times during pregnancy:

1. An initial smear is taken during a visit to the antenatal clinic for registration.
2. At 30 weeks testing is performed a second time.
3. To avoid infecting the baby during childbirth, Cytology is performed at 37 weeks of pregnancy.

This frequency of this test is due to the fact that during pregnancy women may experience a hormonal imbalance, and as a result, this leads to changes in the vaginal microflora. A weakened immune system may be a favorable factor for the development of vaginal candidiasis and other undesirable consequences.

Pregnant women should be aware of the special importance of conducting this type of analysis, that this is a safe type of diagnosis, it is performed with a sterile instrument and cannot be a source of infection for the woman.

It is very important to take a PAP test before pregnancy. If during its passage an increased content of leukocytes, erythrocytes, and morphologically changed cells is detected, pregnancy should be postponed. Its planning is allowed after complex therapy, in the event that a repeat analysis is negative.

Liquid cytology of the cervix

This technique has become widespread in Europe and Russia since approximately 2004.

It is distinguished by a high degree of reliability and ease of implementation:

The result is normal if the smear contains, in small quantities, unchanged columnar epithelial cells. The analysis should not contain inclusions of fungal mycelium, papillomaviruses and other bacterial infections.

The decrypted result is usually issued on time, in 7 or 10 days after taking the material for research.

Advantages and disadvantages of liquid-based cytology of the cervix

All experts in the field of medicine (gynecology and oncology) argue that this type of analysis should be done once a year.

This will make it possible to identify cancer pathology at an early stage of development. Only timely detection of this disease will allow for a complete recovery.

Cervical cytology allows you to identify women who are at risk. Register them and carry out monitoring to monitor the progression of the oncological process.

Analysis price

How much does it cost to undergo this type of analysis? The cost for this type of research, depending on the region of Russia, can be from 1000 to 3000 rubles . For some groups of the population this is a large price, but considering that cervical cytology is prescribed no more than once a year, this is an acceptable amount. Especially considering that this is beneficial for health.

A special examination of smears for cytology, also called a Pap test in women, is a very effective research method that, as a result of the study, can detect a malignant tumor at the earliest stage of the disease and helps prescribe timely treatment.

When doctors talk about a cervical cytology test, they plan to subject a woman to the following procedure: test samples will be removed from her vagina and cervix and examined closely under a microscope. Cytological tests are recognized as the most effective way to determine the presence of inflammation or the formation of cancer cells in a woman’s genital organs.

Cytological examinations are often compared with histological examinations, but there is one significant difference between them: the cytological examination method is non-invasive, which means that to conduct this study it is not necessary to make a puncture in the tissues of the woman’s genital organs. Cytological analysis is carried out using a painless cervical smear or fingerprint.

In order for the analysis to provide reliable information, it is very important to follow all the rules for preparing the patient for it. The analysis should, of course, be deciphered by the doctor who treated the woman and has access to her medical record.

The obvious advantage of the cytological method is that it takes a lot of time to conduct the study. An ordinary doctor only needs one day to perform this analysis and prescribe treatment that normalizes the cervix. If the study shows that the patient suffers from any oncological process, this information will not be considered one hundred percent. In order to confirm or refute them, the doctor will resort to a biopsy, which will eliminate all existing doubts.

If the patient has some contraindications to a biopsy, the doctor will have to rely on the cytology data and assume that they are correct until a safe way is found to prove otherwise. Also, cytological analysis of the cervix is ​​very helpful for doctors on days when they need to examine a large number of patients in the shortest possible time.

Characteristics of a smear for cytology

A cytology smear is also called a Pap test. To implement it, doctors examine the resulting smear from the cervix under a microscope. The purpose of the process is to diagnose possible cancer diseases at the initial stage.

Cytological examination of cervical smears actually successfully identifies malignant tumors that have affected the woman’s reproductive organs. It is also able to provide information about the formation of microflora, the presence of which can be dangerous for the vaginal environment. Doctors acknowledge that cervical examinations are not guaranteed to provide accurate results. If dangerous microflora is detected in the vagina, the woman will receive a referral for additional examination. Another doctor will take a smear of her flora and perform an STD test.

Cytology is not a new word in medicine. The study has been used by domestic doctors for several decades. The method is valuable because it allows you to identify up to 5 types of changes at the cellular level of the patient. Doctors recommend that all women whose age ranges from 18 to 65 years undergo this examination at least once a year.

