A cytology smear is a study of material taken from the cervical canal and cervix under a microscope. Thanks to him, it is possible to establish the presence of oncology and infection in the uterine cervix. The smear also determines the presence of pathogens in the mucous membrane.

However, the Pap test is not a means of detecting inflammatory processes in the ovaries and uterus. It is recommended that women undergo a preventive smear at least once a year during a routine examination by a gynecologist. Women with weakened immune systems who often change sexual partners and regularly use contraception are at risk. The Pap test is also indicated in the following cases:

• if the menstrual cycle is disrupted;
• if there are chronic diseases of the cervix and cervical canal;
• in case of unsuccessful attempts to get pregnant;
• when planning pregnancy;
• after surgical operations on the genital organs;
• when taking hormones;
• if there is a spiral inside the uterus;
• for diabetes mellitus;
• with papilloma and herpes viruses;
• with high degrees of obesity.

Preparing for analysis

For the most accurate research result, you need to follow several preparation recommendations:

• stop taking topical medications (vaginal ointments, suppositories), douching;
• if you are menstruating, wait until it ends;
• for previously identified diseases, undergo a course of treatment and take a control smear;
• do not urinate for 3 hours;
• give up sexual intercourse in a couple of days.

What is the procedure for taking a smear?

When examining with mirrors in a gynecological chair, the doctor takes 3 smears with a special brush from:

• uterine cervical canal;
• vagina;
• the mouth of the paraurethral passages.

To prevent metal objects from causing discomfort to the patient, they are first dipped in warm water. With a qualified approach, the procedure for taking a smear is painless and not dangerous. Materials for the Pap test are applied to glass and sent to the laboratory. The results obtained are quite reliable.

Possible complications

After taking a smear, complications may occur in the form of bleeding for several days. If the approach to manipulation is incorrect, abdominal pain, fever, and stenosis (in the presence of adhesions) are observed. That is why the sampling must be carried out by a qualified gynecologist. After a Pap test, it is recommended to avoid sexual intercourse, douching, and the use of topical medications.

Read also:

• Warts on intimate places
• Growths on the skin: how to fight?

What does a cytology smear show?

The results of the study are divided into 5 degrees:

1. there are no changes or deviations from the norm in the cells - the woman is considered healthy;
2. changes in the structure of cells were detected - the results indicate the presence of inflammatory processes;
3. there are some cells with modified nuclei - there is suspicion of the initial stage of oncology. To clarify the results, the patient is sent for microbiological or histological tests;
4. there are a large number of cells with modified nuclei - there is serious suspicion of cancer. To clarify the diagnosis, colposcopy and biopsy are performed;
5. There are a lot of modified cells, which indicates a severe degree of cancer.

If the reaction is positive, in addition to oncology, infectious diseases can be detected. In this case, deciphering the cytology of a smear from the cervical canal requires a more thorough approach. These could be:

• papilloma. A virus that penetrates the vagina and cervix and forms growths there.
• chlamydia. They are dangerous due to severe complications, although the disease itself may not make itself felt with pronounced symptoms.
• Trichomonas. A sexually transmitted infection, manifested in the form of yellow-green discharge, itching, pain during sexual intercourse and urination.
• gonorrhea. An infection that often leads to infertility.
• candida. Vaginal fungus, noticeable by itching and white discharge with an odor.

If a large number of viral infections are detected in the smear, after treatment, doctors will advise you to undergo another test to detect oncology. The fact is that in the presence of viruses, cancerous changes become less noticeable. At 2-4 degrees of pathology the following are diagnosed:

• erosion of the uterine cervix;
• candidiasis;
• cercivit;
• parakeratosis of the uterine cervix;
• vaginitis;
• herpes.

How to decipher the analysis?

Based on the conclusion given by the laboratory, it is quite difficult for an uninitiated person to determine what a cytology smear shows. The record consists of numbers, Latin letters, each of which has its own meaning.

• The letters of the Latin alphabet U, C, V indicate 3 areas of smear collection.
• The norm of leukocytes is determined at the rate of 15 units.
• The presence of viral, bacterial and fungal infections.
• The nature of changes in epithelial cells.
• Degree of purity. If it is indicated by the numbers 1,2, the woman is healthy. With a purity of 3.4, there is suspicion of disease.
• The normal number of squamous epithelial cells is 10 units. If this amount is exceeded, we can talk about a benign tumor.
• The volume of mucus secreted.
• If atypical cells are present, a separate recording is made.

