Early diagnosis of neoplasia and cervical cancer is the most important area of modern gynecology. The main method of screening is cytological examination. Material for it is most often taken using a smear or targeted biopsy. This traditional method is technically simple, but gives up to 40% false negative results. And this means that there is a risk of late detection of cervical cancer even in women undergoing regular preventive examinations.
The liquid cytology method is a more modern and informative screening option using the Papanicolaou test (). Despite its recent introduction into clinical practice, it is already recognized as the most effective method for the early diagnosis of cervical cancer. After all, the effectiveness of high-tech liquid cytology reaches 95%, while the sensitivity of traditional methods is on average 60%, and in some cases does not exceed 40%.
When and who needs such screenings
There is an opinion that a regular oncogynecological examination should be carried out only by women approaching the premenopausal period. But it's not. According to current clinical guidelines, cervical cancer screening with cytological examination is recommended for all women from 21 years of age. In general, it is recommended to start 3 years after the first sexual contact. So early entry into intimate life is the basis for the early start of preventive gynecological examinations.
In the first 2 years, screening is carried out annually. Subsequently, with negative results of repeated cytological studies, preventive examinations become more rare and are carried out 1 time in 2-3 years. After 65 years, the frequency of screening studies is determined individually.
The reason for the increase in oncogynecological examinations is the appearance in a woman of background and precancerous diseases of the cervix. At the same time, the patient is classified as a high-risk group for developing cancer, and a cytological examination of gynecological smears is performed on her annually. Additional screening activities are carried out during the preparation of a woman for conception.
Liquid cytology during pregnancy is performed according to strict indications. These include the identification of changes in the patient's cervix, suspicious for precancer or malignant transformation. It should be remembered that such an analysis increases the likelihood of a threatened abortion and may require measures aimed at normalizing uterine tone.
How to prepare for the study
Preparation for liquid cytology of the cervix begins 2-3 days before the test and includes:
- sexual rest;
- refusal to douche;
- cessation of the use of any means for vaginal administration (candles, tablets, sprays).
When is the best time to get screened?
Cytological examination is not carried out during menstruation, 5 days before and 5 days after. Preference is given to the first half of the menstrual cycle, although this recommendation is not strict.
If the patient was performed, a cytological examination is permissible no earlier than 24 hours after it. And in the case of a biopsy of the cervix - only after 3 weeks.
How is liquid cytology performed?
Currently, several technological variants of liquid cytology are used in clinical practice. The best known and sought after of these is Becton Dickinson (BD) Sure Path™, which was approved by the FDA in the US in 1999 and has been officially approved by NICE in the UK since 2004. Since that time, it has been actively introduced into everyday clinical practice in Europe, the Russian Federation and neighboring countries.
The main stages of this research are:
- Material collection. For this, a specially designed combined cytobrush of a special design is used. It is carefully inserted into the cervical canal, after which it is rotated (2 counterclockwise and 3 along its course). This ensures the maximum possible and at the same time less traumatic obtaining of superficially located cells of the mucous membrane of the cervix - from its vaginal part, from the cervical canal and adjacent areas of the vagina. Such manipulation does not require anesthesia, because the sensations experienced by a woman do not exceed the pain threshold.
- The placement of the cytobrush with the obtained material in a special test tube (vial) with a special liquid, which gave the name to the technique. Such an environment not only has preservative and stabilizing properties, but also promotes the formation of a suspension with a uniform distribution of cells and other elements throughout the volume. The tubes are transported to a laboratory licensed for liquid cytology and equipped accordingly.
- Automated preparation of a cytopreparation. It includes vacuum filtration of a portion of the suspension from a test tube, centrifugation, applying the resulting cell sediment in a uniform layer on a glass slide, Papanicolaou staining using wet fixation.
- Microscopy of the cytopreparation. The Pap test based on liquid cytology is carried out according to the same principles as in the case of the traditional method. But at the same time, the features of color, position and size of cells after wet fixation of the cytopreparation are taken into account. That is why the study can only be carried out by a specially trained certified laboratory doctor.
Deciphering the results of the analysis is carried out only by a gynecologist or oncologist. The response from the laboratory can be received 5-10 days after the sampling. But often this period is extended to 2-3 weeks. The speed of obtaining a response depends on the time of transportation, the workload of the laboratory and the method of informing the polyclinic link about the data of the studies. If necessary, an express study is carried out, in which case the doctor will know the result within the first 24 hours.
Scheme of carrying out liquid cytology of the cervix
What happens after research?
The recovery period after liquid cytology does not fundamentally differ from that when taking a conventional smear for oncocytology or. Within 1.5 weeks, it is recommended to maintain sexual rest, stop using vaginal tampons and douching. In the first days after the test, light bleeding from the vagina is acceptable, so it is advisable for a woman to use sanitary pads.
Increased body temperature, prolonged or profuse spotting, pain in the lower abdomen - warning sign. The appearance of such symptoms requires prompt medical attention.
What is the difference between liquid cytology and conventional cytology?
The key differences between these screening methods include:
- In a conventional cytological examination, tissue samples are taken at sight, the sites for examination are selected by the doctor based on visual changes in the mucous membrane. In the case of a liquid technique, the material from any woman is obtained from the entire circumference of the cervix. This significantly reduces the likelihood that any modified section will be skipped.
- During conventional cytology, the biomaterial is dried on glass at room temperature before shipment. And with liquid cytology, it is placed in a special test tube (bottle) with a special stabilizing medium, which prolongs the allowable period of transportation and storage of the obtained sample. The biomaterial placed in a test tube is suitable for research within several months and does not require the creation of special conditions.
- With the traditional method, filtration is not carried out. Therefore, if there are inflammatory elements in the smear, a large amount of mucus and other impurities, the result of a cytological examination is not reliable enough and usually requires a second PAP test after treatment. This shortcoming is devoid of the liquid technique.
