Description

Method of determination Microscopy

Material under study See in the description

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The vaginal part of the cervix - ectocervix is ​​lined with stratified squamous non-keratinized epithelium. In women of reproductive age, it is constantly rebuilt by proliferation-maturation-desquamation and is completely replaced by a new population of cells every 4 to 5 days.

Normally, the squamous epithelium is represented by the following types of cells: cells of the superficial layer, cells of the intermediate layer, and cells of the basal-parabasal layer. The cellular composition depends on the presence / absence of the menstrual cycle and its phase. The squamous epithelium performs a protective function.

The cervical canal - endocervix - is lined with a cylindrical mucus-producing epithelium. Cyclic changes in the epithelium of the endocervix are poorly expressed. The main function of the cylindrical epithelium is secretory.

The transformation zone is the junction of the stratified squamous and columnar epithelium in women of reproductive age, which basically coincides with the area of ​​the external os. Depending on age and hormonal balance in the body, it can also be located on the vaginal part of the cervix. In women of older reproductive and postmenopausal age, the boundary line is actually localized within the external pharynx. According to statistical data, precancer occurs from the zone of transformation.

Material for research. In the direction for the cytological examination of biological material, clinical data, diagnosis, features and place of obtaining the material, data on the menstrual cycle must be indicated.

Swabs are taken prior to bimanual examination and colposcopy. The instruments used must be sterile and dry, as water and disinfectant solutions destroy cellular elements.

During a preventive examination (cytological screening) of women, it is advisable to obtain cell material from the surface of the vaginal part of the cervix (ectocervix) and the walls of the cervical canal (endocervix), in the presence of pathological changes in the cervix aimingly.

Modified Eyre-type spatulas or Cervix-Brash, Papette brushes are used as a tool for taking material from the cervix during a preventive examination of women. For diagnostic purposes, the material is obtained separately with spatulas from the ectocervix, brushes such as Cytobrash from the endocervix.

Material for cytological diagnosis is obtained in various ways: by aspiration and scraping of the contents of the posterior fornix of the vagina, cervix, or by obtaining an imprint smear. The resulting biological material is applied in a thin layer on a glass slide and dried in air. The glass must be marked with not only the last name / code, but also the place where the cell material was taken (cervix, cervical canal). The markings on the slide and in the direction for cytological examination must correspond to each other.

Please note that in children under 16 years of age, gynecological tests are taken only in the presence of parents. Medical offices do not do cervical scrapings and swabs for pregnant women 22 weeks or more, as this procedure can cause complications. If necessary, you can contact your doctor to take the material.

Literature

1. Petrova AS Cytological diagnosis of tumors and pretumor processes. Medicine, 1985. - p. 296.
2. Prilepskaya VN Diseases of the cervix, vagina and vulva. - M.: MEDpress, 1999. - p. 406.
3. Shabalova IP Cytological atlas. Moscow, 2001. p. 116.

Training

Preparation conditions are determined by the attending physician. In women of reproductive age, smears should be taken no earlier than on the 5th day of the menstrual cycle and no later than 5 days before the expected start of menstruation. You should not take cell material for research within 24 hours after sexual intercourse, sanitation of the vagina, introduction of medications into the vagina.

Indications for appointment

Cytological smears should be taken from all women over 18 years of age, regardless of clinical data, once a year. In the presence of clinically pronounced pathological changes in the cervix, the cellular material is taken aimingly. The frequency of cytological examination is determined by a gynecologist (at least 2 times a year). (Order No. 430 "On the approval of instructive and methodological guidelines for the organization of the work of the antenatal clinic" dated April 22, 1981 of the USSR Ministry of Health).

The cytological method of research occupies one of the important places in the diagnosis of diseases of the cervix. Due to its high accuracy, it is one of the leading research methods in the diagnosis of background, precancerous and cancerous processes of various localization.

Advantages of the method:

1. painlessness and safety of obtaining cellular material;
2. the possibility of studying the pathological focus in dynamics;
3. the possibility of diagnosing a malignant neoplasm in the initial stage of development;
4. small financial costs.

Disadvantages of the method:

1. the impossibility of establishing signs of infiltrative growth (cell, not tissue material is examined).

The specificity of this screening method is 69%. The rate of false-negative smears ranges from 5 to 40%. Inadequate sampling from the endocervix is ​​the most important factor in causing false negative results.

The effectiveness of the cytological research method largely depends on the preanalytical stage: how correctly the cellular material is taken and the smears are prepared.

Interpretation of results

The interpretation of test results contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. An accurate diagnosis is made by the doctor, using both the results of this examination and the necessary information from other sources: history, results of other examinations, etc.

It should be remembered that the cytological method of research, like any other laboratory research method, does not always provide comprehensive information for making a diagnosis. Only a clinician has the right to make a final diagnosis (based on the study of anamnesis, observation of clinical manifestations and data from the histological method of examination).

The result of a cytological examination of the obtained biomaterial (smears-imprints) can be presented by a cytologist in the form of: - description of the cellular composition; - descriptions of the cellular composition and conclusions; - descriptions of the cellular composition and conclusions in a hypothetical form; - descriptions of the cellular composition and recommendations.

The form of the answer depends on a number of reasons: the adequacy of the cellular material (few cells, many elements of blood, mucus), an incorrectly completed referral for a cytological examination: the reason for the examination (clinical diagnosis) was not indicated, the presence / absence of menstruation; it is not indicated where the material came from, the marking in the direction does not correspond to that on the glasses, etc.

Result interpretation

Possibilities of cytological diagnosis of certain diseases of the cervix and options for interpreting the results of a cytological study:

Endocervix. Normally, with correctly obtained cellular material from the transformation zone (ZT) - the junction zone of the squamous and columnar epithelium - cells of the squamous and columnar epithelium are present in the smear without changes. Cytological conclusion: cells of squamous and cylindrical epithelium without features were found in the obtained material. The presence of a small number of metaplastic epithelial cells is an indication that the material was obtained from ST. In the absence of the above description, the swab was not taken from ST and the patient cannot be said to be at no risk of cervical cancer. Such swabs are commonly seen in postmenopausal women and patients who have undergone cervical treatment that has moved the borderline into the cervical canal. Depending on the patient's history, this may be a reason for re-sampling the material.

