Cervical smear for cytology. Cytological examination of smears (scrapings) from the surface of the cervix (external uterine pharynx) and cervical canal for atypia

The difficulty of diagnosing diseases of the genital organs in women often leads to a loss of time necessary for successful treatment. Often the development of cancer cells is asymptomatic, and only a special examination can reveal a dangerous disease. A cytology smear or Pap test in women allows you to detect cancer at an early stage and begin treatment on time.

Cytological examination of cervical tissue in women allows us to identify 5 types of changes in cells. Cytology smear is inexpensive and effective method diagnostics, used in medicine for more than 50 years. It is recommended that all women aged 21 to 65 years, without exception, undergo the study at least once a year.

Decoding the Pap test gives a complete picture of the presence or absence of any abnormalities.

A cytological smear (Pap test, Papanicolaou smear, oncocytology smear) is performed during a gynecological examination. The doctor uses a mirror to examine the vagina, the entrance to the cervical canal and the cervical mucosa. If there is a suspicion of an anomaly, cells are collected with a special brush from 3 areas: from the walls of the vagina, the cervical canal, and the entrance to the cervix. The procedure is comfortable, painless and does not require special preparation.

The mucus is applied evenly onto a glass slide, dried and sent to the laboratory.

A laboratory technician uses reagents to stain a smear and examine it through a microscope. This method determines the following indicators:
cell structure;
cell size;
epithelium shape;
mutual arrangement;
number of cells per unit area;

pathological changes in cell structure. A cytology smear allows you to identify most inflammatory diseases, precancerous pathologies of the epithelium (dysplasia), and malignant tumors. After taking a smear, it is often observed bloody issues

within 2-3 days, which is the norm. Extremely rare - severe bleeding, abdominal pain, chills, increased body temperature. In this case, an urgent examination by a gynecologist is required.

Ideally, every woman can undergo cytology tests regularly, without special instructions from a doctor. A routine gynecological examination can reveal the presence of inflammatory processes in the cervix and cervical canal. A cytological smear is only a method of confirming the diagnosis. Therefore, it is better to follow the recommendations of the gynecologist - if there are no indications for analysis, then there is no need to worry ahead of time.

However, cytology testing should be carried out for women under 40 years of age - once a year, for older women - 2 times a year or more often. Cases in which cytological examination is mandatory:

in case of violations menstrual cycle;
in inflammatory processes of the cervical canal, cervix, etc., especially chronic ones;
in case of reproductive dysfunction;
during pregnancy planning;
before surgery and others medical procedures;
before installing an intrauterine device;
taking hormone-containing drugs;
obesity 2, 3 degrees;
diabetes;
the presence of papilloma virus and genital herpes in the body;
active sex life of a woman with frequent changes of partners.

How to prepare for analysis

To ensure the maximum degree of purity of the smear, you should follow the rules before going to the gynecologist:

Do not use topical medications (vaginal tampons, suppositories, ointments).
Do not douche.
Wait until your period ends.
For inflammatory diseases with abundant secretion, general treatment should first be carried out. After a control smear confirming recovery, you can begin a cytology test.
You should not urinate 3 hours before the cytological analysis.
It is better to abstain from sexual intercourse 2 days before taking the secretion.

Following these rules will help you avoid unnecessary worry and repeated visits to the doctor.

If a doctor has prescribed a smear for oncocytology, this does not mean that the doctor has made a terrible diagnosis and is waiting for its confirmation.

Remember: prevention is better than cure.

What can a cytological analysis reveal?

How to interpret a smear for oncocytology? Decoding of data obtained in the laboratory is understandable only to a doctor. And the gynecologist does not always give a detailed picture of the disease, not wanting to waste time on explanations.

During the research process you can get 5 results:

It is important to remember that a smear shows only the degree of cell changes, the presence of inflammation, infections, but does not precisely determine the cause that causes them.

The gynecologist does not make a diagnosis based on cytology tests alone; this requires comparison with other tests.

