Cytology is the basic preventive examination for cervical cancer. However, cytology is performed not only for the early detection of possible neoplastic changes. When to do the first cytology and how often to repeat it? How to prepare for the test? Is it possible to have intercourse before the Pap smear test?
Cytology - what is it?
Cytology , otherwisecervical swaby, is the basic preventive test for cervical cancer, which should be used by both teenagers and and women of childbearing age.
Thanks to cytology, we canprevent 60-80 percent. cases of invasive cervical cancerbecause this test detects it is still pre-invasive, when it is fully curable.
Cytology - when to do the test for the first time?
The first time we should have a cytology testat the age of 20-25 or shortly after the beginning of sexual life(at the latest 3 years after the beginning of sexual intercourse).
The earlier a girl undergoes sexual initiation, the sooner she should have her first cytology done.
Cytology - what are the indications for the test?
Cytology also allows you to findhuman papillomavirus (HPV) infectionassociated with this tumor.
Cytology is used not only for the early detection of possible neoplastic changes, but also for:
- control of conservative and surgical treatment of erosions of the cervical disc,
- diagnostics of the condition of the vaginal epithelium,
- assessment of the effects of hormonal drugs,
- determining the date of ovulation and the duration of the second phase of the cycle.
Cervical smear is also performed on pregnant women.If for some reason cytology was not performed during pregnancy, then the material for this examination should be collected as soon as possible, i.e. already during that first postpartum visit to the gynecologist.
Read also: CYTOLOGY - an incorrect Pap test result does not have to mean the worst
Cytology - how to prepare for the test?
Cervical smears are not collected during menstruation. It is best to reportfor the smear test between the fourth day after the menstruation and the fourth day beforenext.Also wait, at least two days, if you have used any vaginal medications (e.g. medications, contraceptives) or irrigations.
It is also worth knowing that you cannot have sex before the Pap smear test.In addition, you should not undergo a gynecological examination within 24 hours before the planned cytology.
In the case of an intimate infection (it may be evidenced by vaginal discharge, itching, burning), it is better to do the examination after the condition is cured, because the smear taken by the gynecologist may not be suitable for evaluation due to the existing inflammation.
Read also: METHODS OF CONTRACEPTION: natural, chemical, mechanical and hormonal
According to an expertBarbara Grzechocińska, MD, PhD, obstetrician gynecologist, 1st Department of Gynecology and Obstetrics, 2nd Faculty of Medicine, Medical University of WarsawShould a virgin get a Pap smear?
I'm 29 years old and I've never had sex. My period has been significantly delayed in the last 2 months (almost 2 weeks), and I also feel pain in the sacral part. Before, I had infections that disappeared after a while and I did not treat them. I went to the gynecologist, who carried out the examination, prescribed a vaginal cream because she didn't like the discharge. When I asked for a cytology, she refused me, saying that in my case it was not needed, because I had not had sex. As far as I know, virginity does not protect against cancer. Then two other doctors refused me this way. So I signed up for a free cytology under the NFZ program in my city and there I was given a "supposed" cytology, because I do not know if it can be called a cytology, since there was no speculum and you took a swab "on top" with a stick, and not a special brush. Besides, she explained to me that since I am a virgin there is no way to get into the cervical canal. I know that the method used on me is not very reliable, so I may as well be sick and not know anything about it. What is left for me in this situation? Maybe I should wave my hand like my other virgin friends who are about 30 years old (there aren't enough of them at all) and recognize that pap smear is not a test for me?
Barbara Grzechocińska, MD, PhD, obstetrician-gynecologist replies:
Cytology is atest for precancerous conditions and cervical cancer . Since it has such a purpose, the swab should be taken from the disc and the cervical canal and not from the vestibule of the vagina. In women who havehave not had intercourse, the likelihood of developing cancer is extremely low.This is due to the low likelihood of contracting the papillomavirus. Perhapshence the reluctance to get your pap smear, but of course the smear for testing should be obtained and it is possible. In this case, a small speculum is inserted into the vagina.
Cytology - what does the test look like?
You just need to lie down comfortably on the gynecological chair and relax.The doctor inserts a speculum into the vagina.Then with a special brush with flexible fibers (resembles a trident)collects the secretion containing mucosa cellsfrom the cervical epithelium.
