Cytology PAP test. What is dad? Padnicolau smear

Papers Cytological Magnifier Papinicolau, Pap-Test (recommendations for women)

Cytological (cervical) smear ( None name - analysis of papanicolau, dad test) - Simple, fast and painless examination for the patient. It is carried out during the inspection on the gynecological chair. With the prophylactic goal of the smear is made every year, since the beginning of her sexual life.

Mask Master Objective - identification of those changes in cervical cells, which can later grow into cancer. In the event that a woman addresses a gynecologist regularly, the changes are fixed at the earliest stage. In addition to the diagnosis of cell anomalies, the smear shows the presence of a number of pathogenic microorganisms into the vagina and allows you to determine the condition of the mucous membrane. The results of the smear often do not allow the final diagnosis and require other examination techniques.

Cytological smear is taken from three sites Vagina mucosa:

• from his arches,
• with the outer surface of the cervix and
• from the cervical channel.

This uses a special spatula. After taking, each sample is applied to the glass, and then sent to the cytological laboratory. There, the smears are studied in detail for the presence of deviations in the structure of cells. For this, it is used by painting by the Papanicola method, drying, examination under the microscope and so on.

How often do you need to repeat the procedure for taking a cytological smear?
Opinions of doctors on this issue are divergent. In most cases, the cell is required for about 10 years so that cancer tumor is formed from light changes. Therefore, part of the doctors indicates the lack of need to conduct a study often. But, at the same time, there were cases and rapid development of the disease. From here Recommended Sailing Frequency is once a year or a year and a half .

Cervical cancer (cervical cancer) is the second most common cause of death from oncological diseases and mortality of women around the world. The best way to detect cervical cancer is regular dadnikolau tests, or dad smears. Padnicolau smear is based on a microscopic study of cells taken from the cervix.

In the smear of Papanicolau, viral infections can be found (for example, human papilloma virus [HPV]) and other provoking cancer factors. Timely treatment can stop cervical cancer before it completely develops. A woman can have cervical cancer and not know about it, because the cancer often proceeds asymptomatic.

Matter Cancer Risk Factors:

• Several sexual partners (or sexual partners who have several partners)
• The beginning of sexual life at an early age
• Viral infections such as HPV, human immunodeficiency virus (HIV), or herpes variety virus (HSV)
• Weakened immune system
• Availability in the past sexual cancer
• Smoking

Screening cervical cancer woman is recommended annually, starting from 18 years old, or when it becomes sexually active, if younger than 18 years old. A woman with a negative result of Papanicola's smear for 3 years can be examined less often if it does not have sex contacts during this period.

The upper age limit for screening does not exist because the incidence of cervical cancer increases with age. Very often, cancer is diagnosed with women over the age of 50. Even after menopause, a woman must systematically make Papanicola smear.

Many older women believe that they no longer need Pad smear, think that they are not at risk of developing cervical cancer due to their age, because they cannot be sexually active. This is not true. These women need Pad smear, because their risk is higher. Even if the woman's uterus is removed, it should conduct an annual annual screening on cancer, if there are abnormal silent results in papanicolau or oncological diseases of the sexual system in history.

Complications of smear Papanicolau
The procedure for taking a smear of Papanicolau is not complex and painful. The only risk is the undetection of the cervical cancer and its late treatment.

Preparation for smear Papanicolau
The best time to smear Papanikolau is any time without menstrual secretions. 2 days before the start of the test, you need to avoid the following events, as they may disguise the abnormal cells and lead to false negative results of the smear:

• Sexual intercourse
• Sprinting
• Application of vaginal (except to the doctor's discharge)
• The use of vaginal contraceptives (contraceptive foam, creams or jelly).

Patty Take Procedure
Taking a smear of Papanicolau, as a rule, is part of the gynecological examination and is accompanied by a chest survey, performed by an obstetrician-gynecologist. Saving a smear will take only about 1 minute from the total inspection time.
Woman lying on a gynecological chair on his back, knees are raised, and the legs are fixed in stepping. The doctor will use a small metal or plastic tool, called the mirror to open the vagina so that the walls of the vagina and the cervix can be clearly seen.

In the photo - taking a cervical canal

A sample of mucus and cells will be obtained from the cervix (parts of the uterus, which goes into the vagina) and the mucous membrane of the cervical canal (inside the cervix) with a wooden scraper or a small cervical tassel. The sample of cells is evenly distributed over the glass and is fixed by the retainer.

In the photo: applying the material by the rash for the slide

This sample is sent to the laboratory for a thorough study under the microscope. If the doctor uses a new look of Papanicolau's smear called Thin-Prep test, the sample is washed into the vessel and goes to the laboratory for examination. The cytologist considers both types of tests.

• If a woman has an abnormal repetition of the smear of Papanicolau, the smears must be taken by a doctor in 4-6 months for 2 years before receiving 3 consecutive negative tests.

• If the positive feedback of Papanicola is obtained due to infection, it is necessary to treat the main reason. Pap-test should be repeated for 2-3 months, because cervical cancer can be hidden by infection.

Although Papanicola's smear is the best method of early detection of cervical cancer, this system is not perfect because even the best laboratories can miss some cell changes, the woman should pass the smear annually.

Recently, 2 computerized systems (PapNet and AutoPap) were approved in the United States to detect the anomalous cells of Papanicola's smear. To ensure the accuracy of the test, they use computer technologies rechecking dads in which abnormal cells may not be detected by a cytologist. These tests are more expensive than the cost of the usual smear of Papanicolau, but they can be useful if a woman has a high risk of cervical cancer.

Interpretation of smear results

Properly interpret the results of the smear is able to only a specialist doctor. In modern practice, the assessment of changes in the cells of software, the so-called method of papanicola, when allocated Five stages of the development of pathology.

1 Stage: Cells with any deviations are missing, there is a normal cytological picture. This stage is characteristic of completely healthy women.