It takes 1 to 5 days to determine the results of the analysis. The basis for deciphering a smear for cytology is always the established norm.

Read also:

Many women are afraid of routine examinations and their consequences, preferring to avoid the gynecologist's office. In vain, since timely detection of diseases will contribute to effective treatment and a speedy recovery. Cytology smear is one of the most inexpensive and effective ways identify pathology at an early stage.

ladyspecial.ru

Cytological examination of the cervical smear: decoding, what is it?

In gynecology, cytological examination of smears is often used.

Based on the results of this test, the gynecologist can tell what is happening in the female genital organs - whether they are normal or whether an inflammatory process is occurring somewhere deep in the tissues.

Using a smear, you can detect precancerous conditions, cancer, infectious diseases and malfunctions of the ovaries.

What is a cytological examination?

Unlike histology, cytological examination does not require a tissue sample.

The laboratory will study only the material that was taken from the cervix or vaginal walls using a smear or print.

The results of a cytological study are quite reliable if the woman prepared for the study, and the doctor correctly deciphered the data received from the laboratory.

A smear is taken from the cervix or vagina. The cells of these organs, having “worked out” their term, are rejected from the surface.

In addition to them, on the surface of the epithelium there are leukocytes - special cells that protect the tissues of the vagina and cervix from pathogenic microorganisms. The second function of leukocytes is the decomposition of dead and mutated cells.

Material for cytological diagnosis is collected from the surface of the cervix or vagina, stained and examined under a powerful microscope.

The substance can be used for biochemical research. A histological test during a biopsy is considered more accurate, but it allows one to study only the processes occurring in a specific place in the organ.

A cytological examination examines the general clinical picture and processes occurring throughout the vagina.

Cytological examination of smears allows you to quickly obtain ready results - within a few hours.

If atypical cells are found in the smear, the doctor will issue a referral for a biopsy, since with the help of histological examination, cancer, precancerous or background conditions are diagnosed with almost 100% accuracy.

Cytological examination of smears is indispensable for primary diagnosis and as screening during general medical examination.

The technique makes it possible to examine a large number of patients in a short time for infectious diseases, hormonal disorders, inflammation, including erosion, cancer and precancer.

Based on the results of the study, it is possible to identify women at risk of cancer.

A cytological examination of a smear must be carried out for almost any patient’s complaints.

The study is universal, it is carried out when planning pregnancy, infertility, any type of vaginal discharge, menstrual irregularities, and the appearance of warts, herpes, and condylomas in the genital area.

Cytological examination is done as part of effectiveness monitoring hormonal treatment, before installing intrauterine contraceptives and before prescribing oral contraceptives.

Preparation for the procedure

The discharge for cytological examination is collected easily, simply and painlessly. In public medical institutions, the analysis is done free of charge.

It must be borne in mind that 5–10% of the results will be false. Such a high percentage of inaccuracy is explained by the fact that a huge number of patients, going to the antenatal clinic for a smear test, do not even assume that they need to prepare for the procedure.

What is involved in preparing for research? Within two days they begin to abstain from sex; they cannot douche, use ointments, or vaginal suppositories.

In addition, 48 hours before the visit to the gynecologist, stop taking oral contraceptives and anti-inflammatory medications. Tampons should not be inserted into the vagina, even for medicinal purposes.

3 hours before submitting the biomaterial for a PAP test, refrain from urinating.

The discharge is not taken on the days of menstruation if there is itching in the vagina and there is copious discharge, if there is a pronounced inflammatory process on the surface of the reproductive organs.

If a cytological test for oncology gives a negative result for two years in a row, then in the future you can do cytology less frequently - once every three years. After 60 years, a woman can completely refuse smear cytology without risk to her health.

Why do women over 60 years of age not require cytological screening? According to statistics, in women over 60 years of age who undergo regular screening examinations for cervical cancer, oncology occurs extremely rarely.