Clinical diagnosis in the direction of the polyp of the cervical canal, and the corresponding cytological picture allow the cytologist to conclude that the cytogram corresponds to the clinical diagnosis of the polyp of the cervical canal. If there is no clinical diagnosis, and the cellular composition is represented by large clusters of cells of the columnar epithelium, the cytologist gives a descriptive answer with the assumption of hyperplasia of the cells of the columnar epithelium or a polyp of the cervical canal.

Ectocervix. In reproductive age, the normal cellular composition of imprints from the vaginal part of the cervix is ​​represented by squamous epithelial cells, predominantly of a superficial or intermediate type. The wording “in the obtained material cells of the squamous epithelium of the surface layers without features are noted” indicates that the obtained biological material consists of cells of the squamous epithelium of the surface and intermediate layers in various combinations in accordance with the phase of the cycle. At the beginning of postmenopause (normal), cells of the squamous epithelium of the intermediate layer are noted in the smear. In some women, during the whole subsequent life, an intermediate type of smear (squamous epithelial cells of the intermediate layer) is observed, sometimes with the presence of cells of the surface layer, which is apparently associated with the function of the adrenal glands, an active sexual life. The presence in the preparation of cells of the squamous epithelium of the surface layer (estrogenic type of smear) in the first 5 years of menopause should be alarming in relation to neoplasms of the ovaries, uterine fibroids. Postmenopause is characterized by the presence of cells of the basal-parabasal layer (i.e., deep layers).

Erosion (ectopia) of the cervix. The concept of cervical erosion (true erosion) involves a defect in the cervical mucosa caused by various diseases (syphilis, traumatic injuries, the effects of radiation therapy, cervical cancer, etc.). The term cervical ectopia (pseudo-erosion) means the displacement of a high cylindrical epithelium on the vaginal part of the cervix. Provided that there is a clinical diagnosis of "erosion / ectopia of the cervix" in the direction and the correct sampling of biomaterial from the ectocervix (cellular material is represented by squamous epithelial cells of all layers in various combinations, clusters of cylindrical epithelium cells, elements of inflammation), the cytological conclusion has the following form of answer: the cytogram corresponds (does not contradict) the clinical diagnosis - erosion of the cervix.

Cytological conclusion: the cytogram corresponds (does not contradict) the clinical diagnosis of cervical ectopia suggests the presence in the obtained material of squamous epithelial cells of the surface layers, clusters of cylindrical epithelium cells.

Conclusion: a cytogram of endocervicosis occurs if the clinical diagnosis of erosion/ectopia of the cervix is ​​not indicated in the referral for cytological examination, and morphologically, cells of the squamous epithelium and clusters of cells of the cylindrical epithelium are noted.

It is not always possible to make a cytological diagnosis between superficial endocervicosis (ectopia of the cervix) and proliferating endocervicosis. A descriptive cytological response occurs when: - cells of the squamous epithelium and single clusters or single cells of the cylindrical epithelium are found in the material obtained from the ectocervix; - cellular material obtained from ecto- and endocervix and presented in one mixed smear; - smears are not smeared.

With healing endocervicosis, a large number of cells of metaplastic epithelium are found in smears (metaplasia is the replacement of one type of epithelium with another). Metaplastic epithelium is a target for human papillomavirus exposure - an area for the development of precancerous conditions. The presence in smears from the cervix of a small number of cells of metaplastic epithelium is an indicator of a normal physiological process.

Histogenetic mechanisms of replacement of the columnar epithelium by squamous: - progression of squamous cell transformation - direct ingrowth of the native epithelium under the columnar. As the squamous cells develop and mature, the endocervical cells move upward, degenerate, and eventually slough off. A similar process is observed during re-epithelialization of true cervical erosion healing; - squamous metaplasia - proliferation of undifferentiated reserve cells of the endocervical epithelium and their partial transformation into a fully mature squamous epithelium. The first stage of the process is the appearance of reserve cells, then comes reserve cell hyperplasia, followed by differentiation into immature squamous epithelium, and at the final stage mature squamous epithelium is observed.

Leukoplakia of the cervix. With the cytological method for diagnosing simple leukoplakia (a benign lesion of the cervix, a background disease), hyperkeratosis is detected, i.e., in the material obtained from ectocervix, layers (clusters) of squamous epithelium scales were found (there is no nucleus in the cytoplasm of the cell), separately lying squamous epithelium scales, dyskerocytes . If there is a clinical diagnosis of "leukoplakia of the cervix" - in the cytological report it is noted that the picture does not contradict the clinical diagnosis - leukoplakia of the cervix. In the absence of a clinical diagnosis of cervical leukoplakia, depending on the available material, the cytologist gives a descriptive answer, possibly with a recommendation to exclude cervical leukoplakia. Single scales of squamous epithelium have no diagnostic value. Leukoplakia with atypia - a cytological method of research is not always possible to identify, which is explained by the presence of squamous epithelium scales on the surface of the stratified squamous epithelium, which prevent the receipt of cellular elements. It is necessary to conduct a morphological study of the biopsy of the cervix.

Dysplasia of the cervix. Dysplastic changes occur in the stratified squamous epithelium of both exocervix and endocervix. As a rule, changes begin at the junction of the squamous and columnar epithelium. Dysplasia can simultaneously develop in several areas of the cervix and cervical canal, often changes are expressed to varying degrees. Spectrum dysplasia (CIN) is not a single disease. There are two biological essences of the process: a productive human papillomavirus infection and a cancer precursor.

Dysplasia-I (mild dysplasia, CINI) is one of the least reproducible cytological diagnoses. Dysplasia-I is often difficult to differentiate from reactive epithelium. It is not always possible to make a differential diagnosis between dysplasia III (severe dysplasia, CIN-III) and intraepithelial cancer by cytological examination.