2 Stage: There are small changes in the structure of cells caused, however, the inflammatory process of internal genital organs. This stage is also the norm, but at the same time, the doctor necessarily benefits you a more thorough examination for the identification of the causes of inflammation and eliminate them.

3 Stage: There are cells with anomalies in the structure of the nuclei, but their number is extremely small. In this situation, it is necessary to repeatedly take a smear or conducting a special histological examination of the modified tissue.

4 Stage: Separate cells can be found with obviously malignant changes (such as the increased mass of cell cores, changes in chromosomes and cytoplasm). At the same time, this gives reason only to suspect the disease, and not to put the final diagnosis.

5 Stage: A large number of typical cancer cells are observed in the smears.

The accuracy of cytological smears from the vagina is high (dad-test) when it comes to changes in the cervix. However, this analysis does not mean anything about the state of the uterus itself, ovaries or uterine pipes. And in 20-30% of cases of dad test False-negative results. The guarantee of a reliable interpretation of the data gives only a comprehensive examination (cervical colposcopy, the biopsy of the mucous membrane, etc.).

Most laboratories in the United States use Standard Terminal Set Classification Betar (cervical and vaginal cytological diagnosis) for the report or interpretation of the results of the smear of Papanicolau. By Classification of befaire Papinicolau smear samples that do not have abnormal cells are interpreted as a "negative result of intraepithelial or malignant lesion" (that is, women do not have cancer).
Samples with cellular disorders are divided into the following categories (as indicated at the National Institute of Cancer (USA):

• ASC (Atypical flatclellular cells): flat-cell cells Thin, flat cells that form the surface of the cervix. Co-start system divides this category to the following 2 groups:
  • ASC-US. (Atypical flatclellular cells of uncertain significance): PlateLock cell cells are not completely normal, but doctors are not sure that the changes mean cancer. Sometimes these changes are associated with HPV infection. ACS-US is considered soft anomalies.
  • ASC-H. (Sypical plane cell cells can not be excluded flatwakellic intraepithelial lesions): cells are not normal, but doctors are not sure that the changes mean cancer. ASC-H often means a precancerous state.
• AGC (atypical gland cells): gland-free cells-production-producing cells found in the endocervical channel (in the center of the cervix) or in the mucous membrane of the uterus. Irony cells are not normal, but doctors are not sure that cell changes mean.
• AIS. (endocervical adenocarcinoma): precancerous cells in iron fabric.
• Lsil. (Weakly sprinkled flat-belling intraepithelial lesions): Low-class means that there are some early changes in the size and shape of the cells. The word of the lesion refers to the region of anomalous tissue. Intraepithelial refers to a layer of cells that form the surface of the cervix. Lsils are considered insignificant deviations as a result of HPV infection.
• Hsil. (Librated flat-belling intraepithelial lesions): Bright means that there are more noticeable changes in the size and form of abnormal (prejudice) cells, that is, cells are very different from normal cells. HSILS is characterized by more serious deviations and have a higher probability of cancer progression.

When should be addressed for medical help
Early stages of precancerous cervical diseases and cancer often do not have signs or symptoms. Therefore, it is very important to do regular papanicola strokes. Usually appear when cancer progresses and it is already difficult to stop it.
With the following symptoms, immediately consult a doctor:

• Unusual vaginal discharge
• Blood stains or light bleeding, in addition to the usual period of menstruation
• Bleeding or pain during sex

These symptoms are uniquely denoted by cancer, these symptoms can also cause other factors, but check is necessary to determine the cause.

If the result of the smear of Papanicolau is normal, the woman will continue the routine screening.

If its papanikolau is the result is atypical (could not be qualified as normal or abnormal), the re-smear must be made in 4 months. If the re-test is abnormal, the doctor will make colposcopy. During this test, the doctor looks at the neck of the uterus through the Colposcope tool (a special microscope), is looking for an explanation of the anomalies in Papanicola's smear. It does not painfully hurt and does not have side effects. It is possible to perform this procedure during pregnancy.

If there are abnormal cells on the cervix, the doctor will perform a biopsy (will take a sample of fabric to view under the microscope).
If the result of a smear of a woman is abnormal, colposcopy and biopsy should be carried out immediately. The biopsy is the only way to determine the prejudice state, cancer or its absence.

Several types of biopsy is carried out under various kinds of anesthesia.

For the treatment of precancerous fabric states or at a very early stage of cancer, the doctor can remove abnormal fabrics completely during biopsy.

If the results of biopsy and papanicolau are normal, Papanicolau smear must be executed again after 4 months.

If the biopsy is the norm, but Papanicolau is not the norm, the doctor will repeat the colposcopy and biopsy.

If the biopsy result is intraepithelial neoplasia or cancer, you need to immediately begin treatment from cervical cancer.

Important recommendations:
1. All women leading a sex life or over 19 years old are recommended once a year to undergo a gynecological examination with cytological analysis of Papanicolau smear (dad-test). After a negative result is received twice, you can pass this analysis less often - once every three years, up to the achievement of sixty-five years

2. If a woman uses hormonal contraceptives or transferred genital herpes, it is recommended to make a smear papanicolau twice a year.

3. Infertility, uterine bleeding, overweight (obesity), genital herpes, genital warts, a frequent change of sexual partners, receiving hormone-estrogen are factors for more frequent cytological smear.

Papanicolau test - Analysis for identifying precancerous and cancer cervical diseases. This study has many synonyms - dad test, dad-smear, cytological smear. Dadnikolau test was called in honor of the author, a physician and founder of medical cytology - Georgios Papanicolau.

Dads test are carried out during the gynecological examination to all women older than 21 years. With the help of a spatula and brush-endobrash, the doctor takes samples of cells from the surface of the cervix and cervical canal. The resulting material is applied to the slide, fixed with alcohol and sent to the laboratory. The laboratory technicians paint the smear according to the method developed by Papanicolau, study the structure of cells, paying particular attention to the typical, size, degree of maturation, size and structure of the nuclei, their ratio with cytoplasm.

