Cytological studies of vaginal discharge

Cytological method of investigation is one of the main methods of diagnosis of pre-tumoral and malignant diseases of the female reproductive system.

Cytological examination is subject to all women with a preventive goal at least once every 6 months, dispensary patients - once every 3 months; an important role is played by this method of examination, first of all in groups with an increased risk of morbidity.

For cytological examination of the cervix, the material should be taken from the ectocervix and the cervical canal with anatomical tweezers, Volkmann spoon, gaunt probe, special Eyre metal spatula, wooden plates. The material is taken with dry sterile tools to avoid cell destruction.

It is possible to investigate native smears with a phase contrast microscope or stained with hematoxylin-eosin, subjected to fluorochrome treatment.

The nature of the pathological process is recognized by the following features: the morphological features of the cells, the quantitative relationship of individual cellular groups, the location of cellular elements in the preparation.

When evaluating the results of a cytological study, it should be borne in mind that the main control of the correctness of the cytological diagnosis is the histological conclusion.

Screening cytological methods

Produced for the purpose of early detection of uterine cancer and cervical cancer. The nature of the pathological process is recognized on the basis of the following features: the morphological features of the cells, the quantitative relationship of individual cell groups, the location of cellular elements in the preparation.

Papanicolaou smear

This is a simple effective test for detecting changes in the cervical epithelial cells. Developed in 1943, initially this test was designed to detect only cancer cells. Currently, this test can reveal background and precancerous diseases of the cervix. In the study of Pap smear a specially selected composition of fixatives and paints is used, which allows one to identify with the greatest degree of reliability early precancerous diseases of the cervix. This technique is standard for developed countries in Europe and America, since it gives the least amount of false negative results.

Hormonal colpositis

The method is based on the definition in vaginal smears of individual cell types of epithelium (superficial, keratinizing, intermediate, parabasal and basal). The material for the study is taken from the posterior vaginal vault. In women of reproductive age with a two-phase menstrual cycle in a smear under microscopy, only surface and intermediate cells are found in different ratios. With respect to the keratinized cells and the total number of surface cells, a karyopicnotic index (KPI) is calculated.

Colpositology (cytological examination of the vaginal discharge)

Colpocytological examination of the cellular composition of the vaginal smears is based on cyclic changes in the vaginal epithelium (vaginal cycles). They are characterized by the degree of maturation of the epithelium, as a result of which parabasal (oval with a large nucleus) and intermediate cells (spindle-shaped with a transparent cytoplasm and a vesicular nucleus having a clear chromatin pattern) are determined in the smear. Of the uppermost layers of the epithelium, surface cells occur. These are large polygonal cells with an unstructured (pycnotic) nucleus. They appear at the maximum growth of the epithelium, which is observed when the estrogen stimulation of the organism increases.

The quantitative ratio of cells in the smear and their morphological characteristics are the basis of hormonal cytodiagnostics.

Methods of research.

1. The material is taken from the lateral parts of the vault of the upper third of the vagina, as they are most sensitive to hormonal effects.
2. When taking a smear, one can not be roughly manipulated, since cells that separate from the walls of the vagina are subject to examination. Non-observance of this rule leads to the fact that cells from the lower layers of the epithelium enter the smear, the presence of which is treated as hormonal deficiency.
3. When analyzing the smear, the age of the patient and the day of the menstrual cycle should be taken into account.
4. 2-3 days before the study, it is necessary to stop all vaginal manipulations and recommend to the woman to abstain from sexual activity. Polychromatic coloring methods are advantageously used.

In the cellular composition of the vaginal smears, four degrees of estrogen saturation of the organism are distinguished.

• The first type of smear (the first reaction) - it determines the basal cells with large nuclei. Epithelial cells of other layers are absent. There can be leukocytes. This pattern of smear reflects a significant estrogen deficiency.
• The second type of smear (the second reaction) - mainly parabasal cells with large nuclei are looked through. Among them may be individual cells of the intermediate and basal layer. Leukocytes are single or absent. The picture reflects the average degree of estrogen deficiency.
• The third type of smear (the third reaction) - is mainly represented by cells of the intermediate layer with medium nuclei, sometimes there are surface cells. This type of smear characterizes a slight estrogen deficiency.
• The fourth type of smear (the fourth reaction) - mostly large and flat, well-defined cells of the surface layer with a small (pycnotic) nucleus are found. A smear testifies to sufficient estrogenic saturation.

The following indices are calculated:

1. index of maturation (IS, numeric index) - percentage ratio of surface, intermediate and parabasal cells. It is written down as follows: 2/90/8, which means that 2% of parabasal, 90% of intermediate and 8% of surface cells are in the test smear;
2. karyopicnotic index (CI) - the percentage of surface cells with pycnotic nuclei (less than 6 μm in diameter) to cells with vesicular (nonpicnotic) nuclei more than 6 μm in diameter. Characterizes the estrogenic saturation of the body, since only estrogenic hormones cause proliferative changes in the mucous membrane of the vagina;
3. eosinophilic index (EI) - percentage of surface cells with eosinophilic stained cytoplasm to cells with basophilic cytoplasm. Characterizes an exclusively estrogenic effect on the epithelium of the vagina.

Due to the embryological similarity of the mucous membrane of the vagina and the bladder, the latter also reflects the hormonal changes that occur in the woman's body. Urocytology is indicated in cases where colpocytology studies are difficult or impossible ( colpitis, vulvovaginitis, prolonged uterine bleeding ).