Cytological conclusion: Dysplasia - I (weak, CIN-1); Dysplasia -II (moderate, CIN-II); Dysplasia -III (severe, pronounced, CIN-III). If there are cells with signs of malignancy in the obtained material, the cytologist gives a conclusion on the cytogram of the malignant neoplasm and, if possible, specifies the form of cancer.

Inflammatory processes of the cervix. Inflammation - a cellular reaction (in the focus) - is represented by a degeneratively altered epithelium, proliferative changes of a reparative, protective nature, and inflammatory atypia. In an acute nonspecific inflammatory process, a pronounced leukocyte infiltration (many neutrophilic leukocytes), incomplete phagocytosis is noted in the smear. The composition of the cell population of the epithelium may change. Cytological conclusion: cytogram of ecto-/endocervicitis. In subacute and chronic inflammation, eosinophils, lymphocytes, macrophages/cells such as foreign bodies (multinuclear macrophages) join - cytological conclusion: a cytogram of chronic ecto-/endocervicitis. Acute inflammatory processes are more often observed in the age group of 20-24 years, chronic processes and their consequences occur in women aged 25-34.

Infectious lesions of the cervix. Cytological features of smears for infectious lesions of the cervix depend on the pathogen and the duration of the inflammatory process.

Mycoplasmas, ureaplasmas and corynobacteria as the cause of inflammation are observed in a group of young women (up to 20 years old). In the age group over 30 years, anaerobic microorganisms occupy the first place among the causative agents of inflammatory processes in the genitals. Mixed infection increases the pathogenicity of each of the pathogens. In such cases, inflammation causes a pronounced tissue reaction, accompanied by damage to the epithelium, destruction and dysplasia. This leads to the development of not only colpitis, endocervicitis, but can play a significant role in the formation of cervical ectopia. Incomplete phagocytosis is noted (phagocytic activity of leukocytes is suppressed). The cytological conclusion indicates the type of flora with a recommendation to exclude a certain type of infection.

Bacterial vaginosis (BV) - (clinical diagnosis). In cytological preparations, BV is represented by key cells. If the key cells are not found, and the flora is cocco-bacillary, it is recommended to exclude the presence of gardnerella (ureaplasma) in the cytological response; in the presence of mobiluncus bacilli, a recurrence of the pathological process after the treatment is possible.

Genital herpes - the herpes simplex virus has a high tropism for epithelial and nerve cells. Relapses are mainly due to the persistence of infection in the nerve ganglion. Cytological examination of the obtained material may show changes in squamous epithelial cells specific for their defeat by this type of viral infection: multinucleated cells of the "mulberry" type. Form of cytological response: signs of a viral infection were found in the material obtained. It is recommended to exclude the herpes simplex virus.

Papillomavirus infection of the genitals. The human papillomavirus is able to persist for a long time in the basal layer of the squamous epithelium, which causes a high frequency of recurrence of the process. The frequency of coincidence of cytological and histological diagnoses in condyloma was 42%: CIN-I - 56%, CIN III 74%. False-negative cytological responses are explained by the consequence of incorrect material sampling - 90%, incorrect interpretation - 10%.

In addition, underdiagnosis in cervical smears may be due to the presence of koilocytes in the deeper layers of the squamous epithelium or the presence of a large overlap of elements of inflammation and flora. Cytological conclusion: the obtained material showed signs of a viral infection. It is recommended to rule out the human papillomavirus. Indirect changes characteristic of a viral infection: an increase in the size of the nucleus, nonspecific multinucleation. The form of the cytological response: the obtained material shows indirect signs of a viral infection. It is recommended to exclude the herpes simplex virus, human papillomavirus.

Trichomoniasis. An inflammatory reaction develops in the presence of a large number of protozoa. Proper preparation of the patient is essential for the quality of the study. Termination of the use of trichomonocidal drugs for 5-7 days before taking the material. In the cytological preparation, there are signs of an acute/chronic inflammatory process, mixed flora, Trichomonas. Cytological conclusion: trichomonas colpitis.

Chlamydial infection. Chlamydia are tropic to columnar epithelium. Often found in women with cervical ectopia. In pregnant women and menopausal women, signs of infection may be observed in the squamous epithelium. They can also be found in macrophages. Cytologically, the presence of intracellular specific inclusions is determined, which are more often detected with a fresh or untreated infection. Cytological forms of response: cells with cytoplasmic inclusions morphologically similar to chlamydial infection were found. It is recommended to exclude the presence of chlamydial infection.

Squamous intraepithelial lesions (SIP) of the cervix are associated with significant qualitative and quantitative changes in the vaginal microflora. Deficiency of lactobacilli is observed in all patients with PIP, there is an increase in representatives of opportunistic flora. In the cytological conclusion, changes in the flora are indicated, if possible, a representative of the opportunistic flora is characterized. The presence of nonspecific vaginosis is noted.

To date, the main way to examine the internal female organs is a smear for cytology, which shows the development of infections and dangerous pathologies. It differs from other types of laboratory research in a special set of dyes and fixatives, which increase the reliability of the final results.

What is a cytology smear

Cytological Papanicolaou, Pap test) is a laboratory microscopic examination of the upper ball of the cervix, designed for the timely diagnosis of cancer. This method is the most painless, simple and fastest among all known methods of examination.

Purpose of analysis

In order to prevent and prevent the development of dangerous diseases, the cytology of a smear from the cervical canal is done to every woman. This analysis allows you to identify violations in the cellular structure of the cervix that cause the development of cancer. To avoid possible pathologies, all women should regularly visit a gynecologist. If changes occur, they are fixed at an early stage, when the disease is treatable, and full recovery is still possible.

In addition to cellular pathologies, a cytology smear allows you to evaluate the mucous membrane and determines the presence of harmful microorganisms in the vagina. The PAP test is the exact data of these parameters, so in such cases it is necessary to use additional methods of analysis.

Indications for Pap test

A smear is prescribed to all women after 18 years of age during a routine examination by a gynecologist once a year. Also indications for analysis are: violation of menstruation, the presence of papillomavirus and genital herpes, free sexual intercourse, infertility, the use of hormonal contraceptives, the establishment of an intrauterine device, pregnancy planning. Infectious diseases often also serve as a reason to take a smear for cytology. What the result shows can only be determined by a specialist.