The value of the study. Panicolau test allows you to identify dysplasia and cervical cancer in the initial stages, while the disease is well treatment. Thanks to the massive conduct of the dad test over the past 40 years, it was possible to reduce the incidence of cervical cancer by 60-70%, and mortality from this type of cancer decreased by 4 times.

Cervix

Cervix - The lower part of the uterus, which one end opens into the uterine cavity, and the other in the vagina. It is a tube of 3-4 cm long, consisting of smooth muscles and fibers of connective tissue.
In the cervixa two parts:

• exoceservix or the vaginal part is the lower segment of the cervix, which comes into contact with the vagina;
• endocerviks or cervical Canalwhich is also called canal cervixa - This is a through hole that passes inside the organ.

Cervical canal has two outputs:

• inner zevopens into the uterus cavity;
• outdoor Zev Opened in the vagina.

Mucous membrane Wallows extocerevix and cervical channel. It has two main components:

• Epithelium - cells located on the surface of the mucous;
• Basal membrane - Thin plate of connective tissue, which is the basis of the mucous membrane.

On different sites, the mucous membrane of the cervix is \u200b\u200blined up Two types of epithelium.

• Basal - 1 layer of small undifferentiated (immature) cells lying on the basement membrane;
• Parabazl - 2-3 rows of cells in which the first signs of ripening appear;
• Intermediate - 6-12 rows of moderately differentiated cells;
• Surface - 3-18 Radov cells lying on the surface. They are not inclined to organize and constantly lunch, replacing new, rising from the basal layer.

Testimony to conduct dad dough

A smear on cytology must be handed over to all women older than 21 years, regardless of the intensity of sexual life and the number of partners.

• First smear At the age of 21 or 3 years after the start of sexual life.
• 1 time per year During the usual gynecological inspection to all women from the 21st to 64 years.
• 1 time in 2-3 years Women rent up to 65 years, who have 3 times in a row in the smear, no changes were found in the structure of the cervix epithelial cells. After 65 years, the test can be carried out less often.
• 1 time in 6 months- Women of the following categories:

• women with impaired menstrual cycle;
• patients with oncological diseases in the family;
• women with erosion, dysplasia or other diseases of the cervix;
• signs of contamination of the person's papilloma virus are found;
• to control the treatment of cervix.

Method of holding dad dough

When is it better to do a dad test?

For the preparation of the material, the epithelium scraping from the surface of the vaginal part of the cervix and from the cervical canal is carried out. The best time is the period between the 10th and 20th day of the menstrual cycle. The material is not desirable to take later than 5 days before the intended menstruation and during menstrual bleeding. During this period, physiological changes occur in the mucous membrane, which will erroneously be accepted for signs of the disease.

To take the material, the gynecologist uses disposable tools:

• eira Spatula - to take a smear from the vaginal part. Its narrow end is inserted into the outer zev, and the scraping from the vaginal part is short and wide;
• curetki - Folkmann spoons - to take scope from sites causing suspicion;
• an endoble brush - for the spacing of the epithelium inside the cervical channel.

How to spend dad test?

Material for dad dough takes to extended colposcopy and bimanual research - palpation (tackling) of the uterus and its appendages. This avoids the pollution of the material with Talc.

• Woman posted in an observation chair. The doctor conducts inspection of the cervix with gynecological mirrors.
• Cleansing the cervix from mucus,. It is conducted in the event that a large amount of the secret interferes with scraping.
• Samples of material take from several sections:

• In the area of \u200b\u200bthe outer sewage, where precancerous and cancer cells are most often appear;
• On visible foci of pathological changes, if any;
• From the inner surface of the cervical canal. This procedure is carried out after removing the mucosa.

• The resulting material from each site is applied with a smooth layer on separate slide glasses, touching all the surfaces of the brush. The smears are fixed by fixing solutions containing alcohol. It is necessary to avoid breathing and deformation.
• Glass marked (sign), the direction containing brief information about the patient is attached to them.
• In the laboratory, the samples are painted to better consider the features of the structure of the cells. Sample microscopy. It is estimated:

• cell type;
• the size;
• the presence of inclusions in cells;
• the degree of their maturity;
• the number and features of the structure of cell cores;
• condition of cytoplasm;
• the ratio of cytoplasm to the kernel.

• The result of dad dough, as a rule, is directed by the doctor after 1-2 weeks. In private laboratories, the waiting time of the PAP test is 1-3 days.

Dads Test based on liquid cytology Used in modern laboratories is considered more informative. The technique allows to obtain a high-quality cytological preparation and eliminates the destruction of cells during drying and fixing on the slide glass. If necessary, you can prepare a few more drugs, if the first has been unsatisfactory, and conduct additional studies to determine the human papilloma virus or identifying the proliferation markers (cellular division).

Methods of conducting dad dough based on liquid cytology:

• The brush make 5 rotational movements clockwise in the area of \u200b\u200bthe outer mouth. Thus, it is possible to make scraping from the entire transformation zone. Another brush collect material from the walls of the cervical cervix.
• The tips of the brushes are removed and placed in separate bottles with a canning liquid.
• The tube is shaken, as a result of which the cells are moving into the liquid.
• In the laboratory, the liquid is centrifuged. Of the cells formed cells prepare preparations, painted them and study under the microscope.

How to prepare for dad dough?

Pap-test requires a certain preparation. 1-2 days before visiting a gynecologist it is necessary to refrain from:

• sex contacts;
• drafting;
• vaginal preparations - creams, candles, spermicidal gels;
• arms inside the vagina and the vaginal soul;
• hot bath.