- With the traditional method, far from the entire volume of the resulting tissue falls on the glass and is subjected to subsequent research. Up to 35-40% of the cells remain on the doctor's instrument and gloves. This creates the possibility that existing malignant tissues will remain undiagnosed. With the liquid method, such a loss of biomaterial does not occur. This is ensured by placing the cytobrush in a stabilizing and suspending medium, followed by automated centrifugation of the sample and the formation of a special cytopreparation with a standardized even layer of cells on a slide slide.
- In a traditional smear for oncocytology, cells on a glass slide are usually arranged in several layers, overlapping each other and thereby worsening visualization. Liquid cytology bd shurepath is free from this drawback, the resulting cytopreparation is monolayer.
- The possibility of re-analysis of the same biomaterial or other studies using liquid cytology. After all, the suspension in a test tube does not lose its properties for several months, and its volume is sufficient to obtain several cytopreparations. With the traditional technique, the tissues under study are not protected in any way, and there is a high risk of damage during storage.
In general, liquid cytology using automatic screening is a significantly more informative technique compared to the traditional collection of smears from the cervix for oncocytology. And its main advantage is a small percentage of false-negative results of oncogynecological screening, which is ensured by the progressive technological features of the test with strict adherence to the rules for sampling biomaterial.
Diagnostic capabilities
Fluid cytological screening is aimed at identifying a variety of cellular atypia, which indicates the presence of a precancerous condition or cervical cancer in a woman. The single-layer and uniformity of the cytopreparation provide a high degree of visualization, allowing the laboratory assistant to reliably determine the nature of the changes. This minimizes the chance diagnostic errors and false negative results.
The presence of a suspension and its sufficient volume allow, according to indications, to additionally conduct other studies:
- analysis for tumor markers;
- any PCR studies;
- HPV testing;
- immunocytochemical studies with the determination of proliferation markers.
But liquid cytology does not allow diagnosing inflammatory conditions, because the mandatory filtration step removes detritus, leukocytes and other impurities from the suspension. Therefore, if colpitis is suspected, it is advisable to take a parallel traditional smear for oncocytology. This is a significant drawback of the technique.
However, Pap fluid cytology is recommended by the WHO, FDA, and global cancer communities as the "gold standard" for early detection of cervical cancer. But at present, in the Russian Federation, when conducting screening, the traditional smear for oncocytology is most often used. This is mainly due to insufficient technical equipment polyclinic level and the lack of proper qualifications among doctors. Liquid cytological examination is still carried out mainly by large private laboratories: Hemotest, Invitro and others.
Cytological analysis (from the Greek “cytos” - cell) is a study of the number, structure and shape of cells and an intercellular component obtained from a living organism, under an optical microscope. It allows you to identify pathological changes in the early stages and clarify their localization quite quickly, unlike other instrumental methods.
Cytological analysis is one of the most common diagnostic methods in gynecology and obstetrics.
In the women's health clinic, various fluids (vaginal and menstrual secretions, urine) and (more often) surface layers of cells that are taken from various parts of the reproductive system are subjected to cytological examination.
For example:
- vulva;
- vagina;
- cervix and cervical canal (internal cervical canal);
- internal cavity of the uterus;
- fallopian tubes;
- ovaries.
For the cytology of the external sections (to the uterus), freely exfoliating layers of cells are required, therefore this study belongs to fairly painless, fast (from several minutes during surgery to several days during a routine examination) and mass methods recommended for the annual routine examination of women from 18 ( subject to the onset of sexual activity) or 30 to 65 years.
Representatives of risk groups for oncology are examined 2 times a year; cancer patients on treatment and endocrinological patients - more often, according to indications.
To study the cellular composition of deeper organs, additional measures are required:
- endoscopy (uterus);
- organ punctures;
- washings and impressions obtained during laparoscopy, open incision or during surgical operations.
A smear for cytology includes the study of the surface (epithelium) and middle (mesothelium) layers of organs, as well as other included components, and is used to solve several problems.
They are:
An analysis for cytology in gynecology is one of the most informative studies (for example, when establishing hormonal activity, cytology successfully competes with a blood test), however, the degree of its reliability is directly dependent on the qualifications of the doctor taking the material, on the strict adherence to the rules for staining and sample preparation and from the correct choice of the place of the fence.
Therefore, the method requires a systematic repetition, and if deviations are found, supplements with a comprehensive examination.
Varieties of cytological tests
Cytological analysis has been known in gynecology since the beginning of the 20th century, when the Greek physician Georgios Papanikolaou first used it for the early diagnosis of cervical cancer. Currently, several new methods have been developed showing improved reliability.
The procedure for carrying out manipulations during the sampling of material remains common for all these types, the differences relate to the methods of preparation, processing and analysis of the sample taken.
For example:
The study of the prepared sample is traditionally carried out visually by a cytologist using a powerful microscope, but in recent years, instrumental analysis has also appeared.
Differences between cytological and histological analyzes
Sometimes diagnosticians need to study not individual cells, but their relative position and the nature of the intercellular space. In this case, the patient is referred for histology (from the Greek "histos" - tissue) - the collection and further examination of a small fragment of tissue (structurally and functionally related group of cells).
Features of histological examination:
- refers to biopsy methods;
- requires more complex preparation;
- carried out in a hospital;
- performed under anesthesia;
- differs by a more labor-intensive technique of aiming when taking;
- requires complex processing of the selected material;
- hardware learning is required.
Tissue sampling is not indicated in the presence of very small foci of the detected lesion.
Histology is commonly used to diagnose human papillomavirus (HPV) and the level and stage of the cancer.
Differences between a cytological study and an analysis for oncomarkers
Tumor markers are specific protein molecules that can be produced by both altered and healthy cells of the body in the presence of disorders.