Risk group

Regardless of age, there are certain factors that increase the risk of developing cancer. With prolonged action on the female body, they weaken the immune system. This risk group includes women who have many sexual partners, smoke, have weak immunity, are carriers of viruses, have begun sexual activity at an early age, and have had cancer of the reproductive system in the past.

How a smear is made

To obtain reliable results, a woman should stop taking antibiotics a week before the analysis. The day before the study, you need to stop douching and put vaginal suppositories and have sexual intercourse.

A smear is taken on a chair during an examination by a gynecologist. The doctor takes 3 smears: from the walls of the vagina, from and from the mouth of the paraurethral passages. This procedure is completely painless. To take a smear, a gynecological mirror and a spatula are used. To prevent objects from being cold and not creating discomfort, they can be heated with hot water before use.

At the next stage, the doctor applies the test material to a special glass, on which a laboratory analysis of the smear for cytology will already be carried out under a microscope.

Interpretation of the results of the study

The last and most important stage of the study is the transcription of the smear for cytology. According to the analysis, the doctor can obtain information about the state of the epithelium, the presence of inflammation and the composition of the microflora. In modern medical practice, the Papanicolaou technique is widely used to decipher the results of a smear, according to which 5 stages of the development of pathologies are distinguished.

Stage 1 - there are no abnormalities, cytology is normal. This stage indicates the health of a woman.

Stage 2 - during a routine examination or in the presence of complaints, a woman takes a smear for cytology, which shows a slight change in the structure of the cells. It is caused by inflammation of the internal genital organs. This stage is also considered the norm, but more thorough research is still required to establish the causes of the disease.

Stage 3 - a small number of cells with anomalies in the structure of the nuclei were found. In this case, it is necessary to take a second smear and conduct a histological examination of the tissue.

Stage 4 - during the analysis, cells with malignant changes can be detected. For example, an increased mass of nuclei, changes in the cytoplasm and chromosomes. The result obtained is not a final diagnosis, but serves as a reason for further examination.

Stage 5 - in smears are present in large quantities.

Deciphering a smear for cytology may take some time. It usually takes a few days, but there are times when you have to wait a week for results.

The reliability of the results of the Papanicolaou method is very high, especially when a smear is examined for cervical cytology. But this analysis does not provide any information about the state of the uterus itself, ovaries and fallopian tubes. There are cases when the PAP test gives false data. Therefore, for an accurate interpretation of the results, it is necessary to undergo a comprehensive examination.

Positive results: types of pathologies

If the data obtained from the study correspond to the norms, then no deviations have been identified, and the woman is healthy. In the case of positive results, the development of pathology takes place.

The detection of abnormal cells does not always indicate the presence of cancer. Often during the Pap test, dangerous infectious diseases are detected.

1. Papillomavirus infection - the formation of genital warts in the vagina and on the cervix. This virus is very dangerous for women's health.

2. Chlamydia - the most common. Basically, this disease occurs without severe symptoms. In addition, it is difficult to diagnose it in the laboratory. This complicates treatment, and its absence threatens with serious complications.

3. Trichomoniasis is a popular sexually transmitted disease. The main symptoms of the disease: itching, yellow-green discharge, discomfort during urination and during sexual intercourse. Timely diagnosis of pathology allows you to completely cure the disease.

4. Gonorrhea - an infectious disease of the genitourinary system. The chronic form of the disease is often the cause of infertility in women.

5. A yeast infection is an overgrowth of a fungus that lives in the vagina. For some reason, its reproduction is out of control, and inflammation occurs. It is accompanied by irritation and itching, white discharge with a characteristic odor.

If the result of the smear test is positive due to the presence of an infection, the identified diseases should be treated. Very often it is difficult to determine cancer precisely because of viruses. Therefore, after a course of therapy, it is necessary to repeat the analysis in order to obtain more accurate data.

Depending on the pathology, sometimes it is necessary to take a repeated smear for cytology, which shows the dynamics of changes in the structure of cells over a certain period.

Pap smear collection during pregnancy

At the slightest suspicion of the presence of infections and fungi harmful to the fetus, cytology is often used. The inflammatory type of smear allows you to diagnose pathological processes if a woman complains of burning and itching of the external genital organs, changes in the color and smell of discharge. To analyze the state of the microflora of the vagina in pregnant women, a smear for cytology is done at least three times. If necessary, the doctor may order additional Pap tests.

The Pap test for pregnant women is carried out according to the usual technology.

Possible complications after taking a smear

Taking a smear for cytology should be done by a specialist doctor who knows the technique of this process. After performing a Pap test, some complications are possible. Most often they are manifested by severe pain after manipulation and bloody discharge during the day or a little longer. These symptoms are considered quite normal and do not require treatment. If after the study there are severe abdominal pain, fever and chills, you should consult a doctor.

Cytology with improper sampling also sometimes has dangerous consequences. With gross intervention, stenosis provoked by adhesions can develop. For this reason, it is not customary to take a prophylactic smear in deep places of the cervical canal.

Within a week after the Pap test, intimate relationships, douching and the use of tampons should be abandoned.

A cytological smear is considered the best method for detecting cervical cancer in the early stages of development. But even the best laboratories sometimes fail to detect cellular changes. Therefore, for a greater likelihood of detecting pathology, you need to take a smear annually.

Timely diagnosis of various gynecological diseases is an important component in their successful treatment.

Cytological analysis of cervical cells (“cervical cytology”), helps to detect a fairly common oncological disease in time - cervical cancer.

But the "usefulness" of this analysis is not limited to this, according to its results, one can judge the beginning changes in the structure of cells and their functioning, the presence of inflammation and infection.

When conducting a cytological analysis, tissue cells, their number, shape, relative position and other characteristics are examined. Of greatest importance is the ability to detect precancerous changes cervical cells.

Since such changes do not manifest themselves in any way in the general well-being of a woman, it is difficult to detect them in other ways. Material for research is taken by scraping a very small amount of tissue from the surface of the cervix with a spatula, spatula, spoon or probe.