After 60–65 years of age, the risk of infection with the human papillomavirus is minimal. In addition, in menopausal women, the tissue of the cervix changes, which can cause false positive results.

Women at risk require a cytological smear examination more often - once every six months or even every 3 months.

The cancer risk group includes patients with HIV infection, identified oncogenic papilloma viruses, who have been using hormonal drugs for a long time and who are protected from pregnancy using intrauterine devices.

Diagnosis using PAP test

To screen for cervical cancer, a Papanicolaou smear (PAP test) is done. Morphological analysis of the discharge makes it possible to evaluate the cellular material obtained from the cervix.

Before taking a smear for a Pap test, abstain from sexual intercourse for at least a day, do not douche, and do not use vaginal medications.

Biomaterial for a smear is taken at any time of the cycle, except for the days of menstruation. To obtain biomaterial, a scraping is made from the cervical canal.

Scrapings are taken separately from the ectocervix and endocervix. The cervix is ​​inspected using mirrors and the surface layer is lightly scraped off with a spatula, without pre-processing anything.

For a smear, biomaterial is taken from the cervical canal after removing the mucus plug. The resulting discharge is mixed and one general smear is prepared.

The Pap test makes it possible to assess the degree of damage to tissues and individual cells trapped in the print.

The condition of the cells is assessed based on several dozen signs of atypia. If no signs of abnormality in the structure of the cells are detected, then the condition is interpreted as normal.

The following results may be recorded on the cytology results form:

The test result is negatively affected by non-compliance with the technology for collecting biomaterial, poor-quality smear preparation, and insufficient qualifications of the cytologist.

If the smear is assigned a third, fourth or fifth class, then further research is required.

The patient will have to undergo another study, a more detailed one - a cervical biopsy. If the smear is assigned a second class (inflammatory), vaginal sanitation and HPV typing are indicated.

When conducting a study for pathogens of infectious diseases of the reproductive system, discharge is taken from the external genitalia, the vagina of the cervix, from the uterine cavity and from the uterine appendages.

Using microscopic examination of smears, gonorrhea, trichomoniasis, candidiasis, bacterial vaginosis and other infections are detected.

Pathogenic microorganisms can be detected in a smear directly (by examining the discharge under a microscope) or by culture.

The latter method is the gold standard for gynecological examination to detect infections. Culture reveals chlamydia, gonorrhea, and trichomoniasis.

How long does it take to wait for results? Cytology will be ready in an average of 2 days; in special cases, results can be provided within an hour.

The time it takes for the patient to receive a piece of paper with numbers depends on the workload of the laboratory.

Cytological examination using classical technology requires the mandatory personal participation of a specialist.

Mask analysis does not involve the use of automatic systems, which is possible with other types of research.

A cytological examination of a cervical smear can be done at a public or private medical institution.

At the state antenatal clinic at your place of registration, the smear will most likely be sent for study to its own laboratory.

Women who prefer paid medicine can go to any private clinic of their choice. In the latter case, having received the results of the study, you need to familiarize yourself with it and, seeing deviations from the norm, make an appointment with a doctor as soon as possible.

It is especially important to quickly contact a gynecologist if signs of malignancy are detected, which can be indicated in the study form as the abbreviations ASC or AGS, Papanicolaou class III, IV, V, CIN.

Cytology and bacteriological examination of cervical smears make it possible to diagnose the vast majority of infectious, sexually transmitted, oncological and gynecological diseases.

The study will be useful to all women, even those who do not have any symptoms of diseases of the reproductive organs.

Cytological analysis of a smear from the cervix makes it possible to exclude or detect cancer at any stage, even the earliest.

moydiagnos.ru

Cytology of the cervix: what is it, interpretation of the study, types and what does it show?

Today, cervical cancer, according to statistics, ranks third among the most dangerous cancers among women. Therefore, when visiting a gynecologist, you should take a cytology test, which is one of the most reliable ways to diagnose cancer, and is also absolutely painless and takes no more than a minute.

Now women have a choice of liquid cytology of the cervix or PAP test, only with their help can latent pathological processes or a precancerous condition of the organ be identified in the early stages.

Indications and features of the analysis

A smear for oncocytology is taken:

Please note that you should take a smear for cytology once a year. If the analysis reveals cellular abnormalities, then examinations are carried out every six months or more often.

