Cytology of the cervix

Cytology of the cervix is a laboratory study that determines the cellular structure of the cervix uteri (cervix uteri), as well as the cells of the cervical canal. One of the variants of cervical cytology was first applied at the beginning of the 20th century by a scientist from Greece Papanikolaou with the purpose of early detection and prevention of oncological diseases in gynecology.

Since then, the PAP test is used universally along with a new method - ThinPrep ( liquid cytology ), which allows timely detection and effective treatment of hidden chronic and precancerous diseases of the cervix.

[1], [2], [3], [4]

Indications for conduction

The main task, which cytology of the cervix decides, is the prevention of the oncological process. Early detection of atypical cells allows time to stop cervical cancer (cervical cancer), which according to statistics is the third most common oncological pathology in women. The danger of an asymptomatic course of the disease is great, therefore the main purpose of the procedure is the timely detection of precancerous changes in the cells. This makes it possible not only to increase the percentage and duration of survival, but also a confident hope for a successful cure. The method of PAP in gynecology practice is considered to be one of the fastest and most accurate for obtaining data on the presence or absence of the initial stages of oncological processes, cancer diseases or background pathologies of non-tumorous etiology, which can provoke life-threatening cancer. Many doctors call cervical cytology the "gold standard" of diagnosis and screening of such intra-epithelial changes and conditions:

• A variety of cellular anomalies of high or low degree.
• The presence or absence of pathogenic microflora for diagnosis of the mucous membrane of the cervix.
• Violations of the normal rhythm of the menstrual cycle ( cycle frequency, its delay or absence).
• All kinds of diseases of a viral origin - HPV (human papilloma virus) - condyloma, Herpes simplex genital (herpes).
• Infertility (infertility).
• Defects of the mucous membrane of the cervix (all types of erosion ).
• A long cycle of therapy with hormonal drugs.
• Abnormal discharge from the vagina, including with blood, especially after sexual intercourse.

Cytology of the cervix is needed as a screening test if:

• Pregnancy is planned
• Births occur several times in a row (for example, 3-4 times within 4 years).
• The first birth occurred at an early age (under 18 years).
• A woman often changes her sexual partners.
• Postmenopausal period (climacteric period).
• Contraception is planned in the format of an intrauterine device.
• Previously, cytology was never performed, or the woman was not examined for the last 3 years.
• The last fence of tissue material does not correspond to the norms or determined the changes in the cells.
• Examination of the cervix with a mirror shows visible pathological changes (color, structure).
• The woman has diseases related to immunodeficiency (HIV).
• Family history is burdened with oncological diseases (someone from direct relatives was ill or sick at the moment with oncological disease).

In general, an annual screening cytological examination should be mandatory for every woman who has reached adulthood. If the cytology of the cervix shows clearly expressed clinical deviations of the cellular material, the examination should be performed more often - at least 2 times a year or in the complex therapeutic plan.

Preparation

Preparation, which involves the cytology of the cervix, does not belong to the category of complex. The procedure itself is very fast, almost without discomfort and unpleasant sensations, and the preparation consists in the following actions:

• Eliminate sanitation (hygienic procedures) in the form of douching
• Several days before the procedure (2-3 days) should adhere to the regime of abstinence in intimate life
• Do not use hygiene tampons, tablets, liquids, creams, suppositories and gels for the vagina
• 2 hours before the test, a woman should refrain from urinating

To cytology of the cervix showed a reliable result, it is important to know this information:

• PAP test and menstrual cycle are not compatible. The procedure is carried out 3-5 days before the start of menstruation or after them, it is best to do it on the 10-12 day of the cycle.
• Cytology will not be accurate for any infectious disease, especially in the acute phase, as a rule, the analysis is performed after the basic treatment. An exception is the necessity of obtaining the result of cito, in this case, cytology of the cervix is carried out twice - during the illness and 2 months later for cytological control.
• A stroke during intravaginal therapy will not be informative, it should be performed 5-7 days after the end of treatment.
• It is not recommended to take a tissue material intake during inflammatory processes in the vagina, the indices of which can be secretions, itching, burning.

Clarification of the conditions for preparation for the procedure can be obtained from the treating gynecologist.