The fence passes from three different parts of the cervix (arch, outer surface, canal). Before this, the uterus is cleaned of secretions with a cotton swab. The process is quick and painless during the examination of a woman on a gynecological chair. Usually, simultaneously with tissue scraping from the surface of the uterus, in the same way, but using a special brush, material is also obtained from the cervical canal.

The resulting material is applied in a thin layer on a glass slide. (make a smear) and this glass is sent to the laboratory for analysis. The study itself takes place under a microscope. In many clinics, cells are simultaneously examined by staining according to the Papanicolaou method (PAP test), by drying and in other ways.

An integrated approach allows you to get more accurate results. An assessment of the state of individual cells and a general assessment of the material makes it possible to diagnose a disease or say that a woman is healthy. Based on the results of the analysis, a cytological conclusion is drawn up. Usually the doctor receives it 1-2 weeks after the material is taken.

There is an assessment of the results of a cytological examination of cervical cells according to the already mentioned Papanicolaou technique.

This method allows distinguishing five states of cellular tissue (stages of disease development or classes):

To date more popular interpretation of the results of cytological examination of cervical cells from the cervical canal by the Bethesda method.

This method reveals the presence of various changes in the cell nucleus (dyskaryosis).

Depending on the number of cells dyskaryosis and their location, one or another diagnosis can be made.

Cytology of the cervix in this interpretation allows you to determine the following conditions:

• No pathological changes
• Various atypical cell conditions, including cervical dysplasia (cervical intraepithelial neoplasia)
• Carcinoma (cancer) of the cervix.

These states are denoted by Latin letters. To decipher them and understand what is hidden behind the combinations of Latin letters in the analysis results, the table below will help.

The most common are analyzes with the designation CIN 1, 2 or 3 .

This designation means dysplasia of the first, second or third degree of severity.

First degree dysplasia suggests the presence of dyskaryosis in single, mature cells located scattered or in small clusters among normal cells.

Dysplasia of the second degree- there are more pathological cells, pathologies are more diverse and are found not only in the surface layer, but also about half the thickness of the epithelial layer.

Third degree- pronounced changes, about 2/3 of the epithelial layer is affected.

Presence in the diagnosis CIN speaks of the need to be tested for the presence of the human papillomavirus (HPV), since it is he who in most cases provokes the development of cervical dysplasia.

Importance of cytological analysis

Considering the results that cytological analysis gives, its importance can hardly be overestimated. This is one of the simplest, cheapest, and most reliable methods for determining the presence of precancerous conditions of the cervix.

Cervical cancer occupies almost half of the cancers in women.

In the initial stages, it proceeds without symptoms, and until the middle of the 20th century it was almost impossible to diagnose precancerous conditions. But with the advent of the Pap test in the 40s of the 20th century, this became possible, which saved a huge number of women's lives.

Timely detection of initial changes in cells allows relatively simple and effective treatment of dysplasia and other precancerous conditions.

Doctors advise to conduct a cytological analysis of the cervix at least once a year.

It is believed that cancer cells develop rather slowly, so many doctors allow the test to be taken once every 2-3 years. But there are times when the disease develops very quickly. Such a gap is acceptable if the previous two cytological analyzes were negative.

Regardless of previous test results, women at risk ( HIV carriers taking steroids, chemotherapy, etc.)- the analysis must be taken every year or more often, according to the doctor's recommendation.

If a pathology is found in the analysis, repeat it after three months, six months, or as recommended by a doctor.

Also note that the cytology of the cervix in 5-10% of cases are false negative. Experts attribute this to improper sampling of material and improper preparation for analysis.

For the result to be reliable, for at least two days a woman needs:

• Refrain from sexual intercourse
• Do not sanitize (douche) the vagina
• Do not use vaginal suppositories, tablets, creams and other preparations.
• Before the direct sampling of the material, do not urinate for 2-3 hours.

Cytology analysis cannot be taken:

Compliance with these simple rules will allow a woman to be calm about her health, and if any pathologies are found, it is effective and relatively easy to treat them.

A smear is a method of examination in which the doctor collects a small amount of material from the surface of the mucosa. Smear analysis is most often used in urology in men and in gynecology in women. A smear study for flora allows you to check for the presence of pathogenic bacteria, cancer cells, in some cases - to assess the hormonal background and the general condition of the tissue. A smear from the vagina for flora is taken every three months, during preventive examinations by a gynecologist.

In the case when you are undergoing treatment, a swab for infection is taken after the end of the course of therapy to confirm its success. An analysis from the vagina or cervix is ​​a painless procedure that allows you to get an idea of ​​\u200b\u200bthe state of women's health.

Gynecological smear - 4 main types:

1. Smear on flora.

2. A smear for sterility.

3. A smear for cytology (PAP test for atypical cells of the cervix).

4. A smear for latent infections (PCR).

1. Smear on flora: norm and deviations from it

What is it for: the study allows you to evaluate the microflora - the presence of pathogenic bacteria and their number.

Such an analysis, taken from a healthy woman, should show 95% of lactobacilli in the collected material. Lactobacilli produce lactic acid, thereby protecting the genitals from infection and maintaining the desired acidity. In women "in position" the number of lactobacilli decreases, so the body's natural defenses are weakened. In order to prevent the development of diseases that cause sexual infections, a smear during pregnancy should be taken by all expectant mothers, without exception.

Vaginal swabs are examined to ensure that there are no infectious agents such as:

• trichomonas;
• gardnerella.

To identify infections that cannot be detected by analysis of the flora, a smear is taken for latent infections. One of the most common methods for detecting latent infections is the PCR method.

Normally, the microflora in a healthy woman may contain gardnerella and candida, but their number should be low. Gardnerella and candida begin to actively develop with a decrease in immunity. The body's defenses can be weakened for various reasons:

• pregnancy;
• fatigue;
• emotional overwork;
• the presence of a disease, the fight against which the immune system is “busy”.

When assessing it, four groups of purity are distinguished.