For example:
- inflammatory process;
- benign formations;
- when smoking;
- when taking medicines;
- during pregnancy, menstruation and other physiological changes;
- depends on age.
Therefore, the test for markers is also not 100% reliable. The analysis requires the study of venous blood, urine and other fluids.
The objectives of the study are similar to the analysis for cytology:
- detection of the presence of a tumor and determination of its nature (oncological or benign);
- evaluation of the effectiveness of anticancer therapy;
- search for metastases and recurrences.
Analysis for tumor markers is used for women at risk for reproductive cancers, digestive system and other organs and is not used for preventive examination. Sometimes the method is used to clarify the results of a cytological test.
Many tumor markers reveal different diseases, so this test requires a comprehensive examination.
The advantage of the test for gynecology is the ability to determine changes in the organs above the cervix (ovaries, uterus, fallopian tubes). The test for tumor markers requires more careful preparation of the patient due to the high sensitivity of the objects of study to physiological fluctuations.
Differences from microbiological analysis (smear on flora)
A smear from the vagina, cervical canal, urethra and rectum for microflora (pathogenic, symbiotic and opportunistic microorganisms) is performed through manipulations similar to a smear for cytology, and is included in a routine gynecological examination recommended for every six months for every woman.
Usually both types of smear are taken at the same time. Cultures may be required for microbiological analysis. Microscopy for bacterioflora is performed using a different staining method (Gram).
Indications
Cytology analysis in gynecology is part of the screening examination of the adult female population in many countries of the world. A planned cytology test is mandatory for all women over 18 (this age decreases with an earlier onset of sexual activity) and under 65 years of age.
At an older age (due to a decrease in estrogen levels and a decrease in the reliability of the result), a smear is prescribed at the discretion of the gynecologist. The focus group includes women over 30 years of age.
For women of screening age, in the absence of positive test results (that is, in the absence of detected pathologies, stage 1 cytogram) for 2 years, the planned period is postponed for every 2 years, with a negative result within 3 tests - for 3 years.
Indications for an unscheduled cytological examination may include:
Test tolerance
Screening cytological examination is carried out on cells no further than the outer part of the cervical canal and refers to non-invasive methods.
Taking freely exfoliating cells from the vagina does not cause discomfort, the patient experiences some discomfort when taking material from the surface of the cervix and from its canal, however, this procedure is short-term and also does not include penetration into the deeper layers.
To reduce discomfort, the gynecologist can preheat the instruments in hot water. This study is rightfully considered a trivial medical procedure and should not cause concern.
Women who are forced to frequently take a smear for cytology (for example, cancer patients) get used to these manipulations very quickly, which should serve as excellent evidence for women who avoid this test due to fear of pain or possible complications.
Preliminary preparation
The reliability of the results of a cytological study to a large extent depends on the correct preparation and the well-chosen time for visiting a gynecologist.
A smear should not be taken under the following conditions:
How is material collected for analysis?
A cytological smear is taken during a routine gynecological examination, which takes no more than 15 minutes, and does not require the patient to special training. After setting up the dilator and introducing the mirrors, the specialist makes a scraping from the vaginal wall, the outer surface of the cervix and from the canal with a spatula or brush, places the smear on a glass slide and sends it to the laboratory assistant.
How long to wait for a response?
In emergency situations (for example, when performing a surgical intervention), the result of cytology is provided to the surgeon within a few minutes, before the completion of the operation. Waiting for a response during a scheduled screening examination in a antenatal clinic takes up to 2 weeks, since in this case the time to prepare the result depends on the workload of the institution and does not require urgency.
In private clinics, an answer can be given within 1-3 days, however, it should be remembered that the most accurate result of a cytological examination can be obtained if all stages of sample preparation are followed, which takes about 7 days outside the cito ("urgent") mode.
Deciphering the results
Cytological analysis in gynecology ends with the issuance of results in the form of a cytogram.
The cytogram contains information about one of the 5 stages of the development of the disease according to the Bethesda system from 2014:
- Absence of deviations. Negative test result.
- Small changes in cell morphology; atypical cells are absent. As a rule, this stage indicates the presence of inflammation, the detection of which will require additional examination measures.
- Some cells contain deformities of the nuclei, which indicates their tendency to be atypical. The stage is characteristic of dysplasia and erosion of the cervix, requires a histological examination to exclude precancerous conditions.
- Presence of cells with malignant deformities: enlarged nucleus; altered cytoplasm; change in the structure of chromosomes. This stage indicates a precancerous level of dysplasia.
- The presence of cells with malignant changes in large numbers.
In addition to epithelial cells, the cytogram describes other components of the smear:
- the degree of microbiological purity of the vagina (the norm is 1 and 2 degrees; 3 and 4 degrees indicate infectious inflammation);
- the number of leukocytes (white blood cells that appear in a smear when different types inflammation; normal - up to 10 pieces in a smear from the surface of the cervix, up to 30 - from the urethra);
- the presence of mucus (the norm is a moderate amount);
- the presence of bacteria and fungi (microorganisms must be absent);
- the content of squamous epithelial cells (no more than 10 pieces).
Cytogram-detectable disorders
An analysis for cytology in gynecology is an informative method that allows you to diagnose many disorders at an early stage. In addition to varying degrees of progression of malignant processes, a cytogram helps to detect a wide range of other pathologies.
Infectious diseases:
Benign formations and dysplasia (cell deformations) are dangerous with the possibility of degeneration into cancer:
- polyps- proliferation of cells;
- leukoplakia(hyperkeratosis) - deformities of the epithelium (mucous lining) of the cervix;
- erythroplakia- atrophy of the cells of the upper layer, can be observed with low estrogen;
- dysplasia- changes in the structure of cervical epithelial cells (refers to precancerous conditions).