After these actions, pathological cells can be erased or washed from the surface of the cervix, which will make the result of the study in unreliable.
Dad test is not held:

• during menstruation;
• during inflammatory diseases of the cervix.

What can be the results of dad dough?

To evaluate the result of the dad test, several systems are used:

• System developed by Panicolalu In 1954, which classifies changes to 5 classes:

• I class - a normal cytological picture, unchanged cells;
• Class II - minor cell changes associated with inflammatory process in the vagina and cervix;
• III class is a suspicion of malignant formation, single cells with an anomaly of the structure of the core and cytoplasm;
• IV class - single cells with obvious malignant changes;
• V Class is a malignant tumor, a large amount of cancer cells.

• The system proposed by the National Institute for the Study of US Cancer In 1988. In 2001, it was revised and is now widely used in all countries.

• NILM. - the absence of signs of malignancy and the defeat of the epithelium;
• ASCUS. - Atypical cells of a flat epithelium of an indefinite character. May indicate inflammation, but neoplasia is not excluded (the prejudice state, which can be transformed into a malignant tumor);
• ASC-H. - Atypical cells of a flat epithelium. It is impossible to exclude the defeat of the flat epithelium of high degree of severity - NSIL;
• Lsil. - Defeat of flat epithelium low severity. Indicate a weak dysplasia or damage to human papillomavirus;
• Hsil. - Defeat of the flat epithelium of high degree of severity. May talk about dysplasia medium or high, rarely about carcinoma in situ;
• AGC - atypical glandular cells, atypical cells of ferrous epithelium cervical channel;
• Agus. - anomalous glandular cells of an indefinite value;
• Carcinomain situ. - the beginning of the formation of a cancer tumor, cells do not go beyond the basement membrane;
• HIGH-GRADE SIL plateLock carcalete cancer - A large number of malignant cells, which indicates a rack based on a flat epithelium;
• Adenokarcinoma - Cancer based on cylindrical epithelium.

Options for the results of dad-test

I. Normal result.If the consequences are the terms: Nilm.(Negative for INTRAEPITHELIAL LESION OR MALIGNANCY), negative result, class I -this means that the woman of health and altered cells has not been detected. In the cervix there are no serious disorders: inflammation, dysplasia, cervical cancer. Signs indicating candidiasis and bacterial vaginosis are allowed.
In the material may be present:

• unchanged flat epithelium cells;
• cells of cylindrical and metaplastic epithelium;
• leukocytes in small quantities;
• bacteria in small quantities.

II. Pathological result, positive or unsatisfactory, class II.-V. In conclusion, it is necessarily indicated which changes are detected in the material.
1. ASC-US -atypical cells of a flat epithelium of an indefinite value. Their appearance may be caused:

• dysplasia;
• infection of human papilloma virus (HPV);
• chlamydia and other sexually transmitted infections;
• atrophy of the mucous in the period of menopause.

Recommended:

• take an analysis to identify Papillomavirus (HPV analysis);
• re-pass the dad test after 1 year.

2. Lsil -low degree of severity flakes of low severity. Moderate amount of atypical cells on the surface of the cervix. This means that some cells of the flat cervix epithelium have atypical signs. The risk of cervical cancer is low.
The reasons:

• dysplasia;
• papillomavirus infection.

Recommended:

• conduct analysis on HPV,
• colposcopy, when you find HPV,
• conduct dad in a year.

3. ASC-H -. Epithelium cells from the surface of the cervix anomalous. To eliminate the malignant process, additional research is needed. 1% of women with ASC-H is found early forms of cancer, well-teased.
The reasons:

• preiodine changes - dysplasia 2-3 degrees;
• rarely, the initial form of cancer.

Recommended:

• mandatory expanded colposcopy.

4. HSIL -. A large number of atypical cells indicating the 2nd and 3rd degree of dysplasia. 2% of women with HSIL detects cancer. Without treatment, 7% of women during 5 years, dysplasia is transformed into cancer.
The reasons:

• high degree dysplasia;
• rarely, cervical cancer.

Recommended:

• if a first-degree dysplasia was detected during the examination, the dads and colposcopy are carried out every 6 months for 2 years;
• women over 25 years old immediately undergo diagnostic excision - removal of the cervical mucosa section.

5. AGC. -. Changed atypical cells from the cervical cervical either from endometrial - internal membrane of the uterus.
The reasons:

• dysplasia 1-3 degrees;
• cervical cancer;
• endometrial cancer.

Recommended:

• colposcopy;
• collection of material by scraping the mucous membrane of the cervical canal;
• hPV analysis;
• women over 35 years old with irregular bleeding - the collection of material by scraping endometrial.

6. AIS.(adenocarcinoma in sita) or plane carcinoma. In the analysis, cells are found typical cervical cancer.
The reasons:

• high degree dysplasia;
• cervical cancer

Recommended:

• colposcopy;
• diagnostic scraping of the cervical canal;
• endometrial scraping for diagnostic research;
• diagnostic Excius - removal of the plot of mucous membranes.

7. Big-quality glands. In the material, normal unchanging cells of ferrous epithelium are detected - endometrial cells, endometrial cell cells, histiocytes (stroke tissue wandering cells).
The reasons:

• endometrial hyperplasia - precancerous changes in endometrial;
• endometrial cancer;
• in the absence of symptoms (irregular menstruation, bleeding from vagina, not related to menstrual bleeding) in women who have not reached menopause, bednocal glands are considered an option for the norm.

Recommended:

• diagnostic endometrial scraping for women reached menopause or having symptoms of endometrial hyperplasia;
• there is no need for further examination to women who have not reached menopause and not having symptoms.

Inadequate drug.This phrase suggests that the material was taken incorrectly. In the scrap case, there is not enough epithelial cells, there is no cylindrical epithelium from the cervical canal, the smear is contaminated with blood or prohibited. In this case, the woman needs to re-pass the dad test in 2-4 months.
What to do with the "bad" result of dad dough?
Depending on the age of a woman and the nature of the changes, the doctor can choose one of the options.