• First. The reaction is acidic - pH 4.0–4.5. Most microorganisms are Doderlein sticks (they are also lactobacilli), in a small amount - leukocytes in a smear, epithelial cells. Such results indicate a healthy reproductive system.
• Second. The reaction is acidic - pH 4.5–5.0. In addition to lactobacilli, gram-negative bacteria are present - these are most often the causative agents of infections, which become discolored after laboratory staining.
• Third. The reaction is alkaline or slightly acidic - pH 5.0–7.0. Predominantly bacterial microflora, epithelial cells are also in large numbers. Several lactobacilli have been found.
• Fourth. The reaction is alkaline - pH 7.0–7.5. Lactobacilli are absent, the flora is represented by pathogens. There are a large number of leukocytes in the smear. Such an analysis indicates inflammation of the vaginal mucosa.

If the result is poor (Group 3 or 4), your doctor may refer you for a retest or culture to clarify the results.

Decryption

Results may vary from laboratory to laboratory. Depending on which laboratory you passed the smear, the rate may fluctuate. Since research methods may differ in each individual laboratory, the results will be different. It is advisable to take all the tests in the same laboratory so that you can observe changes over time and these changes were not associated with a change in the laboratory in which you take the tests. Decoding must be carried out by a doctor.

To indicate the number of bacteria in the study of smears from the urethra, vagina, as well as in the analysis of the cervical smear, CFU / ml is used. These units are read as a quantity colony forming units per milliliter of liquid.

2. Sterile smear

Why it is carried out: allows you to determine the presence or absence of genital infections, assess the hormonal background of a woman, as well as the composition of the contents of the vagina, during pregnancy, the results of a smear allow you to assess the risk of miscarriage.

This test is called a smear for purity, or a smear from the vagina "for sterility."

The study is carried out according to the following indicators:

• squamous epithelium

Squamous epithelium - cells of the mucous membrane of the cervix and vagina. An analysis of a woman who is healthy necessarily shows it in a small amount. If the epithelium is absent in the smear, this indicates hormonal disorders, while the level of androgens is increased, and estrogen is lowered. The epithelium in an increased amount indicates inflammation.

A cervical smear with an increased level of squamous epithelium indicates inflammation in the cervix, a smear from the urethra - in the bladder, a swab from the vagina, respectively, - to inflammation of the walls of the vagina.

The amount of squamous epithelium is also affected by the phase of the cycle. Depending on the day on which the analysis was made on the flora, the norm is different.

If you passed a smear for flora, it should be deciphered by your doctor.

• lactobacilli(synonyms: gram-positive rods, lactobacilli or Doderlein rods)

With healthy genital organs, lactobacilli (rods) predominate in the smear. The results of smears in which the number of lactobacilli is 95% of the total number of bacteria are considered good. Sometimes during the study, the number of lactobacilli is below normal. At the same time, the acidity in the vagina decreases and it is easier for pathogenic microbes to enter the body.

• Leukocytes

In the study of smears, the number of leukocytes is determined - this is one of the important indicators.

Leukocytes are the "defenders" of the body. Leukocytes in a smear are present in large numbers when pathogenic bacteria actively multiply in the body. That is, the more leukocytes are increased in the analysis, the more pronounced the inflammatory process.

If a cervical smear contains up to 30 white blood cells, from the urethra - up to 5, and from the vagina - up to 10, this is normal. Such values ​​are typical for all women who live sexually.

Leukocytes in a smear, the rate of which is significantly increased, indicate only the presence of an inflammatory process. The cause of the infection must be determined by a doctor. This requires additional studies, such as bacterial culture, immunoassay and polymerase chain reaction (PCR).

• red blood cells

The number of red blood cells increases during menstruation, injuries of the vaginal mucosa, or inflammation. The analysis normally may contain several erythrocytes.

• Slime

Mucus is secreted by the glands of the cervix and vagina - a smear from the vagina and from the cervix should contain it in a small amount.

3. Smear for latent infections and polymerase chain reaction

What is it for: allows you to detect infections that cannot be detected by analyzing a smear for flora

In 1983, American biochemist Kary Mullis developed the polymerase chain reaction method, for which he was awarded the Nobel Prize. Thanks to the scientist, it became possible to “recognize by sight” bacteria and viruses, even with their minimum number. Often, the polymerase chain reaction is called PCR diagnostics. PCR analysis and PCR smear are also synonymous. A swab, scraping or urine sample taken for analysis allows you to identify hidden diseases.

The polymerase chain reaction is a biological research method in which a section of DNA is replicated in a laboratory.

What is PCR analysis for? In the study, it is necessary to highlight which type of infection causes the disease. But bacteria are sometimes so small that it is impossible to recognize them. In such cases, PCR diagnostics of infections saves.

For analysis, a piece of DNA from a bacterium is taken and repeatedly cloned. When the DNA "grows", it is possible to determine what kind of bacteria or fungus the laboratory technician is dealing with.

PCR diagnostics of infections gives an accurate result. It allows you to identify not only the genus, but also the type of bacteria: for example, not only to say that the fungus of the genus Candida, but also to clarify that it belongs to Candida albicans. If the exact type of infection is not established, treatment may not be effective.

Often, PCR diagnostics are used in the study of smears for sexually transmitted infections. Most sexually transmitted diseases, such as gardnerellosis, chlamydia, mycoplasmosis, gonorrhea, ureaplasmosis, may not show signs in the early stages of development. Symptoms appear in the later stages. Thanks to PCR analysis, sexual infections can be detected at the initial stage of development and, accordingly, they can be quickly cured.

When conducting such an analysis, it is also possible to identify viral infections such as hepatitis or papilloma. Other methods can detect not the virus itself, but only the presence of its metabolic products or antibodies to it.

The polymerase chain reaction method allows you to identify infections in any environment: in blood, urine, saliva, on mucous membranes. In addition, thanks to PCR analysis, viruses are isolated in soil and water.