Inflammations of a non-infectious nature (for example, caused by decompensated diabetes mellitus).
The state of the hormonal background and its deviations:
- high estrogen is an oncological risk factor for diseases of the genital organs and mammary glands;
- reduced amounts of estrogen possible reason infertility and instability of the menstrual cycle;
- increased values of androgens - male sex hormones;
- deviations in the content of prolactin;
- discrepancy between hormonal activity and the phase of the cycle.
Additional examinations that can be prescribed if 2-5 stages are detected in the cytogram:
Table 1:
| Phenomena | signs | Duration | Frequency of occurrence |
| Norm |
| 1-2 days after the procedure | Often |
| Dangerous |
| More than 3 days | Rarely |
Table 2:
| Causes | Possible consequences | Actions |
| Pass on one's own |
|
|
| Seeking urgent medical attention |
Analysis cost
Cytological examination in Russia is included in the free medical insurance program. Private services offer to carry out a test within 1000 rubles. (data for 2018), with the possibility of taking material at home.
Where can I get a smear for cytology?
An analysis for cytology in gynecology is one of the mass types of examination of the female population in Russia.
According to the compulsory health insurance program, a smear for cytology is given at the antenatal clinic at the place of residence.
Almost all private clinics in Russia offer similar services. Large institutions have their own laboratory facilities for testing samples, smaller ones send samples to intermediary centers.
Possible complications after taking a smear
The standard procedure for taking cytological material from areas up to the back of the cervical canal may be limited to slight discomfort in the cervical region, which disappear after 1-2 days. However, sometimes there are other manifestations.
Normal and dangerous complications after a cytological examination
To prevent complications after taking material for cytoanalysis, you should follow a few simple rules:
- within 1-2 days, be limited to a shower when taking water procedures;
- at least 1 week to refrain from sexual activity, douching, using a tampon and other intravaginal means.
Features of cytological examination in pregnant women
During normal pregnancy cytological smear taken 3 times - when registering, at the 30th and 36th week. main goal research is in this case the detection of infections dangerous to the fetus, as well as the identification of atypical cells, which, subject to predisposition, first appear during pregnancy.
Contraindications to manipulation are increased uterine tone and the threat of abortion.
The life of a modern active woman includes many factors that can adversely affect her health, therefore, for the timely diagnosis of possible pathologies, it is extremely necessary to be regularly examined by specialists. Cytology analysis in gynecology is one of the most accessible, simple and effective methods early detection of violations.
Article formatting: Lozinsky Oleg
Video about cytology analysis
What is a cytology test and how is it done:
Often, when visiting a gynecologist, after an examination in a gynecological chair, an ultrasound scan, a woman receives a referral for a smear for cytology. Let us consider in detail this type of study, we will name the indications for its implementation, the features of the material sampling.
What is "cytology" in gynecology?
In most cases, when cervical cytology is prescribed, the girl does not know what it is. To begin with, it must be said that the cervical canal is an anatomical formation, according to appearance pipe-like. It directly connects the vagina with the uterine cavity. It contains stratified and cylindrical epithelium.
Taking material from this area of the reproductive system helps to identify atypical cell formations in time. So it is possible to diagnose a precancerous condition and prescribe the appropriate treatment. The assessment of cellular structures takes place under a microscope with high magnification. The nuclear content of the cells is subjected to careful analysis.
What does a cytology smear show?
A common variant of this type of study is the Pap test. It was first used in the early 20th century by the Greek scientist Papanikolaou. He was directly involved in the diagnosis of malignant processes in the early stages. This smear for cytology also allows you to identify background processes of non-tumor origin, which have a risk of turning into cancer.
Considering all the above possibilities of the PAP test, doctors prescribe it for the following changes in intraepithelial structures:
- anomalies in the structure of cells of high and low severity;
- the presence as a result of previous studies of pathogenic microflora in high concentration;
- violations of the menstrual cycle of an unidentified nature;
- diseases of the reproductive system of a viral nature (HPV, herpes);
- abnormal discharge from the vaginal cavity after menstruation.
Atrophic type of smear for cytology
PAP test in gynecology is one of the main studies that help identify the cell ratio in the cervical canal. With an atrophic type of smear in the field of view of the microscope, the laboratory assistant fixes a large content of squamous epithelial cells. This indicates changes in the structure of the epithelial tissue, which is often recorded in dysplasia. Further diagnosis, by conducting, establishes the degree and severity of the violation. A smear for pathological cytology is the initial stage of a comprehensive examination of the reproductive system.
Inflammatory type of cytology smear
The cytology of the cervix helps to identify inflammatory processes at an early stage, prescribe the correct therapy. With an inflammatory type of smear, changes are recorded at the cellular level - the ratio of glandular cells, squamous epithelial cells may increase. At the same time, the woman notes the presence of symptoms of inflammation, which are manifested in a change in the cycle - acyclic discharge, an increase in the volume of menstrual blood, strong.
When to take a smear for cytology?
Almost like any study of the reproductive system, cytology analysis is carried out on a certain day of the menstrual cycle. The procedure for taking the material is carried out on the 10-12th day from the moment it starts. It must be borne in mind that the result may be inaccurate if there is an infectious process in the body. If necessary, the analysis is also carried out with the disease, but after 2 months from the moment of recovery, a control study is prescribed. If a woman uses vaginal suppositories, baths, douches, an analysis is possible 7 days after the end.
As for the indications for the study, doctors can prescribe an analysis for:
- frequent births (3 times in 4 years, for example);
- early first delivery (birth of the first child before the age of 18);
- setting an intrauterine device;
- lack of examinations of the reproductive system over the past 3 years;
- the presence of visible changes when viewed in a gynecological chair using mirrors;
- aggravated anamnesis (tumor-like processes were recorded in the family along the female line).