It is best to check the preparation conditions with your doctor.

These methods of taking material are painless and do not require special preparation or time.

The collection of material is done as follows:

1. The woman sits on a gynecological chair, then the vaginal walls are expanded using a speculum and a smear is taken. This may cause slight discomfort.
2. At the same time, a smear is taken to examine the microflora.
3. In certain situations, colposcopy is performed simultaneously with oncocytology analysis.
4. The resulting material is preserved by applying it to glass or placing it in a flask and transferred to the laboratory.

As a result, the study shows:

1. Negative result – the cells are not susceptible to pathological processes, the cell structure is not damaged and pathogenic microorganisms are not detected.
2. Positive result – atypical cells were detected in the mucous layer. The elements may differ in shape and type from normal cells.

Decoding the cytology test has the following stages:

Decoding cytology

It is worth saying that you can only trust the decoding of the study results to the attending physician. All information provided on the Internet is for informational purposes, since only a gynecologist knows about the characteristics of the patient’s body.

After receiving the results, you need to consider:

Only a gynecologist can tell you exactly how many times you need to take an oncocytology test, so you should never refuse to take a smear. After all, the woman’s health depends on this.

It must be taken into account that there are indicators that indicate benign changes in cells. This is not normal, but it is not a reason to refer the patient to an oncology clinic.

Benign changes are possible with:

1. Herpes.
2. Human papillomavirus.
3. Thrush (candidiasis).
4. Pregnancy.
5. Vaginitis.
6. Trichomoniasis.
7. Using the IUD for contraception.
8. Taking antibiotics and hormonal drugs for a long period.

Feedback from our reader - Victoria Mirnova

If a woman is diagnosed with poor cervical cytology, this does not necessarily indicate cancer. Most often this indicates dysplasia. There are the following types of dysplasia:

1. Mild degree - indicates the development of an inflammatory process that can occur without symptoms.
2. Moderate – there is a risk of developing an oncological process.
3. Severe degree – precancerous condition of the cervix.

Do not panic if your cytology results are poor. The gynecologist performs additional procedures to diagnose changes in the cervix and explains to the patient the treatment plan and prognosis of the disease.

The following studies are mainly prescribed:

1. Repeated smear for cytology.
2. Biopsy of the affected area.
3. Colposcopy.
4. Curettage of the cervix.
5. Blood test (advanced).
6. Test for human papillomavirus.
7. When diagnosing dysplasia, cauterization is performed.
8. If a viral disease is detected, then treatment of the woman and her partner is necessary.

Correctly selected treatment and timely smear tests make it possible to recover and monitor the condition of the cervix in the future.

After collecting the material, the glass or flask is transferred to a laboratory where microscopic examination is carried out.

Many people are interested in how many days later can they apply for a transcript of the analysis? You should come to see your doctor for interpretation of the results after 14 days.

Cytology analysis does not have negative consequences. Almost always the smear is taken painlessly. But in some situations, a woman may experience slight bleeding for a maximum of 2 days. This is normal and does not require additional treatment.

• nervousness, sleep and appetite disturbances...
• frequent headaches...
• bad breath, plaque on teeth and tongue...
• change in body weight...
• diarrhea, constipation and stomach pain...
• exacerbation of chronic diseases...

ginekologii.ru

Oncocytology: what is it, areas of application, gynecological smear for cytology

For some reason, everyone thinks that oncocytology concerns exclusively the female genital area (cervix, cervical canal). This is probably because the condition of the cervix is ​​the subject of daily study by any cytologist, while a smear for oncocytology can be applied to the glass after scraping or fine-needle aspiration biopsy (FNA) from other places. In addition, you can make smears-imprints of the mucous membrane of the larynx, nasopharynx, skin (melanoma), and soft tissues. In principle, if an oncological process is suspected, material for research can be obtained from any place, albeit using different methods. For example, using fine needle aspiration biopsy. Most often this is done if there are doubts about the health of the mammary or thyroid gland, where cytological diagnosis plays a role main role, because histological verification is provided only during surgical intervention(urgent histology) and after organ removal.