Advantages of the polymerase chain reaction:

• the accuracy of determining the infection;
• the ability to isolate the virus (and not the decay products or antibodies to it);
• a small amount of the test material is sufficient (even in the presence of one pathogen cell);
• the ability to detect infection in any environment (urine, blood, saliva);
• the speed of the analysis;
• the only method for isolating some infections.

4. Pap test, or cytological smear

What is it for: allows the diagnosis of cervical cancer.

The PAP test has different names: a smear for cytology, as well as a test, analysis or Pap smear, a smear for atypical cells. The analysis is named after the Greek scientist who first applied this method. To conduct a Pap test, a swab is taken from the cervical canal (cervix) during a gynecological examination on a chair.

A cytological smear in a woman over 30 years old is a mandatory annual analysis. Cervical smear results help diagnose cervical cancer, the second most common cancer in women.

How is a smear taken for cytology?

Several factors may affect the results of the study. To get a reliable result, refrain from going to the toilet 2-3 hours before taking a smear. Otherwise, you will wash away the epithelium and bacteria that are important for examining a vaginal smear.

For accurate results, 48 ​​hours before the test:

• do not have sex;
• do not douche (so as not to wash the contents of the vagina);
• do not use vaginal contraceptives (spermicidal creams, ointments, foams);
• do not take baths;
• do not use tampons or vaginal suppositories.

Taking a smear from the cervix

The interpretation of the smear and, accordingly, the success of the treatment depends on whether the woman followed the requirements listed above. A Pap smear can be taken on any day of the cycle when there is no menstrual flow.

A smear is taken by a gynecologist when examined on a chair.

Eyre spatula - a plastic stick for taking a cervical smear

In this case, the doctor uses a gynecological speculum and Eyre's spatula - a special plastic stick. In terms of time, taking smears takes no more than two minutes. The procedure is painless.

Smears are taken in three places - possible foci of infections: a swab is taken from the cervical canal (cervix), from the vagina and urethral opening.

Taking swabs from the cervical canal

The study is carried out by studying under a microscope or bacteriological culture. In most cases, women do not experience discomfort after a smear. Only occasionally can there be spotting from the vagina and pain in the lower abdomen. They should be gone in a few hours.

It is not necessary to abstain from sex after a smear. Starting from the age of 18, even if the girl does not live sexually, experts recommend undergoing annual preventive examinations and taking a smear for oncocytology. And those who are sexually active, regardless of age, are advised to visit a gynecologist with the onset of intimate relationships. To detect cervical cancer in the early stages of development, after the age of 30, undergo an examination by a gynecologist at least twice a year.

cervical dysplasia

In the presence of "wrong" cells as a result of the analysis of a cervical smear for cytology, the doctor uses a special term: dysplasia.

Dysplasia is a condition of the cervix, in which some of the cells have a broken structure. This means that cells can develop into cancer cells. Therefore, such a pathology can be a precancerous condition.

What influences the development of cervical dysplasia?

The risk of developing pathology increases with:

• smoking;
• a large number of births;
• long-term use of intrauterine and hormonal contraceptives;
• lack of vitamins;
• the presence of sexually transmitted infections (especially papillomavirus);
• early sexual activity (up to 16 years);
• childbirth (up to 16 years);
• a large number of sexual partners (three or more);
• genetic predisposition.

Cervical dysplasia is caused by human papillomavirus (HPV) types: 6, 11, 16, 18, 31, 33 and 35.

Signs may be:

• frequent inflammatory processes;
• spotting spotting;
• bleeding after intercourse or when using tampons.

Some women with dysplasia experience pain in the lower abdomen.

Dysplasia: degrees of development

Depending on how much dysplasia has developed, the degree of its development indicates the depth of tissue damage. There are three degrees: first, second and third.

Degrees of cervical dysplasia

• TO first degree dysplasia refers to slight changes in the structure of the cells of the cervix. In this case, abnormal cells affect only the surface layer of the squamous epithelium.
• At second degree cervical dysplasia "wrong" cells affect the superficial and middle layer of the cervix.
• cervical dysplasia third degree means that abnormal cells have grown on all three layers of the epithelium.

Cervical dysplasia: treatment

Dysplasia of the cervix. HPV - human papillomavirus

If you have cervical dysplasia, treatment involves reducing the number of abnormal cells. To do this, the doctor removes a small affected area of ​​the cervix. If you have been diagnosed with cervical dysplasia, treatment cannot completely remove the human papillomavirus from the body. However, it can prevent the development of a malignant tumor.

Treatment of the disease - removal of the affected area - the uterus can be carried out in different ways: using a laser, freezing and other methods. It depends on the age of the woman, the degree of development and the condition of other genital organs. If the patient has sexually transmitted infections, they are first eliminated. Only after the smear analysis shows that there are no genital infections, treatment is carried out.

When cervical dysplasia is detected in the early stages, treatment is carried out that not only preserves women's health, but also life. To do this, every woman should undergo preventive examinations at least once a year.

Who needs to see a gynecologist?

A smear test from the vagina, urethra, and cervix should be done in women who:

• began to live sexually;
• got pregnant;
• planning a pregnancy;
• have multiple sexual partners;
• feel discomfort in the genitals (pain during sex, frequent urination or burning in the genitals, and others);
• over 18 years old;
• undergo a preventive examination.

Regular examinations in the gynecologist's office, during which you can take a smear test, allow you to notice the onset of the disease in time, make the correct diagnosis, and even save a life. For example, dysplasia of the uterus, the treatment of which was started on time, will not degenerate into an incurable malignant tumor.

Smear: norm and deviations, or Who is at risk

Regardless of age, there are factors that increase the risk of cervical cancer. Their totality and prolonged "action" on the body reduce the body's defenses in the fight against the disease, even in the early stages of development.

A cervical smear for oncocytology is especially important for women who:

• have multiple sexual partners;
• began sexual activity before the age of 18;
• in the past suffered cancer of the reproductive system;
• smoke;
• are carriers of viral infections;
• have a weakened immune system.

Viral infections increase the risk of cervical cancer, such as herpes simplex virus, HIV and human papillomavirus.