Preparing for a cytology smear
Liquid cytology involves evaluating the material after immersing it in a special environment. Previously, a smear for cytology was carried out with the application and fixation of the material on the glass. To obtain an accurate result reflecting the picture of the state of the uterine structures, a woman must adhere to the following rules before the procedure:
- exclusion of douching 5-7 days before the collection of material;
- exclusion of sexual intercourse for 3 days;
- do not use tampons, gels, vaginal creams;
- do not urinate 2 hours before the procedure.
How is a smear taken for cytology?
A Pap smear is performed in a clinic setting. The woman is located in the gynecological chair. During the procedure itself, the gynecologist takes cells from the cervical canal, from the vaginal mucosa. In the first case, a special probe is used - endobrush. Enter it after a slight expansion of the uterine canal by using a dilator. Eyre's spatula is used to take material from the walls of the vagina.
When liquid cytology of the cervix is performed, during the manipulation itself, a woman may feel slight discomfort, mild soreness. Its appearance is due to the expansion of the cervical canal, which is equipped with a large number of nerve endings. The duration of the procedure depends on the experience of the gynecologist, and averages 5-10 minutes. The resulting material is placed in a test tube with a reagent and sent to the laboratory.
Cytology smear - transcript, norm
After a cytology smear has been performed, the interpretation of the results is carried out exclusively by the doctor. Only a specialist can make a comprehensive analysis of the situation, evaluating the results of cytology. The state of cellular structures is a reflection of the state of the reproductive system. Based on the results obtained, doctors can suggest an oncological process by prescribing an additional study (colposcopy, curettage).
Atypical cells in a smear for cytology
When a woman learns that the results of the study revealed a poor cytology, this news becomes a cause for concern. It is worth noting that this conclusion does not mean cancer. According to the established terminology of medical opinions, this definition refers to the presence of pathological changes in the epithelial layer of the vagina and cervical canal.
According to the generally accepted methodology for evaluating results, changes are indicated as follows:
- 0 - the material taken is of poor quality, unsatisfactory (taken in small quantities, the patient was not properly prepared);
- Grade 1 - indicators are normal;
- Grade 2 - there are atypical structures;
- Grade 3 - there is dysplasia of varying severity;
- Grade 4 - precancerous condition, first stage;
- Grade 5 - cancer.
Squamous epithelial cells in a smear for cytology
When liquid cytology of the cervix diagnoses squamous cells in the canal, doctors talk about a disease such as hyperkeratosis. A large number of squamous epithelium scales is fixed in the field of view of the microscope. This type cellular structures are present in the analyzes at . This disease refers to benign tumors. When conducting an additional study, colposcopy, a white area is fixed on the cervix.
It is worth noting that when only single scales are present in the smear results, colposcopy is mandatory. If during its implementation no changes were detected on the surface of the reproductive organ, then the analysis is considered normal. A smear for cytology performed in this case has no diagnostic value. The patient is monitored - once every 3 months a woman visits the consultative department, is examined.
Glandular epithelium in a smear for cytology
Analysis of the smear for cytology, deciphering it, further helps to establish inflammatory processes in the uterus. One of these is cervical dysplasia. With a mild degree of violation, the disease is perfectly amenable to correction by prescribing anti-inflammatory drugs. Moderate and severe dysplasia can be regarded as a precancerous condition. At the same time, a biopsy becomes an obligatory additional study - taking a section of the affected cervical tissue for histological examination.
Polymorphic-rod flora in a smear for cytology
Deciphering cytology often contains the entry "polymorphic rod flora." In order to understand what this means, it must be said that the sticks present in the vagina can have:
- morphotype of lactobacilli (similar in structure and appearance to Doderlein sticks);
- small sticks.
The first type of rods makes up the normal microflora of the vagina. At the same time, the presence of single leukocytes is allowed. The presence of a large number of small sticks indicates a change in the composition of the microflora, which can be recorded with vaginal dysbiosis, gardnerellosis. Such conditions require urgent medical intervention, the appointment of therapy.
Reading time: 6 minA mandatory procedure when visiting a gynecologist is to take biological material to assess the state of the microflora and epithelial cells of the vagina, the internal mucous membrane of the uterine body, endometrium, and cervical canal.
A gynecological smear, the study and interpretation of which is carried out in the laboratory, is highly informative.
The analysis allows you to determine the hormonal level of the reproductive system, the amount and composition of vaginal discharge, the bacterial content of the microflora in women, prevent inflammatory processes, identify developmental pathologies, the presence of neoplasms and sexually transmitted infections.
Diseases of the female reproductive system are dealt with by a specialized area in medicine - gynecology.
There are a lot of reasons for patients to apply: passing a medical examination for employment, pregnancy, pain or unpleasant cramping in the lower abdomen, itching or burning, thrush, heavy menstruation or discharge of unknown origin.
A general smear or microscopy is performed during a preventive examination or during pregnancy planning. The result is the study of the cervical and urethra, vagina, in virgins - the rectum.
Papanicolaou analysis for cytology makes it possible to detect the papilloma virus, precancerous conditions of the epithelium, and the cervix in time. It is recommended to undergo a Pap test for all female representatives with hereditary oncological diseases, persons over 21 years of age.
The bacteriological method of research, bacteriological culture in women, is recommended if there is a suspicion of an inflammatory process, a violation of the microflora, which was caused by opportunistic and pathogenic microorganisms.
PCR is carried out in the form of an analysis for infections transmitted mainly by sexual contact. Gives complete information about the bacterial composition of the internal microflora.
The efficiency and reliability of the method is 98%.
Preparing for a smear test
Before prescribing an examination, the gynecologist or laboratory employee is obliged to warn the patient about how to properly take a smear for flora, which can and cannot be done before the procedure.