Types 2, 3, 4 of changes identified during cytology examination may be a sign of diseases:

ectopia (erosion) of the cervix;
papillomavirus infection;
genital herpes;
parakeratosis of the cervix;
bacterial vaginitis;
cercivit;
vaginal candidiasis, etc.

Decoding the result

Deciphering test results is a simple matter for a doctor, but for a patient it is incomprehensible letters and terms.

If atypical cells are found in the smear, the laboratory technician will write about this in the conclusion and also determine the type of changes. Therefore, if the transcript of the cytology smear does not contain any special notes, then, most likely, no pathologies were found.

The time required for a smear test for cytology is from 1 to 5 days. Pathological changes in the cells of the cervical canal and cervix on the way to the diagnosis of cancer go through several stages, and not in 1-2 days. Cytological examination makes it possible to identify atypical cells at the initial stage and begin treatment, which in most cases leads to complete recovery. Therefore, cytological examination has been widely introduced into medical practice as a quick, painless and inexpensive way to diagnose cancer cells at an early stage.

Cervical cytology is a microscopic examination of epithelial cells that have been taken from the walls of the cervix and cervical canal. Its implementation should be mandatory for every woman aged 18 to 65 years, and repeated every 3 years. The main objectives of studying cervix uteri are:

· Determination of the presence of abnormal changes in cells;
· Determination of precancerous conditions, inflammatory processes and cervical cancer (CC).

Since cervical cancer is on the top list of cancer diseases in women, timely cytology of the cervix can prevent further development of cancer. Due to the absence of symptomatic manifestations of this cancer, it is cytology that can promptly detect atypical manifestations in cells. Most doctors consider this research method the “gold standard” for monitoring the internal state of the epithelial cells of the cervix. It allows you to identify:

· Various cellular atypia at any stage of differentiation;
· Presence of pathological microflora;
· Failure of the optimal menstrual cycle (delays, absence at all);
· Diseases of viral etiology (HPV, herpes, etc.);
· All possible types ;
· Long-term use of hormonal medicines for the purpose of treating a specific disease;
· Pathological vaginal discharge.
from the vagina.

Indications for cytology

Taking a smear from the cervix and cervical canal is indicated for women:

· Planning pregnancy;
· Frequently giving birth (three or four times over four years);
· Frequently changing sexual partners;
· During postmenopause;
· Planning to have an intrauterine device installed as contraception;
· Who have not visited a gynecologist for the last three years;
· Those who have pathological changes when examined by a gynecologist using mirrors;
· With the problem of infertility;
· Suspecting the presence of viral infections (herpes).

Execution technique

Cervical cytology lasts no longer than 15-20 minutes and is painless. During its implementation, the patient may experience only slight discomfort. The procedure begins with an examination by a doctor in a gynecological chair. Simultaneously with the examination, the doctor scrapes the mucous membrane of the cervix and cervical canal. Then the resulting materials are applied to a special glass, fixed and sent to the laboratory for further microscopic examination. Along with the glass, a form is sent there, which indicates the referral number, the patient’s name, the date of the procedure, the patient’s age, the date of the last menstruation and the preliminary diagnosis. If the smear was taken in compliance with all standards, the result will be ready within 8 days.

What can cytology show?

A study of the epithelial cells of the cervix and cervical canal determines the presence of signs of viral, bacterial or oncological pathology. The doctor receives an answer with either a positive (presence of pathological changes in the epithelium) or a negative (absence of pathological changes in the epithelium) result. The norms of cervical cytology look like this:

In addition to determining malignant cellular atypia, it is possible to detect benign or inflammatory cell abnormalities, mixed atypia and unknown etiology, which require additional research methods.

Poor cervical cytology

If pathological changes are found in the material taken for examination, then we can talk about bad cytology. Poor cytology cervix does not indicate end-stage cancer. It requires further decoding by a gynecologist. The found changes are differentiated into 5 classes:

· Zero: poor-quality material collection;
· First: normal indicators;
· Second: atypical changes are determined;
· Third: dysplasia of various stages (mild, moderate, severe);
Fourth: precancerous condition or First stage cancer;
· Fifth: invasive cancer.