• inflammation of the mucous membrane of the vagina;
• dysbacteriosis of the vaginal microflora;
• intestinal dysbiosis;
• sexually transmitted diseases;
• inflammation of the mucous membrane of the uterus;
• tumor processes in the pelvic organs;
• inflammation of the uterine appendages;
• fungal infection of the vagina;
• urethritis;
• inflammation of the cervix.

There are situations when elevated leukocytes do not indicate the presence of a pathological inflammatory process in the reproductive system. In particular, an increase in the content of white blood cells in a smear may be due to inflammation in the male genitourinary system. For example, after unprotected intercourse with a man who suffers from prostatitis, the white blood cells in the smear will be increased. This must be taken into account by the doctor when carrying out diagnostic measures.

Elevated white blood cells in a smear in men

To find out the cause of infertility, men also take a smear from the urethra. An increase in the number of white blood cells indicates the presence of an inflammatory process in the genitourinary system in men. These pathological conditions can lead to reproductive dysfunction and infertility. In addition, if inflammatory diseases of the pelvic organs in men are not treated, the pathological process can pass to nearby organs or even lead to the development of systemic inflammation.

Therefore, elevated leukocytes in the stronger sex are a serious marker of the infectious process, which must be diagnosed and treated in time. For this, the doctor prescribes the appropriate treatment, which in most cases gives a positive effect. Pathological changes in the smear in the form of an increase in leukocytes can be a sign of diseases such as cystitis, prostatitis, orchiepididymitis, and so on. With these pathological conditions, a man has pain or a burning sensation when urinating, as well as turbidity of the urine. In addition, elevated white blood cells can be detected after intercourse with a woman who suffers from inflammatory diseases.

Thus, taking a smear should be carried out in both women and men. This study will reveal inflammatory diseases in the early stages, which are manifested by an increase in the number of leukocytes. This will allow you to prescribe the right treatment in time and increase its effectiveness.

Pap smear during pregnancy

All women, regardless of whether they are in an "interesting position" or not, take a swab for the flora in the same way. The only difference is in the frequency: pregnant women, respectively, more often.

Even if the expectant mother has not recently been ill with anything, she could become infected with the infection and be its carrier for a long time. And since the immune system is weakened during pregnancy, the bacteria at this time can begin to actively multiply.

The analysis of a smear before and after pregnancy can differ significantly. Even if there were no symptoms of the disease before pregnancy, with the onset of pregnancy, diseases that are sexually transmitted are most often manifested:

• gonorrhea;
• syphilis;
• ureaplasmosis;
• genital herpes;
• mycoplasmosis and others.

If a pregnant woman is a carrier of one of the sexual infections, then, most likely, leukocytes will be found in a smear, the norm of which is exceeded. In the case when a pregnant woman has increased leukocytes in a smear, the doctor should prescribe treatment. To establish an accurate diagnosis, a blood smear is also taken. This analysis is carried out on the same principle as the gynecological one. A blood smear allows you to identify diseases such as malaria, typhoid and others.

It is not uncommon for pregnant women to develop thrush, so the study may also show an increased amount of Candida fungus.

What should not be in the smear analysis?

For normal functioning of the genital organs and good health in the body, there must be a balance of good and bad bacteria. A smear for purity may contain little or no micro-organisms and cell structures:

• atypical cells. May indicate a precancerous condition. They have the wrong structure.
• key cells. The key cells in the smear are epithelial cells “glued together” by gardnerella or other pathogens. Key cells in a smear in an increased number can be observed with reduced immunity. In cases where a smear is examined for flora, this category includes squamous epithelial cells that are glued to infectious agents.
• Gardnerella. These are small sticks in a smear. When examining smears from the vagina, gardnerella may be present in small quantities. If a smear for cleanliness reveals an increased number of these bacteria, a bacterial vaginosis. An increase in their number is also observed in vaginal dysbacteriosis.
• Candida. This fungus, like gardnerella, is present in small quantities on the vaginal mucosa in healthy women. If the number of candida fungus exceeds the number of lactobacilli, vaginal candidiasis develops (the popular name is thrush). A gynecological smear confirms the disease in a latent form in the presence of spores, and in an active form - in the presence of fungal filaments. As a rule, the number of candida increases with reduced immunity, including during pregnancy.

Up to 40 different types of bacteria live in the vagina of a healthy woman. As long as the total number of lactobacilli prevails, all bacteria, including Candida and Gardnerella, "peacefully" coexist.

• Cocci (gonococcus, staphylococcus and other cocci in a smear)

Cocci in a smear look like spherical bacteria. A smear for purity may contain several types of cocci, but only extracellularly. Otherwise, cocci indicate a venereal disease.

• Gonococcus. A Gram-negative bacterium that thrives in high humidity. In addition to gonorrhea, cocci in a smear of this kind of bacteria cause inflammation of the urethra, cervix, fallopian tubes, and rectum.
• Staphylococcus. The most common is Staphylococcus aureus, a Gram-positive bacterium. 20% of the world's population are carriers of this type of cocci. Bacteria belonging to this genus of cocci in a smear cause mild skin infections (acne, etc.) and deadly diseases (pneumonia, osteomyelitis, endocarditis, and others).
• Streptococcus. A Gram-positive bacterium that lives in small numbers in the gastrointestinal (GI) and respiratory tracts, as well as in the nose and mouth. If streptococci are found in a pregnant woman in an increased amount in a smear, they can cause miscarriage, early birth and stillbirth. In addition, they cause diseases such as scarlet fever, bronchitis, tonsillitis, pharyngitis and others. In single quantities, streptococci in a smear can be included in the norm.
• Enterococcus. Gram-positive bacterium, which is part of the microflora of the gastrointestinal tract. Withstands heating up to 60 ° C for half an hour. Such cocci in large quantities indicate inflammation of the genitourinary system, pelvic organs and other diseases.

• Trichomonas. A swab for infection does not always reveal Trichomonas, as this bacterium can have altered forms. To confirm its presence, a bacteriological culture is done.

Your result is bad, does the vaginal smear contain pathogenic bacteria? Most infections are now successfully treated. The main thing is not to self-medicate and follow the doctor's recommendations.