1. Repeat the dad test after 3 months. If it turns out to be negative (without pathological changes), then repeated dad tests after 6 months, 1 year, 2 years. With a positive result - spend colposcopy.
2. Conduct colposcopy. If extended colposcopy does not reveal the changes, then re-test after 6 or 12 months. If the colposcopy revealed the foci of change, then the biopsy is carried out. In case of the dubious result of colposcopy, anti-inflammatory or estrogen hormonal treatment is carried out, and after it re-colposcopy.
3. Test to detect human papilloma virus (HPV). When oncogenic types of virus are detected, colposcopy is carried out. In the absence of those - repeated dad test after 6 months.

Error result of dad dough

The sensitivity of the dad dough fluctuates in the framework of 70-95%. The cause of errors can be incorrect collection and fixation of the material, insufficient qualifications of a laboratory assistant, or the processes occurring in the uterus.

1. False positive result of dad dough - The analysis indicates that there is a dysplasia, although a woman is healthy. The reason may be transferred inflammatory and infectious diseases of the genital organs, erosion under healing (regeneration), hormonal disorders. These processes cause cell appearance that may have an unusual form. To exclude errors, colposcopy or repeated dad test.
2. False negative result of dad dough - There is a disease, and the test results within the norm. This is possible if the doctor misconfigured the scraping and the cells of the epithelium from the deaths of the disease did not fall into the smear, or atypical cells did not find in the laboratory. This option is possible, but should not be afraid. When visible changes in the cervix, the doctor will appoint colposcopy and biopsy. Even if the dysplasia foci remained unnoticed, then until the transformation of them in a malignant tumor will be held 2-20 years, and the pathology will be detected during the next PAP test.

What diseases can be detected by this study
Dad test - a diagnostic procedure designed to identify precancerous and cancer diseases of the cervix. Also during the study, signs of inflammation, infections or atrophy of the cervix can be found.

1. Infections.Bacterial and viral infections indicate:

• flat epithelium cells of an indefinite value ASC-US;
• the presence of bacteria in the material;
• changes in the structure of cells caused by the presence of the virus.

Revealed changes do not allow an accurate diagnosis, but only indicate possible diseases.

• Inflammatory atypia - the appearance of cells with minor deviations (thin shells, increased nuclei), which is caused by transferred inflammation;
• Flake carcinoma metaplasia - replacement of cylindrical epithelium multilayer flat;
• Hyperkeratosis is the energization of a multilayer flat epithelium;
• Parararatosis - reinforced oroging or the complete absence of the eczing process;
• Reserves Hyperplasia - an increase in the volume of backup cells.

1. Papillomavirus infection. The appearance of most atypical cells is associated with human papilloma virus. At its presence in the body indicate:

• Atypic cells of flat epithelium of an indefinite value ASC-US;
• Low degree of severity flakes Lsil - disorders in flat epithelium cells;
• Atypic cells of flat epithelium not allowing to exclude HSIL - ASC-H;

1. Neoplasia or cervical dysplasia It is denoted by the Abbreviation CIN (Cervical IntraePithelial Neoplasia) is pathological changes in the mucous membrane of the uterus, arising when a person's papillomavic virus is infected. The virus damages the genetic material in the cell nuclei, which causes the appearance of atypical cells and increases the risk of developing malignant cells. Light dysplasia is capable of regressing (cured) independently, but about 20% over time goes into a more severe stage.

1. Carcinoma in Sita(in situ) - cervical cancer at an early stage of development. The cancer tumor is a cluster of epithelium cells. It does not penetrate the basal membrane and underlying fabrics, does not form metastases. Good treatable. On the development of the oncological process they say:

• Flake carcury intraepithelial lesions of high severity HSIL;
• Cells characteristic of cervical cancer - carcinoma in sieve .

1. Adenocarcinoma -cervical cancer, which originates from the cylindrical epithelium - cells of the cervical canal. On adenocarcine indicate:

• Atypical glandular cells AGC;
• Adenocarcinoma cells in sieve AIS.

1. PlateLoth carcinoma -the view of the cervical cancer, which was formed on the basis of the cells of the flat epithelium. Analysis detected:

• Carcinoma in sita - AIS;
• Atypic cells of flat epithelium not allowing to exclude HSIL - ASC-H;
• Flake carcury intraepithelial lesions of high severity – Hsil.;
• Atypical glandular cells - AGC.

1. Cervical cancer either endometrial cancer - malignant tumor of the inner shell of the uterus. On the oncology indicate:

• Atypical glandular cells AGC;
• Atypic cells of flat epithelium not allowing to exclude HSIL - ASC-H;
• Flake carcury intraepithelial lesions of high severity – Hsil.;
• Cells characteristic of cervical cancer - AIS.

1. Bednocal glands - endometriosis. About this disease they say:

• Benign cells of endometrial;
• Endometrial stroma cells;
• Gisticiocytes - connective tissue cells.

Dad test does not make it possible to make a diagnosis. It is used to highlight a group of women with signs of dysplasia and cancer that need additional examination and treatment.

What to do after dad dough

During the procedure for the fence of the material for a dad-test, the doctor jumps the top layer of the mucous membrane, after which there is no neck of the uterus forms a small leaps. For 3-5 days, scarce bloody or dark brown seals are possible. This state does not require the treatment and use of any medicines.

To prevent infection of damage to the cervix, it is recommended to refrain from:

• sexual contacts;
• scriptures and vaginal soul;
• using tampons.

Padnicolau smear, or Papanicola Test and (English, Pap Test)- A test with which you can define precancerous or cancer cells in the vagina and the cervix. The main difference from the standard cytological study is to further fix the material with alcohol when cooking glass, which increases the accuracy of the analysis.

Scrap is performed from two points: cervical canal and cervix.