Therefore, cytology is an extremely necessary procedure for every woman. The study allows you to identify the disease by early stages development, carry out effective and timely treatment and also save lives.

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The main problem of oncology in general is the diagnosis of the tumor process at the earliest stage and timely treatment of malignant neoplasms. For this purpose, modern diagnostic techniques are used, which make it possible to determine the presence of atypical cells in any tissue of the body.

Gynecological oncology is an important part of conservation reproductive health female population. Diagnosis of malignant neoplasms of the genital organs is the main task of this section of medicine. Cytological examination of scrapings of the cervix and cervical canal is an integral part of diagnosing genital tumors in women. But not all women know:

which specialist prescribes the study;
why and how it is carried out;
what results can be obtained;
how to interpret them.

Women who have been prescribed such an examination are also concerned about other issues. The answers to them can be obtained by reading this article.

What is a cytological examination of the cervix and cervical canal?

Cytological research is a method of laboratory research in medicine, which evaluates the morphological characteristics of cellular elements in a cytological preparation to determine the presence or absence of a tumor process and other changes. The study is carried out using microscopy of biomaterial obtained and prepared using special methods.

In gynecology, cytology is used to study the surface cells of the cervix and cervical canal. The analysis is prescribed by obstetrician-gynecologists at clinics, hospitals and antenatal clinics and used as:

screening (mass examination) of patients;
to establish or clarify a diagnosis;
control of treatment of an already known disease;
early detection of treatable diseases.

Anatomy

Behind the labia majora and minora is the vaginal vestibule, behind which the vagina is located directly. It is a hollow muscular organ located in the pelvis. The vagina occupies a position between bladder and the urethra in front and the rectum in back. The distal end is attached to the cervix. The cervix is an anatomical formation in the lower segment of the uterus. The cervical canal of the cervix is an anatomical through hole that passes through the middle of the cervix and directly connects it and the vagina. It may be absent if embryogenesis is abnormal; this condition is called atresia. Normally, the cervical canal is filled with mucus, which protects the uterus from the penetration of microorganisms and other foreign agents.

To understand the essence of a cytological study, it is necessary to understand that in different parts of the reproductive tract the organs are covered with different epithelium. On the surface of the vagina and the vaginal part of the cervix there is a flat multilayered epithelium, and in the cervical canal there is a cylindrical epithelium. If the cylindrical one extends beyond the canal, this is called ectopia, which is considered a physiological norm and cannot be treated.

Indications for prescribing a cytological examination of the cervix

The purpose of scraping the cervical canal is to identify atypical cells and diagnose precancerous diseases. Main indications for prescribing the study:

Preparing for the study

The study does not require special preparation, but there are several recommendations that must be followed to avoid getting a false result. The study cannot be performed during menstruation. For inflammatory diseases of the genital organs. If during the examination a woman experiences pain, itching or burning in the vagina.

IMPORTANT! You cannot douche before the test, you must abstain from sexual intercourse for at least 48 hours and you must abstain from urinating for 2 hours before the hemotest. If these rules are not followed, results may be inaccurate or altered.

Carrying out the procedure

First, the obstetrician-gynecologist examines the vagina and cervix in speculums and assesses the condition of the mucous membranes; a digital gynecological examination should not be done before the smear. If the epithelium covers a large number of mucus, it must be removed. Then the cervix is scraped (exocervix), using an Eyre spatula. After this, a scraping is taken from the cervical canal (), and the material is collected using a special cytobrush (Cervix Brash). It is inserted into the canal and 4-5 circular movements are performed. After collection, the resulting material is applied to glass, the smear is air-dried and fixed with alcohol or a special preparation (for Papanicolaou examination). The resulting preparations are then placed in a container and delivered to the laboratory. If liquid oncocytology is performed, then the brush is immersed in a liquid fixative, rinsed, and the tip of the brush is removed and left in the fixative.