Techniques for conducting

Cytology of the cervix is considered an obligatory procedure for a comprehensive gynecological examination. This is a standard that allows timely detection of the risks of many diseases, including cancer.

The gynecologist produces scraping from the outer part of the cervix (exocervix), and also from the surface of the vaginal mucosa with a special spatula (Eyre spatula). Cell channels of the cervix (cervical canal) are taken with the help of an endobrush - cervical probe, which allows to obtain a sufficient amount of informative material.

Also, a doctor can use such tools for the collection of cellular material:

• For the smear of the posterior arch of the neck - Eyre spatula.
• Aspiration tool - spirette, for the collection of endocervical material.
• The screen is also designed for the collection of biological material from the cervical canal.
• Cervex-Brush is a sterile medical brush for taking a smear from the T-zone (the surface of the cervix and the cervical canal).
• Standard tweezers.
• Gynecological mirror.
• Cervical double-sided spoon (Volkmann spoon) for a smear on the microflora of the mucous membrane of the cervical canal and the definition of infectious diseases.

All modern instruments are sterile, most of them are used individually for each woman.

Technique of cytology:

• Examination of the gynecological chair with the help of mirrors, at the same time the material is taken for cytology. The walls of the vagina expand, the procedure of the smear (scraping) can deliver a short-term mild discomfort, but most often the cytology passes painlessly.
• Simultaneously with the scrapping the material for bacteriological research (microflora) is taken. Together with cytology, colposcopy can be performed, but this happens only according to indications, usually this procedure is prescribed separately.
• Samples of the material are applied to a special glass, fixed, fixed and transferred to the laboratory technician for accurate microscopic examination by staining. There is also a new method of cytology of the cervix ñ liquid (ThinPrep), in this case the material is placed in a flask and also transferred to the laboratory.

It is very important to mark the analysis. The laboratory should receive glass with material and a special form, which specifies such information:

1. Glass number in accordance with the direction number of the form.
2. The name of the medical institution where the procedure was carried out.
3. Date of analysis.
4. Full name of the patient.
5. Age of the patient.
6. Numbers, dates of the last menstrual cycle.
7. Preliminary (clinical) diagnosis.

Cytology of the cervix does not take much time, the whole procedure lasts no more than 10-15 minutes.

What does the cytology of the cervix show?

The main indices of cervical cytology are in two words - a negative or positive result, in other words, the test shows whether there are signs of cancer, infectious, bacterial, viral pathology in the smear.

Let us consider in more detail what the analysis shows:

1. A negative result means that epithelial cells are not exposed to pathological processes, pathogenic flora is not detected, the structure of cells is not destroyed by viruses
2. Positive indications suggest that abnormal cells are detected in the mucous membrane of the cervix, their structure and quantity go beyond the standard norms. Atypical cellular elements can be diverse in form, type and size, respectively, the interpretation of the analysis is directly related to these criteria.

In modern gynecological practice, traditional for use is the classification of results from the author of the test, the Pap test. The PAP-smear test method assumes a detailed description of the composition, structure of cells, dividing them into 5 categories:

• Stage I - no cellular changes were detected, there was no atypia, which indicates a practically healthy state of the cervix. Cytological picture within normal limits
• Stage II - the test found a number of abnormal cells with signs of inflammation, which can be considered a relative norm, given the prevalence of inflammatory processes in the genital area. As a rule, the woman is prescribed additional diagnostic procedures to clarify the cause, nature, stage and pathogen of inflammation.
• Stage III-analysis shows the presence of a small number of locally grouped atypical cells that have anomalies in the structure of the nucleus or cytoplasm. This is also not a direct indication of a threatening pathology, but it can be a signal about the risk of oncoprocess development. An additional procedure that specifies a PAP test can be a morphological analysis of the tissue material of the cervix (histology). A biopsy helps to eliminate risks or confirm the onset of a pathological process that can be stopped by timely treatment.
• Stage IV-analysis shows a clear picture of malignant transformations of a small number of cells. As a rule, abnormal cells have too much nuclear mass, cellular contents (cytoplasm), chromosomes also have signs of pathological changes. This stage indicates the possible onset of oncological disease (dysplasia). To clarify the diagnosis, additional examinations help - colposcopy, a material intake for histology, and repeated cytology is possible.
• Stage V-test determines a fairly large number of altered cells, which indicates the presence of oncoprocess. In such cases, the results of cytology are the beginning of a complex diagnostic process aimed at determining the type of oncology, its stages and the vector of therapeutic measures.

