Diagnosis of cervical dysplasia

What methods are used to diagnose cervical dysplasia:

• Inspection in the doctor's office, on the gynecological chair. The visible signs of dysplastic changes are determined with the help of mirrors. Criteria - the color of the walls of the vagina, mucosa, the presence of glitter in the zone of throat, the uniformity of the epithelium, the presence of small whitish foci and so on.
• PAP test, cytological examination of epithelial tissue with a microscope. Samples of the material are taken from different sectors of the neck to obtain a complete clinical picture. In addition, cytology makes it possible to determine markers of dysplasia-provoking infection (most often - HPV).
• Colposcopy (enlarged) can be prescribed as an additional method if cervical dysplasia is not diagnosed accurately with the help of cytology. Optical examination in conjunction with the samples gives a clearer clinical picture.
• Biopsy - aiming biopsy sampling. The histological method of examining the tissue material is needed as an important information on the nature and extent of dysplasia (exclusion or confirmation of malignancy, degeneration into cancer). Such a revision is necessary for almost all patients over 40 years old to prevent the development of cervical cancer.
• PCR diagnostics is an immunological method aimed at specifying the type of HPV (papillomavirus), as well as the choice of tactics of medical or surgical treatment
• According to the indications, a detailed blood test and hormonal balance can be assigned .

Diagnosis of cervical dysplasia requires differentiation with such pathological processes:

• Leukoplakia without signs of atypical changes.
• Erosive processes in the cervix.
• The processes of a dystrophic nature, characteristic of the older age group of patients.
• Cervicitis.
• Pseudo-erosion during pregnancy.

If dysplasia (CIN) is defined as a disease of grade III, the patient is referred to the oncogynecologist. An immunologist, an endocrinologist and a surgeon can also be connected to the diagnosis.

[1], [2]

Analyzes for cervical dysplasia

The gold standard for diagnosing cervical dysplasia (CIN) is the PAP test. An analysis named after the doctor who first applied it. Cytological analysis is accepted as mandatory in all developed countries of the world. Its reliability is extremely high (up to 80%), especially if dysplasia of the cervix in primary examination is defined as a disease of the first degree.

In the cytological material, the Pap test shows intraepithelial changes in the layers lining the cervix. Deviations from the norm are usually denoted by Latin letters, let us examine in more detail how this stands for:

• SIL (Squamous Intraepitelial Lesions) or squamous intraepithelial changes.
• LSIL (Low-Grade Squamous Intraepitelial Lesions) - epithelial lesions are not expressed clearly, low degree.
• HSIL (High-Grade Squamous Intraepitelial Lesions) changes, atypia of epithelial tissue cells are clearly expressed. Here there is a differentiation of the analysis - a moderate degree of CIN II, carcinoma in the initial stage, less often diagnose CIN III.
• AGUS - lesion of the glandular cell layer, cervical adenocarcinoma.

Analyzes, procedures that are expected if cervical dysplasia is detected:

1. Examination ( bimanual examination in the gynecologist's office).
2. Cytology.
3. PCR.
4. Examination with the help of a colposcope.
5. Histology (cervical tissue biopsy).
6. Conization (biopsy of the cone).

[3], [4], [5], [6], [7], [8], [9], [10],

Cytology

Cytology for cervical dysplasia is mandatory. This is a standard test that determines and identifies abnormalities in the structure of cells of epithelial tissue. Timely diagnosis helps reduce the incidence of women with such formidable pathology as cervical cancer. All over the world practicing gynecologists use the PAP-test (Pap test), a smear should be taken from women, starting from 18-20 years. Especially relevant is the cytology for such categories of patients:

• Age is more than 40-45 years.
• If a woman has chronic, viral diseases.
• Onkozabolevaniya in the family.
• Early or late childbirth, including frequent childbirth.
• Frequent termination of pregnancy.
• Immunodeficiency.
• Frequent or on the contrary, irregular sexual relations (change of partners).
• Long periods of taking hormonal drugs, including contraceptives.

How is cytology performed?