The next stage of the study is laboratory. Laboratory assistants register the samples received. Then the smears are stained with special dyes (according to Leishman). Liquid cytology preparations are centrifuged or filtered.

The finished preparations are sent to the analytical stage, which is carried out using microscopy. The evaluation criteria are:

Cell type;
Cell sizes;
Inclusions in cells;
Maturity;
Features and changes of kernels;
Cytoplasm.

After evaluating the results, the laboratory issues a conclusion, which is sent to the attending physician.

Decoding the results

Classification of cytological changes according to Papanicolaou:

1 class - negative result(norm – there are no atypical cells, the cells have the same shape and size);
Class 2 – morphological changes were detected that appeared under the influence of inflammation of the vagina or cervix;
Class 3 – there is a suspicion of a malignant process, single cells with morphological abnormalities are found;
Class 4 – individual cells with malignant changes;
Grade 5 – signs of malignant tissue changes were detected.

What can a cytological examination show?

A normal result – there are no altered cells; bacterial vaginosis is possible. Unchanged epithelial cells, moderate numbers of neutrophils, leukocytes and bacteria can be detected;
Detection of unidentified atypical cells - such changes are caused by sexually transmitted infections, HPV, dysplasia, postmenopausal atrophy of the mucosal surface. It is necessary to be tested for the presence of HPV and undergo cytology again in a year;
Low degree of change in the squamous epithelial cover - dysplasia or HPV infection is possible. The recommendations are the same;
The presence of atypical cells indicates the degree or beginning of a malignant process. For further diagnosis, it is carried out (examination of the vaginal walls and the visible part of the cervix using a special optical device);
High degree of squamous cell changes – high level of dysplasia, possible uterus. It is necessary to carry out colposcopy, tissue biopsy, if the woman is over 25 years old, it is possible to perform diagnostic excision (removal of part of the mucous membrane with further histology of the tissue);
The presence of atypical cells – epithelial dysplasia of 1-3 degrees, cervical or endometrial cancer. Recommendations – colposcopy, diagnostic curettage of the uterus and cervical canal, HPV analysis;
Adenocarcinoma in situ (in place), squamous cell carcinoma - high degree of dysplasia or cancerous changes of the cervix. Colposcopy, diagnostic curettage of the uterus and cervical canal, and HPV analysis are prescribed;
Benign glandular changes - endometrial hyperplasia. If a woman does not have non-menstrual bleeding or other pathological processes before her period, then such changes can be considered normal.

Microbiological examination of the cervix and cervical canal

When conducting a cytological examination, it is possible to simultaneously carry out microbiological diagnostics. Based on this, a final diagnosis cannot be made, but one can suspect infectious diseases genital tract.

Trichomonas colpitis - when trichomonas are detected;
Candidiasis (better known as thrush) - when fungi of the genus Candida are detected;
Bacterial vaginosis – decrease in lactoflora (normal vaginal flora), detection of cocci, gonococci, rods or mixed flora;
Chlamydia – chlamydia detected;
under the influence of HPV.

To make a final diagnosis, additional research is necessary:

Microbiological method - flora with subsequent determination of the type of pathogen and its sensitivity to antibacterial drugs;
PCR – diagnostics (polymerase chain reaction) – modern method diagnostics based on DNA determination of pathogens of infectious diseases.

Additional methods for diagnosing malignant neoplasms of the female reproductive system

In addition to oncocytology, there are other studies to confirm tumor diseases of the female reproductive system. These include:

– carried out using an ultrasound machine, it allows you to detect changes in the pelvic organs;
Hysterosalpingography (HSG) is a method of examining the uterus and fallopian tubes, in which their cavities are filled with a contrast agent and an X-ray or ultrasound examination is performed. Allows you to detect obstruction and structural changes in organs;
Hysteroscopy is an endoscopic examination of the uterine cavity. The advantage of the method is that it can go from diagnostic to therapeutic (allows you to perform minor surgical interventions, for example, a biopsy);
Immunohistochemical analysis is a laboratory method for determining the necessary cells using labeled antibodies;
Determination of tumor markers in the blood - substances that are secreted by tumor cells and are not found normally.