You will hardly feel anything during this time. When collecting the sample on the brush, only a slight "pinching" may appear. It is worth the sacrifice, however, because the material from the brush is better for testing.
For the result to be reliable,the smear is always taken in one go from two places:
- cervical disc,which is most visible,
- of the cervical canallocated slightly deeper.
Both samples are placed on separate special slides and immediately (within 5 seconds) fixed with special reagents.
Later these samples go to the laboratory. Here, the specialist , the cytologist observes the size of thecells, whether they are properly built and have the correct shape, under high magnification. If he has a lot of experience, he detects even the smallest changes in them.
Cytology - correct smear collection
The material taken with a sterile brush from the transition zone and from the cervical canal should be immediately spread on the slide, and then:
- fix with dedicated fixers(in case of conventional cytology test) or,
- put in a special container with a liquid medium(in the case of cytology on a liquid medium).
The glass with the smear or the container with the material on the liquid medium should be properly labeled.
The labeling should includetest number and the patient's last name and first name.The smear or container with the collected material should be accompanied by a referral with the patient's data containing:
- name
- surname
- PESEL number and / or bar code
It is also necessary to provide information on the date of the last menstruation and possible hormone therapy used by the patient. Staining of cytological smears using the Papanicolau method is recommended.
Read also: What are the causes and how to recognize the symptoms of cervicitis?
Cytology - result. How to interpret it?
The test result should be formulated in accordance withwithBethesda classification.In cases where the Pap smear test is normal, additional biomarker testing is not recommended.
The cytology result is collected after a few days.It usually tells you which cytology group you have.The lower the better.
In 1980, the International Society of Gynecological Pathologists (ISGYP) proposed the term "cervical intraepithelial neoplasia " (CIN). Pre-invasive epithelial lesions were considereda continuous series of events that morphed into each other.
Cytology - groups
The CIN term, depending on the severity of the changes , has been divided into three grades:
- CIN I
- CIN II
- CIN III
Comparison of the CIN and SIL classification systems for pre-neoplastic changes in the cervix:
| Traditional diagnosis of dysplasia | CIN terminology | Bethesda System, SIL |
| Brodawczak | Brodawczak | LSIL |
| Low degree of dysplasia | CIN I | LSIL |
| Moderate dysplasia | CIN II | HSIL |
| High-grade dysplasia | CIN III | HSIL |
| Pre-invasive cancer | CIN III | HSIL |
Pre-invasive cancer has been included in the CIN III category. The progress of the above-mentioned classification was the treatment of precursor changes in the squamous multilayer epithelium asone continuous process of neoplastic transformation . It has been noted, however, that CIN I is not a fully precancerous lesionas it may regress even in untreated cases.
In 1988, a cytological report according to the Bethesda System (TBS) was developed and implemented for diagnostics (modifications were presented in 1991 and 2001). It introduces terms fora lesions suspected of cancer and cervical intraepithelial neoplasiabased on abnormal morphological characteristics of the cells of the cervical squamous and glandular epithelium.
In 2001, a modified cytology report according to the Bethesda system (TBS)was developed and implemented for diagnostics , the terminology of which is presented in the table below:
| Abnormal squamous epithelial cells | |
| ASC-US | Atypical squamous squamous epithelial cells of undefinedcharacter |
| ASC-H | Atypical squamous squamous epithelial cells, high grade endothelial neoplasia (HSIL) cannot be ruled out |
| LSIL | Low grade intraepithelial neoplasia; includes HPV infections / low grade dysplasia (CIN I) |
| HSIL | High grade intraepithelial neoplasia; includes moderate (CIN II) and high degree (CIN III) dysplasia, CIS (carcinoma in situ) |
| Squamous cell carcinoma | If an invasion is suspected |
| Abnormal glandular epithelial cells | |
| AGC | Atypical cervical glandular epithelial (AGC) or endometrial cells or other glandular cells |
| AIS | Adenocarcinoma in situ |
| Adenocarcinoma | Cells of cervical or uterine adenocarcinoma or ectopic tumor |
Necessary Data To Evaluate Cervical Cytology Screening
The vast majority of cervical cancer screening smears are normal and do not show abnormalities in the appearance of squamous or glandular cells.When formulating the diagnosis, the cytological picture should be correlated with the age of the woman and the phase of the menstrual cycle.