Pap testt. It makes it possible to effectively effectively identify the prejudition changes of the epithelium - cervical intraepithelial neoplasia of varying severity.

This type of study is mandatory for women older than 30 years, especially those who have previously been detected or currently detected by human papillomavic viruses of high-oncogenic risk, as well as for women who have discovered the zones of the altered epithelium with a coloscopic examination of the cervix.

The number of drugs (glasses) can be from 1 to 3. Most often it is necessary to explore two drugs - epithelium from endocervix and extocereservix. Material fence must be made using special calves.

Indications:

• screening cervical cancer.

Preparation
In women reproductive age, the smear is desirable to take no earlier than the 5th day from the beginning of the menstrual cycle or no later than 5 days before the alleged start of menstruation.

24 hours before taking, it is necessary to abandon the use of vaginal medicines, spermcides, lubricants, exclude sexual contacts. You can not paint on the eve of the smear.

If there is a visual pathology on the cervix, the smear must be taken regardless of the above factors.

* Please note that children under 16 gynecological analyzes are taken only in the presence of parents. In medical offices, do not make scraping and smears from the cervical canal to pregnant women with a period of 22 weeks and more, since this procedure can cause complications. If necessary, you can refer to your doctor.

Interpretation of results
First, the quality of the smear is estimated: high-quality, poor quality. If the quality of the smear is unsatisfactory, the smear must be repeated. Papinicolau smear can be positive or negative (I class on Papanicolau).

There are no atypical cells, all cells of the same shape and sizes (negative dad-smear). The presence of different cell form and sizes, their pathological position is characterized as a positive smear by papanicolau. The results of these analyzes show the presence of atypical cells, which often sounds frightening for women who do not understand what it means.

A positive result of the smear on atypical cells means not that you have cancer or a precancerous condition, but only indicates the need for further research. The reason for the appearance of atypical cells may be inflammation (chlamydia, herpetic infection, gonorrhea, trichomoniasis), infection with the human papilloma virus (HPV). These changes are more often characterized as dysplasia II degree. In this case, it is necessary to carry out the necessary treatment and repeat the smear in 3-6 months. When papillomavirus infection is often detected by cellocytosis of cells. Coilocyte 3 cells of the flat epithelium of irregular shape, with clear boundaries. The sizes of coylocyte various, usually they are greater than normal cells. The nuclei is increased in different degrees, the nuclear membrane is uneven, folded. Around the core marks the enlightenment of the cytoplasm.

Cytological classification by Papanicolau
1st grade is a normal cytological picture;
2nd class - change of cell morphology due to the inflammatory process in the vagina and (or) cervix;
3rd grade - single cells with nuclei anomaly and cytoplasm (suspicion of malignant neoplasm);
4th grade - individual cells with obvious signs of illustrative;
The 5th grade is a large number of typical cancer cells. The diagnosis of malignant neoplasm is no doubt.

Bethesda classification
When classified by the BetheSda system (The Bethesda System-TBS), the following terms may meet in conclusion of a cytologist:

• ASCUS (Atypical Squamous Cells of Undetermined Significance) or APPS (atypics PlateClaid uncertain significance);
• CIN (CERVICAL INTRAEPITHELIAL NEOPLASIA) or QIN (cervical intraepithelial neoplasia) (term is used as synonymous cervical dysplasia);
• LSIL (LOW-GRADE Squamous IntraePitelial Lesions) or H-PIP (flat-butter intraepithelial lesion of low severity);
• HSIL (High-Grade Squamous IntraePitelial Lesions) or B-PIP (flat-belling intraepithelial damage to high severity).

If in the conclusion of a cytologist's doctor, there is a weak, moderately or rejected dysplasia (H-PIP and B-PIP), in these cases, colposcopy is produced, as well as separate diagnostic scraping of the mucous membrane of the cervical canal and the bodies of the uterine with histological examination of scraps.

The protocol of standardized cytological conclusion consists of the following sections:
1. Quality of the drug:

• adequate;
• inadequate.

2. Cytogram / Description:

• epithelial cells within the normal range are replaced by negative in intraepithelial pathology or malignancy;
• describes the pathological changes of the epithelium.

3. Cytogram / Features: Main categories of pathological changes of the epithelium:

a) Atypic flat cells (ASC):

• PKNS (ASC-US) of an indefinite value - reactive changes or dysplasia I-weak-Qing-1, most often associated with inflammation;
• non-exclusive in PIP (ASC-H);
• low degree of flat-belling intraepithelial lesions (Lsil);
• H-PIP-Qing 1 (I-light dysplasia), papillomavirus infection-HPV;
• high degree of flat-belling intraepithelial lesions (HSIL);
• Qing 2 (dysplasia II-moderate), Qing 3 (dysplasia III-pronounced), cancer in situ;
• flake carcation cancer.

b) Atypic glands (AGS):

• without additional characteristics;
• cells are suspicious on invasion;
• endocervical adenocarcinoma in situ; - adenocarcinoma.

4. Cytogram / Other types: Other non-tuft changes (when detected).

5. Additional refinements: indicate a specific infectious agent (when discovered).

Papinicolau smear, Papanicolau test or dad-test is a diagnostic procedure, during which the doctor checks the woman's cervix for the presence of cancer or precancerous cells.

Papenikolau smear assumes the collection of cells from the cervix - the lower narrow end of the uterus, which is located on top of the vagina.

Early detection of cervical cancer with a dad-test gives a woman a high chance of successful treatment. In addition, with the help of a smear, you can identify such changes in the cervical cells that can cause cancer in the future. Detection of anomalous cells at an early stage with a smear of Papanicolau - the first step in the fight against the development of cervical cancer.

The content of the article:

Why is Pap-test?