Explanation of results

Interpret the test results can and should only be the attending physician. Any information obtained in the depths of the Internet can only be an introductory and primary information. The following data are publicly available and will help reduce the anxiety of women who fear unintelligible figures and signs in the analysis.

Cytology of the cervix in the statistics shows the following:

• Every ninth test out of ten determines the norm, that is, the following cytology can be safely conducted after 1-2 years for the prevention and screening of the cervix. The analysis should be repeated regularly, despite a good result, as it can not be 100% accurate and does not exclude the risk of the disease completely.
• Every second of a hundred smears is not fully informative due to a lack of biological or cellular material. In such cases, the cytology of the cervix is repeated
• Every twentieth test shows the presence of atypical changes, but this does not at all indicate a developed oncoprocess. Rather, it is a signal and an excuse for a more thorough examination and subsequent treatment.
• The result of the test may show poor results, but this can not be considered an unambiguous and definitive diagnosis. To clarify the nature of the pathological process and its predictions, additional examinations are required, which are prescribed by the doctor.

The interpretation of the results of the cytogram can be performed by different methods. Classical is the Papanicolaou classifier, however in modern gynecology it is also customary to take into account other variants of interpretation of the test, for example, the American system Bethesda System.

Information on the state of epithelial tissue of the cervix can be reflected in the following table:

The presence of benign changes	Pathological changes in epithelial tissue: dysplasia, atypia	Invasive cancer
The test revealed Trichomonas, Candida, coccal infection, cell changes, possibly associated with the herpes virus The test revealed an atypia of epithelial cells associated with inflammation, keratosis, metaplasia, parakeratosis The analysis shows atrophic changes in the epithelium in conjunction with the inflammatory process - colpitis, hyperkeratosis, metaplasia	ASC-US. The test revealed the presence of flat epithelial cells with atypical changes of the unspecified origin HSIL. Analysis does not exclude the high risk of cancer cells Precancerous changes: dysplasia of various degrees (a refinement on the level of depth of epithelial tissue lesion is required)	Planocellular invasive cancer Specification of the condition, type and stage requires additional examination in an oncologist
The patient needs additional examination, observation and comprehensive treatment. Screening cytological control is also required	Additional diagnostic procedures are required to observe the process using repeated cytology of the cervix, colposcopy, biopsy, and long-term treatment.	It is necessary to histological study of the material, perhaps, clarifying the diagnosis after surgery Complex long-term treatment

Also, you can enter into the alarming state the Latin abbreviation in the analysis form, although in fact everything is simply deciphered, according to the "territory" of the material sampling:

• The urethra is the letter U.
• Endocervix, cervical canal - S.
• The vagina is the letter V.

The rest of the information will be provided by your doctor.

[5], [6], [7], [8], [9], [10], [11], [12]

Norms of cytology of cervix uteri

The norm in cervical cytology is the complete absence of atypical changes in the cellular material, as well as the healthy state of the microflora. "Good" cells must comply with the standards of morphological standards, that is, in size, content (structure) and form. The cytogram describes in detail the material taken from the surface layer of the cervix and from endocervix.

The norms of cytological examination look like this:

1. Cytology of the cervix contains cells of single-layered cylindrical epithelium. Alternatively, the test can show the presence of a multilayered (metaplastic) epithelium, this is also considered the norm if a smear was taken in a transitional site in the vagina.
2. Multilayered epithelial cells in the smear from the vaginal part of the cervix are also considered normal if no changes are found in them.
3. Any deviations from the norm, changes in the morphology of cells are described in conclusion and can be indicators of primary inflammatory processes that fit within the limits of the norm.
4. Deviations from the norms in the PAP test do not mean the existence of an oncological process, except for the HSIL indicator. This indicates a high risk of cancer.

It should also be taken into account that there are indicators that indicate benign cell anomalies. This, of course, is not the norm, however, it can not be a reason for increased anxiety about oncology.