In young women, due to the action of estrogens in cytological smears, there are mainly mature cells of multilayered squamous epithelium.
Pap smears collected in pregnant women contain mainlycells of the intermediate layers , rich in glycogen (scaphoid), which is a result of progesterone.
In postmenopausal women, due to the deficit of estrogens, cytological smears mainly presentcells from the basal and parabasal layers.
Cellular pleomorphism occurs in abnormal, atypical and intraepithelial neoplasia cells and the ratio of nucleus to cytoplasm increases.
The contours of the nucleus are irregular, there is a thin nuclear membrane as well as intranuclear invasions and vacuoles. Clear nucleoli and abnormal division figures are found.
The degree of severity of the above-described changes in the appearance of cells determines the diagnosis ofatypia or intraepithelial neoplasia of the cervix.The key cytological feature of human papillomavirus infection is the presence of koilocytes.
The namekoilocytesis an abnormal squamous cell epithelium with an enlarged hyperchromatic nucleus surrounded by a large bright space withon the perimeter of the cytoplasm.
According to an expertBarbara Grzechocińska, MD, PhD, obstetrician gynecologist, 1st Department of Gynecology and Obstetrics, 2nd Faculty of Medicine, Medical University of WarsawInterpretation of Pap test results
The second group came out.The smear is within the normal range.What are endocervical cells and / or metaplastic cells, biocenosis: neutrophils (+), flora bakt. ++ G (+) mix, cond. Lactob.v. ? I am asking for help in deciphering these difficult terms …
Barbara Grzechocińska, MD, PhD, obstetrician-gynecologist replies:
Endocervical cellsare normal cells in the cervical canal.Metaplastic cellsare normal cells on the border of the glandular and multilayered squamous epithelium.
Biocenosisis the term used to describe what bacteria are in the vagina (the vagina is never sterile and is always full of bacteria, just like on the skin).
The G + bacterial floraare Gram positive bacteria.
Lactobacillusare sticks of lactic acid.
The most important information for you is that "the smear is within the normal range" and that there is the second cytological group.
Cytology - how often to do a cytology?
Cytology should be done once a year , and ifliquid cytology is done - every 2 years . If 3 consecutive results are correct, women 30 years or older may be tested every 2-3 years.
Women who frequently change sexual partners should, however, get a Pap smear every year. The risk of infection with the human papillomavirus HPV, several types of which is carcinogenic, increases with the number of partners. With this lifestyle, it is also worth to test for the presence of HPV from time to time.
80 percent In cases, the body deals with and fights the virus on its own. However, inabout 20 percent of infected women, the virus can cause cervical cancer.If the virus is detected, further treatment must be consulted with a doctor and a cytology test at least once a year.
Also, other women who are at increased risk of cervical cancer should undergo the examination every year, and even more often if recommended by the gynecologist. This group includes:
- HIV or HPV infection
- decreased immunity
- pretreatment for cervical erosion or dysplasia, a precancerous condition of the cervix
It's safest to report annually as a small proportion of the results are false-negative.The swab doesn't always stayprofessionally collected or assessed in a laboratory.
On the other hand, in pregnant womencytology is performed twice: in the 1st and 3rd trimesters of pregnancyy, i.e. in the period 1-3 and 7-9 months of pregnancy.
Cytology - where can I get a free test?
Cytology is acheap test(costs PLN 50-85) depending on the city. The examination does not need to be done in a private office.
If you are insured with the National He alth Fund, you can go toa public he alth facility or take advantage of the government'sand early detection of cervical cancer program, which guarantees free cytology every 3 years for women between the ages of 25 and 59.
Poland is one of nine European Union countries where such a screening program has been organized. However, we use it quite reluctantly. Although personalized invitations to the cytology are sent, only 25% of respondents apply for it. women.
These are most often women educated from large cities, from the Zachodniopomorskie and Warmińsko-Mazurskie voivodships. It is a pity that not more, becausethe quality of the examination under the program is high , and in the case of an incorrect cytology result, the woman is referred for further diagnosis and treatment.