Preparation for microscopic examination provides for the rejection of potent antibiotics 2 weeks before the proposed analysis, visiting the bathroom the day before. You should try not to go to the toilet 2 hours before the analysis.
Diagnosis is best done not before, but during menstruation and in the first two days after.
To increase the sensitivity of the test, bakposev on the microflora is carried out in the absence of treatment with antibacterial drugs and douching. Be sure to follow a special diet 2-3 days before bacteriological analysis: limit foods that provoke fermentation or intestinal upset.
Refrain from sexual intercourse with a partner and do not wash yourself 24 hours before data collection.
3-5 days before the appointed PCR diagnosis, it is forbidden to take any antibacterial and contraceptives. For 36 hours it is necessary to exclude sexual contact. It is advisable not to take a shower the day before the PCR and on the eve of taking the analysis. The material is taken during menstruation and for 1-2 days after it ends.
How to take a swab from women
The material sampling technique is usually carried out in the morning in the gynecology department or directly in the laboratory itself. Taking vaginal discharge and sites for research is prescribed only for women who are sexually active. In girls, it is taken more carefully from the lateral fornix of the vagina to exclude damage to the hymen, and from the intestines, secretion.
All manipulations take place on the gynecological chair. At this time, the specialist introduces a special mirror, depending on the age and physiological characteristics of the patient. If the organs are not yet formed, size XS is used, girls will need a mirror S. After labor, examination instruments with a diameter of 25-30 mm, sizes M, L are used.
The collection of material is carried out with a spatula or spatula, brush, applied to a glass slide or placed in a test tube for further transfer of the results to the laboratory.
Smear on microflora: transcript
It is impossible to independently draw a conclusion about how good or bad a smear turned out without the appropriate knowledge. With the help of special symbols, it is very easy to decipher the microscopic examination of a smear. Depending on the localization of the taken biological material, they are distinguished: the vagina - "V", the cervix - "C" and the urethra - "U".
Gram-positive rods, "Gr.+" and the absence of coccal flora. The result is "++++". It is observed quite rarely, most often it is a consequence of intensive antibiotic therapy. Norm: "++", "+++" sticks, the number of cocci does not exceed "++".
Gram-negative bacteria gonococci - "Gn", Trichomonas vaginalis - "Trich", yeast of the genus "Candida". Correspond to diseases like gonorrhea, trichomoniasis and candidiasis.
The presence of key cells and Escherichia coli, if they are listed in the composition of the microflora, indicates that the patient has bacterial vaginosis.
Smear on flora: the norm in women
All patients, without exception, from the age of 14 until the onset of menopause, correspond to the same norm, obtained as a result of laboratory microscopic examination.
Leukocytes. Providing protection of the body from penetrating viruses, bacteria and infections, they can be in sight, but should not exceed the indicator in the vagina - 10, in the cervix - 30, urethra - 5.
Epithelium. A moderate amount of epithelial tissue is normal. A high number indicates possible inflammation, while a too low indicates insufficient production of the hormone estrogen.
Slime. Little or no amount is allowed. The maximum daily rate of excretion of the secretion of the glands of the cervical canal is 5 ml.
Gram-positive rods, "Gr.+". Lactobacilli and Doderlein sticks must be present in large numbers. They are responsible for the body's immune response to foreign bodies. They should not be in the cervix and urethra.
"Gr.-", gram-negative, anaerobic rods are not determined.
Gonococci with symbol"gn", trichomonas, chlamydia, key and atypical cells, fungi, yeast, Candida are absent. If they are found in the results, the patient is assigned an additional examination for gonorrhea, trichomoniasis, chlamydia, bacterial vaginosis, thrush.
Smear for purity
To avoid complications during the period of gestation, pregnant women are advised to determine the degree of purity of the gynecological smear. Normally, in a healthy woman, the vaginal microflora is 95-98% Bacillus vaginalis or Doderlein's lactobacilli. They produce lactic acid, which helps maintain acid levels.
Pathogenic and opportunistic microorganisms are not able to survive in such conditions. But under the influence of various factors, such as sexual activity, menopause, the menstrual cycle and a decrease in immunity, microflora indicators can change.
- 1 degree the purity of the vagina is normally pH 3.8-4.5. Wednesday is sour. Leukocytes and epithelial cells - no more than 10.
- 2 degree. Slightly acidic medium: pH=4.5-5. There is a slight increase in gram-positive cocci, Candida fungi.
- 3 degree. Pathogenic microorganisms are activated, mucus appears, epithelium indicators exceed the norm. Neutral acidity level, pH=5-7. There are more than 10 leukocytes. Mucus, key cells are present, gram-negative and gram-positive microorganisms multiply in favorable microflora conditions.
- On the last 4 degrees, low purity. The pH values reach 7.5. Doderlein's sticks are either absent at all, or are in a single quantity. The vagina is filled with pathogens.
Bacteriological research
The diversity of the composition, in addition to the lactobacillus Doderlein sticks, which are an integral part of the microflora of the vagina of the examined woman, does not begin to be studied immediately. Sowing on a specially created favorable environment of the collected biological material for its subsequent growth, development and reproduction takes time.
It is possible to evaluate bacteriological seeding for flora through a microscope, provided that the number of representatives of microorganisms increases.
- 0 class. observed during antibiotic treatment. The causative agent is missing.
- I class. The number of bacteria does not increase or moderate growth.
- II class. Mixed nature of microflora. Up to 10 colonies of bacteria Gardnerella vaginalis or Mobiluncus, causative agents of gardnerellosis, are determined.
- III class. There are about 100 colonies. Gardnerella and Mobiluncus live mainly in the microflora. Symptoms of bacterial vaginosis appear.
- IV class. Lactobacilli are absent, immunity is weakened. Diagnosis of an acquired infectious disease - aerobic vaginitis.