• A smear allows you to accurately study the cellular structure of the cervical epithelium.
• The material is collected using a medical spatula or brush.
• The resulting material is placed on a special sterile glass, where it is fixed with a fixative.
• The glass is labeled and transferred for examination to the laboratory.
• The laboratory technicians carry out staining of the resulting material and study the results of the reaction with a microscope.

Indications for cytology:

• The main task is the prevention of one of the most common diseases in women - cervical cancer (cervical cancer).
• Determine the cause of malfunction in the menstrual cycle.
• Refinement of the cervix in chronic infectious or viral diseases.
• Persistent infertility.
• Long period of use of oral medications for contraception.
• All endocrine diseases.
• Human papilloma virus in a sexual partner (infection of a woman is almost inevitable).
• Violation of the norm of weight - anorexia or obesity.
• The planned procedure for the introduction of the contraceptive spiral.

Cytology significantly reduces the development of oncology in women, as well as timely diagnose the initial stages of various pathologies of the cervix.

[11], [12], [13], [14],

Smear for cervical dysplasia

A smear is considered to be a simple and generally accepted procedure that is part of a health survey or cervical pathology assessment.

Dysplasia of the cervix is often accompanied or more accurately - provoked by imbalances in the microflora of the mucosa. Bacterial, viral infection can be a primary factor that gives rise to changes in the structure of epithelial tissue cells. A smear for dysplasia of the cervix shows the number of certain indicators. Smears come in these types:

• A smear to determine the state of microflora.
• Determination of the sterility of microflora.
• Cytological smear (PAP test).
• A smear that determines the infection (PCR).

Also, with the help of a smear for dysplasia, a gynecologist can evaluate some criteria for the state of the hormonal system of a woman.

How is a smear for dysplasia of the cervix?

• On the gynecological chair, a small amount of mucus, a cellular tissue is removed from the surface layer of the mucous membrane of the cervix. The choice of the type of material for analysis depends on the diagnostic task.
• A smear can be performed several times. The primary is needed to assess the state of a particular cervical parameter, the following to monitor the success of treatment of diseases. If the therapy is prolonged, the smear is performed every three months.
• A smear is considered a painless and quick diagnostic procedure that requires some preparation from the patient (the doctor gives recommendations on the preparatory measures).

If the woman is healthy, the smear, as a rule, shows the presence of a large number of lactobacilli (up to 95%). They are able to produce protective, lactic acid, which serves as a barrier for the propagation of pathogens. The acidity of the microflora is one of the important indicators of the health of the microenvironment in the vagina.

We will clarify the tasks for which a smear for cervical dysplasia is performed:

• Absence or presence of infectious agents, including sexually transmitted diseases (Trichomonas, Chlamydia, Gardnerella, etc.).
• Definition of latent chronic infections (PCR).
• Assessment of the state of cervical epithelial cells as an obligatory procedure for the prevention of cervical cancer.

Cleanliness of a smear can be such:

1. Healthy reproductive system, the first group of purity (pH 4,0-4,5).
2. The second group - the index of the initial stage of infection, the presence of Gram-negative bacterial flora (pH 4.5-5.0).
3. Determination of bacterial flora in the smear, the third group (pH 5.0-7.0).
4. The fourth group is the presence of a critically large number of pathogenic microorganisms (pH 7.0-7.5), a sign of the inflammatory process.

Normally, the smear for cervical dysplasia should not have such indicators:

• The presence of atypical cells.
• Cells that are infected with infectious agents, key cells (cellular tissue of flat epithelium, affected by infectious agents).
• Candida and other types of fungal pathogens.
• Gardnerelli.
• Kokkovaya bacterial infection (gonococci, staphylococci, streptococci, enterococci).
• Trichomonas.

If dysplasia of the cervix is diagnosed as a lesion of the epithelium of the first or second degree of severity, the smear shows the presence of pathogens, this does not mean that the woman has cancer. A huge number of infections in modern medicine have already been studied and successfully treated. Timely detection of pathological changes in cells of the cervical tissue can prevent cancer in almost 75%, according to some recent data, this percentage has increased, thanks to the program of regular screening activities.