Conclusion

Oncocytology of the cervix and cervical canal is an important diagnostic method in gynecological oncology, although it is not the only one. The test has many applications, including mass screening of healthy women. The method is simple, has no contraindications and can be performed in outpatient practice. All these advantages have allowed cytological research to occupy a leading position in medical practice. Thank you for your attention.

Video: cytological and histological examination

Video: epithelial cytology - introduction

The unfavorable environmental situation, early maturation and sexual intercourse among modern youth, smoking, exposure to all kinds of gadgets and other problems of 21st century society lead to disappointing medical statistics: cases of cancer are being recorded more and more often. The disease also affects the female reproductive organ - the uterus. How to protect your health, are there methods for diagnosing such a serious disease in the early stages? The answer lies, as they say, on the surface. Almost every girl who visits a gynecologist undergoes an analysis, which is aimed at studying the structure of cells, finding atypical ones or those that do not correspond to generally accepted standards. This test is called “atypical cell test”, “pap test” or “cytology test”. What it is and what it is needed for, we will explain in detail in the article.

Cytology as a science

What does the word “cytology” mean? This is a separate science that studies the structure, functioning, and characteristics of living cells. This branch of medicine is also called cell biology.

Clinical cytology is a branch laboratory research, the essence of which is a microscopic descriptive analysis of cytological material. Using cytology analysis, cancer, precancerous conditions and benign neoplasms, as well as inflammatory processes are determined.

Cytology is a science that also studies the ability of cells to respond to external stimuli. This means that this medical field, in addition to identifying diseases, is also involved in the experimental development of drugs.

Cytology in gynecology

Clinical cytology - what is it in gynecology? In this branch of medical science, the cytological analysis method is widely used, as it is highly informative and reliable. With its help, you can determine a large number of different pathological conditions in the vagina, cervix and uterus itself. In addition, the analysis does not require large expenses: all that is needed is a concentrate that stains the material under study and the microscope itself.

The advantages of this diagnostic study are also safety, painlessness, ease of sampling, and low risk of adverse reactions. A smear for cytology is performed even on pregnant women. And the result will be ready within a day after taking the material.

Typically, the material is collected in a complex manner: from the urethra, vagina and cervix. Therefore, this analysis may be called “atypical cell smear” or “cervical cytology”. What it is? This is the same analysis for atypical cells, which has the same method of conducting and interpreting the results.

Indications

So, a smear for cytology. What is it and when is it prescribed? There are no specific indications for testing for atypical cells. This study is recommended for all representatives of the fair sex from the moment they have their first sexual intercourse. During reproductive age, doctors advise women to check their health with a cytology smear at least once a year. Cytology is a simple and reliable way to detect cancer cells.

Cytology analysis is routinely carried out before gynecological surgery, various gynecological manipulations (for example, when inserting a contraceptive - a spiral), when planning pregnancy, directly during pregnancy, if infectious diseases of the reproductive organs are suspected, infertility treatment, menstrual irregularities.

Cytology is a science that studies the functioning of a cell, which means it can be used to detect damaged, atypical structures and their reactions. Therefore, the analysis is also prescribed by the doctor when confirming the diagnosis of “human papillomavirus”, “genital herpes”, “obesity” and “diabetes mellitus” for dynamic monitoring of the patient’s condition, as well as to analyze the effectiveness of treatment methods.

Cytology analysis: how does it happen?

Cytology analysis - what is it, how is it carried out? The material is collected on a gynecological chair. The doctor will use a special medical brush to collect mucus from the vagina, the entrance to the cervical canal, and also from the cervical canal. During sampling, gynecological speculums are also used to visually detect inflamed areas of the mucous membrane. If there are any, the doctor will take an analysis from such a damaged area. The procedure causes discomfort, but the patient should not experience any pain if the procedure is performed correctly.

Cytological material (mucus) is applied to a diagnostic glass, fixed and dried, and then delivered to the laboratory for examination.