Cytological examination
The probability of detecting areas of altered epithelium, papillomavirus and oncological neoplasms is quite high after 30 years, the onset of sexual activity.
The correct interpretation of the Pap test depends on the presence or absence of cancerous, atypical cells.
- NILM. Clinical picture without features, CBO. Leukocytes and bacteria are isolated in small quantities. Possible primary candidiasis or bacterial vaginosis. The epithelial layer is normal.
- ASC US. Found atypical areas in the epithelial tissue of unknown origin. A re-analysis is carried out after 6 months to search for chlamydia, dysplasia, human papillomavirus.
- LSIL. To confirm a precancerous condition caused by atypical cells, a biopsy, colposcopy is prescribed. Mild signs of changes in the epithelium.
- ASC-H. A pronounced lesion of the squamous epithelium. In 1% of patients, the initial stage of cervical cancer is diagnosed, the remaining 98-99% have grade 2-3 dysplasia.
- HSIL. Concomitant symptoms preceding cancer of the squamous epithelium, cervix, were detected in more than 7% of the examined women. 2% have cancer.
- AGC. Atypical condition of the glandular epithelium. Diagnosis: cervical or endometrial cancer, an advanced form of dysplasia.
- AIS. Squamous cell carcinoma, cervical cancer.
PCR analysis
The molecular biological method of PCR diagnostics is characterized by high sensitivity and reliability of the obtained data. Due to the creation of earlier samples of the selected and copied DNA segment, a comparison with the obtained biological material takes place.
Analysis for infections using PCR makes it possible in a short time to find the causative agent of the disease of the female genital organs by obtaining a positive or negative result.
Polymerase chain reaction facilitates the determination of chlamydia, ureaplasmosis, thrush, trichomoniasis, HPV, HIV, the search for the causes of severe pregnancy and hormonal disorders.
The disadvantages of PCR are cases of false data with incorrectly performed tests, possible mutation of the pathogen's DNA.
Cytological examination (cytology) is the main method of screening assessment of the state of the epithelium of the cervix. The main task of cytological screening is to search for altered epithelial cells (atypical, having a structure different from normal epithelial cells).
The term "abnormal cells" includes both cells with signs of dysplasia - mild, moderate or severe (precancerous cells), as well as cancer cells themselves. The difference between them is in the degree of manifestation of changes in the structure of cells.
Cytological screening must be performed for all women (excluding virgins and patients who have undergone extirpation (removal) of the uterus), starting at 21 years old and ending at 69 years old (in the absence of changes in the studies), the regularity of the analysis is 1 time per year, according to order 572n ( November 1, 2012), however, it is permissible to take an analysis once every three years (MZRF order No. 36 en, dated February 3, 2015).
Currently, there are two alternative methods of fixation and examination of biological material, the key difference between which for patients is their effectiveness.
Pap test and liquid cytology
The sampling of the material is carried out in the same way (standardized sampling): with a combined brush or two cytological brushes (Figure 1), since the epithelium must be taken both from the outer vaginal surface of the cervix (ectocervix), and from the inner one - from the cervical canal (endocervix). The need to take cellular material from the cervical canal is due to the fact that the epithelial junction zone (cylindrical and stratified squamous non-keratinizing - the place where "bad" processes most often begin (90-96% of cases)) moves closer to the center and inside the cervical canal with age.
It is recommended to take cytological material before bimanual (two-handed) vaginal examination, colposcopy and ultrasound. You should not take smears in the presence of vaginitis (an inflammatory process in the vagina), during its treatment, during menstruation. Sexual abstinence is also required for two days.
Biomaterial sampling technique:
- the patient lies on the gynecological chair;
- a mirror is inserted into the vagina, visualizing the cervix;
- the area of \u200b\u200bthe external pharynx is gently blotted with a cotton swab to remove mucus;
- when using two cytobrushes: the first brush is placed on the vaginal surface of the cervix and in the exocervix and rotated 360⁰ clockwise 5 times, and the second brush is placed in the cervical canal at a depth of about 2 cm and rotated at least 3 times counterclockwise;
- when using a combined cytobrush: the central part of the brush, which has short bristles located horizontally, is inserted into the cervical canal, while the long bristles are located on the vaginal part of the cervix, the brush is turned clockwise 3-5 times.
Differences between Pap test and liquid cytology
- In the case of performing a traditional cytological study (PAP test), the resulting material is distributed on a pre-defatted glass slide in a uniform thin layer, which is not always possible due to the presence of the human factor (the micropreparation is made directly by a specialist), as well as in the presence of an inflammatory process or bloody discharge (epithelial cells can often be obscured by heaps of leukocytes and erythrocytes and are not visible under a microscope). In view of the above, 10% of smears will be non-informative, which will require re-analysis. In addition, most of the collected cells remain on the cytobrushes, for additional studies (in case of obtaining a doubtful result), a second sampling will be necessary.
- The sensitivity of the PAP test (the probability of reliably detecting "unhealthy" cells) is 55-74%, and the specificity (the guarantee that "unhealthy" cells will be detected when they are present in the smear) is 63.2 - 99.4%. The method of liquid cytology has a number of advantages over traditional research.
- When performing liquid oncocytology, the material is always taken with a combined cytological brush; the collected material, together with a removable brush, is placed in a special container (vial) filled with a stabilizing solution, which prevents the loss of the biomaterial and ensures its long-term storage and additional studies if necessary.
- The information content of liquid cytology is higher, what is provided automatic system preparation and staining of micropreparations, which allows to arrange epithelial cells in one layer, separating them from other cellular elements. Preparations are also evaluated automatically using the CytoScreen system.
- The number of inadequate smears when using the liquid technique is 10 times lower than when using the traditional one and does not exceed 1%.