Pap-test allows you to identify cervical cancer at an early stage, so abruptly increases the chances of a woman for successful treatment

The papanicolau test is used to detect cervical cancer or precancerous states. This procedure is usually carried out during. In women, older than thirty years old, the smear can be taken simultaneously with the analysis of the human papilloma virus (HPV) - a common infection that is transferred to the sexual way and some women can cause the development of cervical cancer.

Who needs to take a smear Papnikolau?

A woman and her attending physician can decide when it comes to start testing tests and how often this procedure should be performed.

How often do you need to pass the dad test?

Women aged 21 to 65 years old doctors recommend repeating dad test every three years.

Women aged 30 years and older can take the test once every five years, provided that the procedure is associated with the analysis of the human papilloma virus.

If a woman has an increased risk of cancer development, her doctor can recommend more frequent dadnikolau tests. In this case, the frequency of checking will depend on age.

Increased risk factors for the development of cervical cancer may include the following.

• diagnostics of cervical cancer or detection during the dough papanicolau of precancerous cells;
• finding a woman under the influence of d iethylstilbstrol.and before one's birth;
• infection with the human papilloma virus;
• immune system, weakened by transplantation of organs, chemotherapy or regular use of corticosteroids.

You can read more about the risks of cancer development.

Who can stop the passage of dad test?

After hysterectomy, not related to cancer treatment, a woman can stop regular passage of dad tests

In some situations, a woman and her doctor may decide to stop performing Papanicolane tests. Such situations may include the following.

Hysterectomy

After complete, that is, the surgical removal of the uterus, including the neck of the uterus, the woman should ask the doctor if it needs to continue the regular survey. If hysterectomy has been carried out for reasons that are not related to cancerous diseases, for example, because of Miom, the doctor may cancel the obligatory dad-tests. But if the patient was subjected to hysterectomy in connection with the detection of cancer or precancerous formations on the cervix, the doctor can recommend continuing the regular surveillance of smears.

Age

Typically, doctors consider the possibility of stopping the passage of the woman of smears after 65 years, if its previous checks on cervical cancer gave negative results, that is, they did not point to cancer. A woman should discuss this issue with a doctor and with him to make a decision based on individual risk factors. If the patient continues to lead an active sex life, and this makes it with several partners, the doctor can recommend continuing to pass Papanicola's smears.

What risks are pa-test?

By and large, medicine does not know the risks associated with dad-test. However, there are significant risks for those women who do not pass this procedure. The maximum of what a woman can detect is small allocations immediately after passing the smear. Middle and strong bleeding after dad test are not the norm.

That is, a dad test is a safe way to check on cervical cancer. However, its results may be ambiguous. When passing the smear, false negative results are possible, that is, situations where the smear does not show the presence of deviations that are actually available.

A false negative result does not mean that medical personnel made a mistake. The number of factors that can lead to a false negative result include the following:

• collecting insufficient cells;
• a small amount of abnormal cells on the studied area;
• hiding anomalous cells with blood or inflamed cells.

It is important!
Even in those situations where the anomalous cells from the first time cannot be revealed, the time will be on the side of the woman. The cervical cancer is developing several years, and if one check cannot detect cancer, then the next time it will happen with more probability.

How to prepare for the surcharge of Papanikolau?

To ensure the greatest effectiveness of PAP test, a woman can follow the recommendations that are shown below:

• avoid sexual activity, scrustling, using vaginal drugs, spermicidal foam, creams or jelly in two days before the procedure. All of the above can clean or hide abnormal cells;
• try not to plan a dad test during the menstrual cycle. The smear can be taken, but it is better not to perform the procedure at this time, if such an opportunity is available.

What to expect from the dough Papanicolau?

What happens during dad dough?

With the help of a speculator, the doctor expands the vagina to get free access to the cervix

Pap-test is usually performed in the doctor's office and it takes just a few minutes. A woman can ask a doctor about whether it needs to be undressing completely or only below the belt.

The patient falls on his back with bent legs. The body body at the time of procedure is placed on the table, and the feet remain on special support supports.

The doctor gently enters the tool in the vagina, which is called a speculaum. This fixture holds the walls of the vagina at a distance from each other to allow the doctor to clearly see the neck of the uterus. Entering speculaum can cause a pressure sensation in the pelvic area.

The doctor then takes a sample of the cervical cells using a soft brush or a flat object, called a spatula or a buatard. As a rule, this procedure does not cause painful sensations.

What happens after passing the dough Papinicolau?

After the smear is taken, a woman can continue the day without restrictions.

Depending on the type of test, the doctor may place the cell collected during the procedure in a container filled with a special fluid (liquid dad-test), or on the slide glass (cytological smear).

Samples are given to the laboratory, where they are checked under the microscope in order to search in cells of such characteristics that sign about cancer or precancerous states.

Upon completion of the procedure, a woman should learn from a doctor when results will be prepared.

Padnicolau test results

Pap-test can suggest a doctor about the presence of suspicious cells that need further examination.

Negative result

If only normal cells were discovered during Papnicolau dough, the doctor will inform the woman about the negative result.

In this case, there will be no further treatment and no further diagnostic procedures until the woman comes to another gynecological examination.

Positive result

If there will be unusual cells during the dough, the doctor will tell the patient about the positive result. A positive result does not mean that a woman has cancer. What does a positive result indicate, depends on the type of cells that were discovered.

Below are the terms that the doctor can sound, as well as the further steps of a woman and its medical team.

Atipia flat cells of uncertain significance

Flat cells are thin and literally flat cells that are on the surface of a healthy cervix. In this case, the Pap-test revealed a small anomaly of these cells, but the changes clearly indicate the presence of a precancerous state.

With a liquid test, the doctor may re-analyze the sample taken to check the presence of viruses in the body, which are known for its ability to promote cancer development. One of these viruses is the human papilloma virus (HPV).

If there are no such viruses, then the abnormal cells found as a result of the test will not be a big problem. If there are viruses, a woman will have to go further checks.