Test portability

We talked about what a cytology smear is and what it is. What are the contraindications and adverse reactions? There are cases when the mucous membrane is too inflamed, so the slightest touch of a medical instrument causes minor bleeding due to damage to the capillaries. This condition does not require treatment and goes away on its own within 24 hours.

If after a few hours the patient has a fever, nagging pain in the abdomen, continuous heavy bleeding, and chills, then it is necessary to call an ambulance. None of the above symptoms are normal when conducting a test such as cervical cytology. What is this, why do such reactions occur? The causes of complications may be unprofessional sampling of material, as well as advanced inflammatory process of the mucous membrane.

Preliminary preparation

Contrary to popular belief that no preparation is needed before taking a smear for atypical cells, it is necessary to take the recommended measures the day before in order to exclude false test results. Therefore, next we will consider the question: “Cytology of the uterus - what is it and how to prepare for the analysis?”

It is necessary 2 weeks before the proposed examination to exclude the use of intravaginal suppositories, local creams, ointments, including contraceptives, and not to use the douching method.
A week earlier you need to give up intimacy.
The study cannot be carried out during menstrual flow. The most reliable results analysis for atypical cells are observed when collecting material on the 5th day after the end of menstruation.
Several hours before the cytology test, it is recommended to refrain from urinating.

Decoding the result

Many people are interested in the question of what clinical cytology is, what it is in gynecology, and how to decipher the obtained indicators. Only a doctor should analyze the test results. The detected indicators do not constitute a diagnosis and require additional research and clarification.

The results are divided into 5 degrees of purity:

The first means that cytological analysis did not reveal any pathological changes in the cells. This means that the patient is healthy.
The second indicates the presence of an inflammatory process. To clarify the diagnosis, the doctor will prescribe additional tests.
In the third degree, cells in which the structure of the nucleus is disrupted are found in the smear. In this case, it is recommended to undergo microbiological and histological examination to make a diagnosis.
If the results indicate the fourth degree, then there is a risk of cancer. The patient is prescribed a full urgent examination using a biopsy and examination using a colposcope.
At stage 5, laboratory technicians found a large number of cancer cells in the smear. In this case, the woman is immediately referred to an oncologist.

In the second and third degrees, after additional examinations, it is necessary to conduct a repeat cytology test.

Cytology smear analysis: what is it, how to decipher it?

In addition to purity indicators, the cytology test result form also contains other parameters:

Latin letters indicate the area of sampling of the test material: U - urethra, C - cervical canal, V - vagina;
the presence of leukocytes in the field of view (normally - up to 15 units);
it is possible to detect infectious agents: fungi, trichomonas or gonococci;
a large amount of epithelium indicates a possible oncopathology (normally up to 10 units);
the presence of mucus in small quantities is normal.

Cytology test results are not a diagnosis. Only a doctor, having assessed the entire situation of a particular medical case, can determine pathology. Thus, grades 2-4 may indicate not only cancer, but also less dangerous and easily treatable health problems, such as candidiasis, vaginitis, cervicitis, cervical erosion, genital herpes, papillomavirus.

Cost of analysis

Cytology is a widespread and accessible method for diagnosing cancer in the early stages. Almost every laboratory or clinic can take this test, so the cost of the test has a wide range depending on the level of the medical institution and its equipment, personnel qualifications, and the like. According to the insurance policy, the analysis is carried out free of charge in public clinics. In private laboratories, such a service costs from 500 to 1200 rubles. Additionally, you will have to pay for the collection of material itself - that’s another 200-500 rubles.

Where to get a smear for cytology?

In any modern laboratory, a smear is performed for cytology; a doctor’s referral is not necessary at all. By contacting a antenatal clinic or a private clinic, for example, “Invitro”, “Hemotest”, you can undergo such a diagnostic test.

Cytology is a science that has saved many lives over the course of several decades of its existence. Don't forget to get tested annually for abnormal cells. Such a simple, safe and affordable test can detect a deadly disease in the early stages of development. Timely request for medical care significantly increases the likelihood of complete medical victory over the disease.