- The biological material remaining as a result of liquid oncocytology can subsequently be used for additional studies, for example, immunocytochemical determination of p16(INK4α) protein or determination of highly oncogenic types of human papillomaviruses.
In 99% of cases, the result obtained using liquid cytology coincides with the results of histological examination.
The only drawback of the method is that it is not included in the compulsory health insurance system, i.e. the analysis is paid.
Cervical cytology results
According to the current clinical guidelines of 2017, the interpretation of the results of the analysis should be carried out according to the Bethesda system, although you can find a cytological conclusion according to the Papanicolaou, WHO and CIN (histological classification) systems. Comparison of systems is shown in table 1.
The conditions defined by the Bethesda terminology system will have clinical significance, therefore, for example, moderate dysplasia, severe dysplasia and carcinoma in situ = CIN II and CIN III = HSIL, and the tactics of managing all of these conditions of stratified squamous epithelium will be the same (HSIL category).
Deciphering the results
So, you are holding an oncocytological conclusion in your hands. The interpretation of the result, as well as the choice of management tactics based on it (taking into account age and lifestyle characteristics), should be carried out not by you, but by your doctor! It is he who directs you to the necessary additional studies and chooses the tactics of treatment, if necessary. But who among us does not look on the Internet to see what the abbreviations made in the cytological conclusion mean and what to prepare for? I think any person worried about their health.
Below we consider the decoding of the abbreviations of the Bethesda terminological system with an indicative (according to the current clinical guidelines (2017) management tactics.
If squamous cells are changed:
NILM
NILM(negative for intraepithelial lesion or malignancy) - negative for dysplasia or cancer- this is the norm, which completely excludes the possibility of the presence of atypical (altered, with signs of possible malignancy) cells. If you see the abbreviation NILM in your conclusion, congratulations! There is a subdivision of a smear negative for dysplasia or cancer into NILM 1 and NILM 2, meaning the first is the absolute norm, and the second is concomitant reactive (inflammatory) changes in the smear, which may be due, for example, to bacterial vaginosis. To clarify the reason for the abbreviation NILM 2 in the cytological conclusion, a smear for flora or PCR diagnostics will help. With regard to the cytological study, there is nothing to worry about. Routine (usual) screening is indicated according to age: at least once every three years up to 29 years; at least once every 5 years in combination with HPV testing over the age of 29; and at least once every 5 years in combination with HPV testing over the age of 29 years.
ASC US
ASC US(atypical squamous cells of undetermined significance, squamous epithelial cells with atypia of unknown significance) is the most common of the variants of deviations found in cytological conclusions. The bottom line is that cells were found that differ in their structure from normal ones, but it is impossible to argue that the differences are due precisely to dysplasia, and not to other causes - reactive states (inflammatory process, hypoestrogenism). According to statistics, the histological picture of CIN III (severe dysplasia) with this cytological conclusion occurs no more often than in 2% of cases. Therefore, you should not worry. But it is worth conducting an HPV test (it should be noted that ASC-US is not accompanied by HPV infection in only one third of cases), and if it is negative, live in peace, having passed both analyzes (oncocytology and HPV testing) in 1-3 years .If HPV is detected, the doctor will prescribe a colposcopy for you, according to the results of which it is possible to take a biopsy (a piece of cervical tissue). In the absence of colposcopic changes in a year, it will be necessary to repeat the cytological examination and HPV testing. Another tactic is also possible: repeated cytological examination in a year. If the conclusion "ASC-US" is received again - colposcopy and HPV - testing, and if "NILM" - no additional studies are required and you can live in peace until the next screening.
ASC-H
ASC-H (atypical squamous cells, cannot exclude HSIL)- Altered cells were also found here, but the probable cause of their appearance is dysplasia. The doctor will prescribe you a colposcopy with a biopsy and HPV testing, further tactics will be determined depending on the results obtained.
LSIL
HSIL
HSIL(high grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion) – atypical cells were found in the smear, corresponding to severe dysplastic changes. The doctor will refer you to a colposcopic examination and excision (excision of the area of the altered tissue with a loop) / conization (removal of the cone-shaped portion of the cervix including the vaginal surface and the lower part of the cervical canal) followed by a histological examination of the obtained biomaterial. Category HSIL by Bethesda classifications also includes carcinoma in situ (see Table 1, WHO descriptive system).
CIS
However, cytological examination does not give an idea of the spatial arrangement of cells with signs of atypia; only histological examination allows to establish the depth of penetration of the pathological process into tissues.
If the cells of the cylindrical epithelium are changed:
AGC
AGC (atypical glandular cells, atypical glandular epithelial cells)- the presence in the collected material of altered cells of the cylindrical epithelium, which in most cases means the location of the pathological process inside the cervical canal.
AIS
AIS (adenocarcinoma in situ, endocervical adenocarcinoma "in situ" (from Latin - "in place")) - the presence of malignantly altered cells of the cylindrical epithelium. As in the case of CIS, it is assumed that the pathological process does not extend beyond the epithelium and the basement membrane is not damaged. But we remember that oncocytological examination cannot determine the depth of tissue damage. It only evaluates the level of malignant changes in cells, according to which it determines the degree of dysplasia or determines atypical cells as malignant. In addition to HPV testing and colposcopy, your doctor will prescribe a curettage of the cervical canal, and if you are over 35 years old, an aspiration biopsy of the endometrium to obtain a histological conclusion about the depth of the lesion and exclude the pathological process in the uterine cavity.
The above management tactics, depending on the results of cytological studies, are indicative. The tactics of management in each case is determined by the attending physician, taking into account the individual characteristics of the patient (age, presence or absence of children, concomitant diseases, the fact of HPV infection, personal qualities).
Dear girls, women, I urge you to regularly conduct a cytological examination and wish to receive exclusively "NILM" in conclusion.