Indications for smear cytology

Realizing that many women do not take their health seriously and will not conduct cytological tests without reason, doctors have formulated a number of signs that, if discovered in themselves, a woman should immediately go for analysis. Among these signs are:

• Any inflammatory processes in the reproductive organs;
• Menstrual irregularities that persist for several months;
• Reproductive problems;
• Planning pregnancy or installing an IUD to prevent it;
• Taking any hormonal medications;
• Diabetes;
• Obesity;
• Damage to the body by viruses such as papillomas or genital herpes;
• Active sex life, which is unprotected sex with untested partners.

Any of these signs is enough for a woman to put everything on hold and go to the nearest medical center for cytology. Doctors urge potential patients not to wait until their condition worsens and the first painful symptoms of the disease appear.

Contraindications for cytological examination

Despite the fact that doctors consider smear tests safe and painless, there are a number of contraindications for it:

• A woman's genital smear (including a sample from the vagina or cervix) cannot be taken during menstruation;
• The analysis cannot be carried out if there is an inflammatory reaction in the vagina and cervix. As the infection develops, the number of leukocytes in the blood increases, which will affect the test results.

What precedes a cervical cytology test?

To prevent cytology from giving a false-positive or false-negative result, it is important to follow a number of rules that the patient will be familiarized with by her attending physician:

• Douching should not be done before the procedure;
• It is unacceptable to take any topical medications;
• You should not urinate for at least 3 hours before the test;
• You cannot have intimacy with a man for at least 2 days before the test;
• It is necessary to wait until the inflammatory process, accompanied by abundant secretion, subsides so that the increased number of leukocytes does not affect the results of cytology.

How to properly perform cervical cytology?

Cytological examination of cervical smears is carried out by a gynecologist directly upon examination of the patient. The doctor carefully examines the woman's vagina using miniature mirrors. Next, he examines the cervical canal and cervical mucosa. Biological material is collected by the doctor directly from the vagina, cervical canal and the entrance to the cervix.

The material remaining on the brush is carefully distributed over a glass slide, dried and transferred to the laboratory, where it will be studied. For analysis, laboratory assistants will stain the smear with special preparations and carefully examine it under a microscope.

Laboratory technicians conducting the analysis are concerned about such characteristics of the material being studied as the size of the cells, their number and location.

After the test, the patient does not have to stay in the clinic. She can return to her daily duties outside. However, young specialists sometimes touch blood vessels, and in this case the patient will have to put up with pain in the perineum and bleeding for 1-2 days.

Interpretation of the results of a cytological examination of the cervix

When the patient is completely healthy, cytology will reveal that her cervix is ​​protected by columnar epithelium and her vagina by squamous epithelium. If the epithelium required in accordance with the norm is not detected during examination of a sample from the cervix, then doctors will be able to diagnose an oncological problem in the woman.

Pap test interpretation

According to the Papanicolaou method, samples from the vagina and cervix obtained by the cytological method can be divided into 5 classes depending on what the epithelium is, examined under a microscope.

Class 1. There are no pathological metamorphoses in the epithelium, all cells in the cervical smear appear healthy and have standard sizes and locations.

Class 2. The morphological norm of epithelial cells is reduced. There is probably an infection developing in the vagina - most likely vaginosis. Further diagnostics are needed to help formulate an accurate diagnosis.

Class 3. A small proportion of cervical epithelial cells have problems in the structure of the nucleus or cytoplasm. The patient is recommended to undergo a repeat cytological examination of the cervix, in which a serious disease can be diagnosed.

Class 4. A significant proportion of epithelial cells are subject to malignant changes. The patient has a precancerous condition.

Class 5. Almost all cells in the patient's smear are atypical. The woman has cancer, which is still in its early stages.

Cytology smear analysis using the Betseda method

If the material used for analysis was taken not from the cervix, but from the cervical canal, doctors use the Betseda method to decipher it. With it, the location of the cells and the metamorphoses experienced by the nucleus are especially important.

If the analysis does not reveal any abnormalities, no special designations will be indicated in its results.

Doctors will use the designation HPV to indicate possible vaginosis or koilocytosis.

If the patient sees CIN in the transcript of the cervical canal sample, it means that the analysis showed she has cervical dysplasia, and the word Carcinoma indicates cervical cancer.

How many days does a smear cytology test take?

The time it takes to receive test results is directly related to the clinic where it was done and can vary from 1 to 5 days.