Plottle intraepithelial lesions

This term is used to identify that the cells obtained as a result of Papanicola dough may be predict.

When the degree of cell change is low, it means that the form, dimensions and other characteristics of the cells suggest that if the precancerous lesions are presented, then until the moment they are cancer, can pass for several years.

If the degree of cell changes is high, there is a high probability that these lesions can develop in cancer far earlier. In this case, additional diagnosis will be required.

Atipia of ferrous cells

Irony cells produce mucus and are located on the inbox of the cervix, as well as in the most uterus. Atypical glandular cells may have small anomalies, but it is almost always difficult to understand whether they are cancer.

To determine the source of such cells and their significance, further expertise will be required.

PlateLock carcinoma or adenocarcinoma

This means that the cells obtained as a result of dad dough look so anomalously that the pathologist is almost confident in their cancer origin.

PlateLoth carcinoma is characterized by the occurrence of cancer in a flat epithelium of the vagina or cervix. Adenokarcinoma is characterized by the presence of cancer in ferrous cells. If such cells are detected, the physician will recommend their further evaluation.

If the results of the PAP test were positive, that is, the doctor may offer to perform a procedure called Colposcopy, during which a special tool with magnifying glass (colposcope) is used to test the tissues of the cervix, vagina and vulva.

The doctor can also take a fabric sample (perform a biopsy) from any site that seems suspicious. Then the sample of the fabric is sent to the laboratory for analyzing and setting an accurate diagnosis.

Cervical cancer Does not arise suddenly. This disease gradually arises from various precancerous pathologies and progresses very slowly for several years. Therefore, in the case of early detection of pathology, the chances of complete recovery are very high. This is especially true of numerous precancerous diseases, which today are very good to treat with the use of the latest methods and technologies.

Cytological Research Shacking Matter (PAP Test) - This is a modern method of early diagnosis of precancerous changes at the level of cells.

As a screening research, this analysis allows to reduce the disease of the cervical cancer by 84%.

Why is the analysis of cytology?

The study is carried out primarily in order to make sure that the cervix is \u200b\u200bhealthy.

As a rule, in 90% of cases, the test confirms the absence of diseases.

In 10% of women, various pathologies are detected, which can be treated with the outcome of complete recovery.

Simple ambulatory therapy for precancerous changes prevents the development of a serious disease.

Subject to regular analysis, a woman practically negates the risk of cervical cancer.

Indications for analysis.

Preventive inspections and screening research.

Suspicion of atypical processes (dysplasia) cervical epithelium.

All women older than 35 years at least once a year.

Women from risk groups.

The risk factors for the development of cervical cancer include

the presence of human papillomas in the body of oncogenic viruses (HPV);

chlamydial and herpetic infection;

chronic inflammatory gynecological diseases;

frequent change of sexual partners;

early start of sexual life;

hereditary factor (cervical cancer in close relatives);

long-term use of hormonal contraceptives;

frequent numerous childbirth;

How is the taking of biomaterial for analysis?

Cytological material from the mucous membrane of the cervical cervix takes the scuffery method. Scales are carried out by special brushes from different parts of the cervix and placed on the slide.

In order for the material of the material in the process of the material, extraneous fabrics, with the taking of the material, special mirrors are used.

The doctor quickly inflicts biomaterial on the glass to prevent drying, then the material is immersed in a special solution and sent to the laboratory.

Cytological examination of the cervical cervix carries the name of the PAP test named Jords Papincolau's scientist.

In the laboratory, the laboratory provides staining of the smear in several stages according to the method of Papincolau, after which it estimates the degree of ripening of the cytoplasm of the epithelium cells and reveals the presence of atypical.

In very rare cases, the inadequacy of the material taken can be revealed. Then the laboratory will simply ask to repeat the sample.

When can a distorted analysis result?

First of all, the distorted result can be obtained if the woman prepared for analysis is not properly.

biomaterial for analysis taken during menstruation and in the smear there are blood;

in the smear there are spermatozoa;

in the smear, extraneous impurities were found: spermicidal creams, grease for condoms, gel lubricant for ultrasound;

the doctor conducted a study by the method of palpation to take the analysis, so the biomaterial is polluted by Talc.

As for girls up to 20 years, they can find false-positive changes against the background of hormonal shifts.

How to prepare for the delivery of analysis on oncocytology?

Compliance with several fundamental preparation rules for analysis is a prerequisite for obtaining reliable results.

the biomaterial is taken at no earlier than 5 days of the menstrual cycle. In any case, bleeding must completely end.

The analysis is carried out no later than 5 days before the expected time of the coming of the next menstruation.

The test is produced no earlier than 24 hours after sexual contact.

If the woman enjoyed Lubricants, hesitated medicines into the vagina, creams, dried with various solutions, used tampons, then from the moment such manipulations should pass at least 48, and better than 72 hours.

The same period of time must pass after an ultrasound study by the vaginal sensor.

There is a slight chance of a negative result of cytology with the modified states of the epithelial cervix layer, so regular tests are needed once a year.

Classification of the results of analyzing cytology

1 class. Anomalous cells in the smear are not found, a healthy cytological situation.

Grade 2. Inflammation of various etiologies lead to a violation of the structure of the cell.

Grade 3. Detected single modified cells. In this case, the diagnosis must be clarified, therefore, a re-cytological study is usually carried out or a biopsy of the modified sections with subsequent cytology.

4th grade. Separate atypical cells were found with signs of malignancy.

Grade 5. Analysis has a large number of atypical cells.

Currently, a more modern and progressive study method is liquid thin layer cytology. This is, of course, more costly and therefore an expensive diagnostic method, but at the same time more sensitive.

The sensitivity indicators of the traditional cytological research range from 35 to 89%, while the sensitivity indicators of liquid cytology are 71-95%. Such criteria allow us to take an analysis on cytology less often - once every two or three years.