Instrumental diagnostics

Instrumental diagnostics is the leading in a comprehensive examination, when cervical dysplasia needs both to clarify the severity level and to monitor the success of treatment of the disease.

The choice of the instrumental evaluation is explained by the fact that dysplasia most often develops and proceeds as a process without clinically noticeable manifestations. The second important place is the laboratory diagnosis. Visual primary examination in the gynecological chair is mandatory, but it is considered only the first step in diagnosis.

What is included in the list of the concepts of "instrumental diagnostics"?

• Examination with the help of gynecological mirrors. This is a special vaginal tool that helps the doctor assess the condition of the cervical epithelium. The most obvious changes in the tissue will be visible to the naked eye, provided that the mirrors are used. Instrumental diagnosis in the format of examination by mirrors shows the shape, dimensions of the neck, as well as possible damage to the external throat, ruptures. Mirrors can assess the criteria for the condition of the lower part (third) of cervix and the mucous neck. The initial stage of leukoplakia, adnexitis, erosive processes, dysplasia of the cervix - this is far from a complete list of pathologies that can detect bimanual studies using vaginal mirrors.
• Colposcope. Examination with the help of this tool is designed to clarify the degree of damage to a specific area of the cervix (an increase of 10 times). Also, colposcopy is carried out simultaneously with the tissue taking for diagnostic tests (cytological tests, biopsy). The colposcope helps to take PCR samples (molecular-biological, immunological analysis for HIV, evaluation of viral load, clarification of strains).
• Extended colposcopy, which may require dysplasia of the cervix, is divided into several stages. Epithelial tissue is treated with a special solution of acid, then once again another drug is applied - Lugol's solution. Only after this, the examination and sampling of the special sample (Schiller's test) takes place. Such procedures are needed to provoke mucosal edema (acid), the edema in turn causes increased circulation for better permeability of Lugol's solution. This tool plays the role of paint-marker. Normally, epithelial tissue should acquire a reddish shade due to glycogen granules. Any affected area of the cervix will not show a change in color.
• Ultrasound examination also refers to a number of instrumental examinations. To specify the diagnosis, a woman can be assigned ultrasound of the genitourinary organs for the exclusion or determination of cysts, benign tumors and so on. This method is suitable for young nulliparous women as an alternative to scrapings, scraping.
• Cytology (Pap test).
• A standard biopsy and a cone - sighting, cone, scraping - depending on the direction of the complex of diagnosis of cervical dysplasia.

Thus, instrumental diagnostics are methods for evaluating epithelial tissue, cervical conditions with the help of medical instruments. With dysplasia of the cervix in gynecological practice, instrumental and laboratory diagnostics are one of the prerequisites for an accurate determination of the degree of severity of the pathology.

Ultrasound

Ultrasound may also be administered to a patient if there is a suspected dysplastic process in the cervix. Dysplasia of the cervix in 75-85% of cases develops and proceeds without obvious clinical manifestations. Often, it is accompanied by inflammatory processes in the organs of the sexual sphere, especially the ovaries, the uterus, and the kidneys can be affected. This is due mainly to the viral, infectious nature of the pathological factors. The first complaints of a woman, as a rule, are symptoms of inflammation, and not dysplasia per se. Gynecologists every time, when meeting patients, do not get tired of repeating the recommendations for preventive regular examinations. Unfortunately, it happens that a woman turns to a doctor only when there are painful sensations, discharge, atypical for a healthy condition, or with the onset of pregnancy. Such situations require more detailed diagnostic actions, including not only standard methods - examination on the chair, but also cytology, sampling of the material for histology and ultrasound examination.

Ultrasound for clarifying the diagnosis is carried out in a special way - vaginally, in conjunction with ultrasound examination of the organs of the genital sphere (small pelvis).

What can show ultrasound of the organs for cervical dysplasia?

• Cysts of different etiology, sizes and species (require clarification and treatment).
• Myoma, fibroids.
• Tumor benign process.
• Changes in the size and shape of the uterus.
• The position of the ovaries in relation to the uterus (the norm or a shift towards the pathology).