A list of changes in the relative norm that cytology can show:

• Atypia of inflammatory etiology.
• Atypical changes triggered by the papilloma virus.
• Mixed atypical changes.
• Atypical deviations of an unclear nature that require specification.

To processes in which there may be deviations from normal boundaries, include the following diseases:

• HPV is a human papillomavirus.
• Herpes.
• Candidiasis.
• Trichomoniasis.
• Pregnancy.
• Long-term use of medicines, especially antibiotics.
• Vaginitis.
• Use of contraceptives (suppositories, tablets).
• Contraception with a spiral.

According to the classification of Traut and Papanicolaou, the first two classes out of five can be considered the norm of cervical cytology, namely:

• I - normal cytological picture
• II-ASC-US or the presence of atypical cells of the unspecified value

Relative norm can be considered class III, where the degree of risk of development of pathology is indicated as low.

Poor cytology of the cervix

What do bad results of the PAP test mean?

Poor cytology of the cervix does not necessarily indicate the last stage of cancer. Exact interpretation of the study can only give a specialist, that is, a gynecologist. According to the generally accepted classification, poor cytology is a pathological change in the epithelial layer of the cervix and cervical canal.

According to the common methodology, the changes are denoted as follows:

• 0 - the material for the test is unsatisfactory (low-quality, in a small amount, uninformative due to insufficient preparation of the patient).
• 1 class is the norm.
• 2 class - the presence of atypical abnormalities.
• Grade 3 - different degrees of dysplasia.
• 4th grade - precancerous state, initial stage.
• 5 class - invasive cancer.

The most disturbing of the above changes is class 5, but any form of dysplasia is also a dangerous signal. Consider the types of dysplasia in more detail:

1. An easy degree of dysplasia is a sign of the onset of the inflammatory process. It can not be missed, since the inflammation can proceed almost asymptomatically and in the future go into a heavier form.
2. Moderate dysplasia is already a threatening signal, indicating that the risk of oncoprocess development is very high.
3. Severe degree of dysplasia is almost a precancerous condition.

Undiagnosed dysplasia along with other provoking factors can lead to a really dangerous condition - oncology.

Any woman, having learned that the cytology of the cervix shows a bad result, is afraid. Let's try to lower it a little by informing.

What if the test showed the presence of obvious atypical cells?

First of all, do not panic, but listen and fulfill all the doctor's prescriptions. Gynecologist usually conducts detailed counseling, both about additional diagnostic procedures, and on the prospect of treatment and the prognosis of the disease.

Usually appointed and held such events:

• Repeated cytology of the cervix.
• Biopsy (histological analysis of the tissue of the affected cervical region).
• Colposcopy.
• Scraping of the cervix epithelium.
• An expanded blood test.
• HPV test.
• When detecting dysplasia, it is treated (more often with the help of cauterization).
• If a concomitant viral infection is identified, not only the woman, but her sexual partner is treated.

Timely diagnosis and adequate treatment give hope for healing, provided that all appointments of the physician are observed and regular monitoring of the cervix.

How many days is the cytology of the cervix uteri?

Cytology of the cervix is considered a standard procedure, the technology of which has been worked out to the last detail. The sampling period does not exceed 15-20 minutes, including a general gynecological examination. Further, the analysis is transferred to the laboratory, where a longer period of time is required for an accurate and thorough microscopic examination. If the PAP test was carried out according to all the rules, the processing of the material will take about 8 days. The result can be obtained from the attending physician 2 weeks after the procedure itself, sometimes it happens more quickly if the analysis is performed in cito mode. It also happens that information about the test scores can come later. This is most often associated with additional fences, for example, biochemical analysis of the secret to the microflora or biopsy according to the indications.

Histological examinations and colposcopy can be scheduled on the same day with cytology, and their processing will take a little longer than working on a single PAP test. Such complex diagnostic measures allow to receive a full, detailed picture and enable to more accurately determine the course of treatment.

In conclusion, we note that the cytology of the cervix should be an obligatory procedure for every woman. Reducing the number of cases of cancer is still an unresolved problem, both for doctors and for women themselves. Timely, regular examinations, tests and tests will allow you to be confident in your own health. To preserve all functions of the sexual sphere in a state of harmony - this task is solved, including by means of preventive measures, among which the important place is occupied by the cytology of the cervix.