If the ultrasound of the organs does not show obvious changes, abnormal abnormalities, young patients, especially nulliparous, can be relieved of a more invasive examination - scraping, and even biopsy.

What is transvaginal ultrasound?

• This is one of the important examinations in gynecological practice.
• Transvaginal scanning helps to assess the condition of the uterine cavity and its cervix to determine a further vector of diagnostic measures.
• Unlike standard ultrasound, which involves the presence of fluid in the body to conduct a sound wave, the transvaginal method does not require a complete bladder.
• With the help of this technology, a gynecologist can evaluate not only the shape, size of the uterus or ovaries, but also more accurately detect the presence of a particular pathology.

Ultrasound and dysplasia of the uterus, how is the examination?

• The patient does not need special training. The rules are almost the same as for the PAP test (abstinence from sexual intercourse, refusal to use candles, tampons, douching).
• When transvaginal diagnosis of a woman there is no need to fill the bladder and endure for a long time.
• The special sensor is smeared and inserted into the vagina. Since it is located quite close to the organs under investigation, the examination itself is considered very reliable and passes quickly.
• The doctor who conducts ultrasound can, as they say, personally see a clear clinical picture and assess the condition of the cavities.
• The procedure does not cause discomfort and pain.
• The result of scanning is known to the doctor and in principle, to the patient right after the procedure.

It should be noted that ultrasound for suspected dysplasia is most often prescribed in order to assess the status of the ovaries. This is necessary to exclude the tumor process and the presence of cysts. Ultrasound, both classical and vaginal, helps to monitor the success of treatment, especially with persistent infertility.

Colposcopy

The colposcope is one of the most used tools in gynecological diagnostics. This is an optical medical device that helps to identify the smallest, invisible in visual simple examination, defects in the mucous tissue. Erosive damages, point or extensive, micro-tumors, hemorrhages, other pathological changes in the cervix are often found precisely during colposcopy. Colposcopy as a method is developing and to date there are two types of research:

1. Standard colposcopy. Dysplasia of the cervix requires such a survey in 55-60% of cases.
2. Videocolposcopy is a more modern technology, assuming the presence of equipment (probe, monitor, processor).

What is the purpose of colposcopy?

• Definition of erosive processes.
• Identify polyps of various species (shape, number, size).
• Assess the severity of dysplastic changes in the epithelial tissue of the cervix.
• Clarify the preliminary diagnosis of leukoplakia.
• To detect oncological processes in the early stages.
• To reveal erythroplasty.
• Exclude or confirm hyperplasia of the epithelium.
• Differentiate such pathologies as - cervical dysplasia, ectopia, adnexitis, leukoplakia and benign tumor diseases.

A more detailed description of the types of colposcopy that can be prescribed for the diagnosis: cervical dysplasia:

1. Standard colposcopy, when a patient is examined in a doctor's office on a gynecological chair. The colposcope is inserted after expansion with special medical mirrors.
2. Colposcopy by an extended method. The initial stages are identical to the simple colposcopic procedure. Further, the mucous cover of the cervix is treated with acid and Lugol's solution. This is how Schiller's test is performed, when dysplasia of the cervix can be excluded by normal color (reddening and brownish hue). Also, the sample can show no response - this is pathology. Damaged areas of the epithelium do not react to provocation by acid and solution, remaining pale, whitish.
3. Variant of advanced colposcopy - color method (color colposcopy). The examination is almost the same as the extended one, but Lugol's solution is replaced with methylene blue and classic green. Thus, you can see the areas of the damaged vascular network.
4. To detect oncological changes in the cervix, luminescent colposcopy is used. The mucous neck is exposed to fluorochrome. Inspection is carried out with the help of ultraviolet, which reacts with the applied solution. All pathological foci in this "illumination" are visible as areas of pinkish color.

Pregnant women with a diagnosis of "cervical dysplasia" can safely undergo the procedure of colposcopy, it is safe for the future mother and for the fetus too. The choice of the type of optical examination depends on the state of health of the patient and how the pregnancy proceeds. But in general, such procedures are considered safe and only help to eliminate unwanted diseases and pathologies.

[15], [16], [17], [18],