Oncocytology involves microscopic analysis (study of the cellular composition and state of cell organelles) of material suspicious of an oncological process and taken from any accessible place.

In this regard, patients should not be surprised by smears for oncocytology, prepared not only from scrapings of the female genital organs, but also fine-needle aspiration biopsy (FNA):

• Enlarged regional lymph nodes (cancer of the larynx, nasal cavities and paranasal sinuses, salivary glands, penile cancer, eye tumors, etc.);
• Tumors of the pancreas, liver, gallbladder and extrahepatic bile ducts;
• Seals and nodes of the mammary and thyroid glands.

Detection and diagnosis of malignant neoplasms of soft tissues, skin, lips, mucous membranes of the mouth and nose, cancer of the rectum or colon, and bone tumors often begins with the examination of smears. And then FNA of the changed lymph nodes and/or histological diagnosis (histology) is added. For example, if a tumor of the rectum or colon is suspected, cytology is the first stage of diagnosis, but cannot replace histology.

It should be noted that some organs are not subjected to histological analysis until surgery, because a piece of tissue in the mammary or thyroid gland cannot be cut off and sent for examination. In such cases, the main hope is in cytology, and here it is important not to make a mistake and not create the risk of removing an organ that could be saved by other methods.

A smear for oncocytology during a preventive gynecological examination or for the purpose of identifying oncological pathology (squamous cell carcinoma of the vulva, cervix and vagina) is taken by a gynecologist or midwife, applied to a glass slide and transferred to the cytology laboratory for staining (according to Romanovsky-Giemsa, Pappenheim, Papanicolaou) and research. It will take no more than an hour to prepare the drug (the smear must first be dried and then painted). Viewing will also take no more time if the drugs are of high quality. In short, for cytology you need glasses, paint prepared in advance, immersion oil, a good microscope, eyes and the knowledge of a doctor.

The analysis is performed by a cytologist, but in other cases, smears during screening after medical examinations are entrusted to an experienced laboratory assistant who is well acquainted with the normal variants (normal - a cytogram without features). However, the slightest doubt is the basis for transferring the smear to a doctor, who will make the final decision (refer to a specialist, suggest a histological examination, if possible). We will return to gynecological smears for oncocytology a little lower, but for now I would like to introduce the reader to what oncocytology is in general and how it differs from histology.

Cytology and histology - one science or different?

What is the difference between cytology and histology? I would like to raise this question due to the fact that many people in non-medical professions do not see the differences between these two areas and consider cytological diagnosis to be a section included in histological analysis.

A cytogram shows the structure and condition of a cell and its organelles. Clinical cytology (and its important branch - oncocytology) is one of the sections of clinical laboratory diagnostics, aimed at searching for pathological processes, including tumor ones, that change the state of cells. To evaluate a cytological preparation, there is a special scheme that the doctor adheres to:

• Stroke background;
• Assessment of the condition of cells and cytoplasm;
• Calculation of nuclear plasma index (NPI);
• State of the nucleus (shape, size, state of the nuclear membrane and chromatin, presence and characteristics of nucleoli);
• The presence of mitoses and the height of mitotic activity.

There are two types of cytology:

1. A simple cytological examination, including taking a smear, applying it to a glass slide, drying it and staining it with Romanovsky, Pappenheim or Papanicolaou (depending on the dyes and methods used by the laboratory) and viewing the smear under a microscope, first at low (x400) and then at high magnification (x1000) with immersion;
2. Liquid oncocytology, which opens up new perspectives, allows the doctor to most accurately determine the state of the cell, its nucleus and cytoplasm. Liquid oncocytology is, first of all, the use of modern high-tech equipment (Cytospin) for the isolation and uniform distribution of cells on glass, preserving their structure, which provides the doctor with easy identification of cellular material after staining microslides in special automatic devices. Liquid oncocytology undoubtedly provides fairly high reliability and accuracy of results, but significantly increases the cost of cytological analysis.

Oncocytological diagnostics are carried out by a cytologist and, of course, in order to see all this, he uses immersion and high magnification of the microscope, otherwise the changes occurring in the nucleus are simply impossible to notice. While describing the smear and establishing its type (simple, inflammatory, reactive), the doctor simultaneously interprets the smear. Due to the fact that cytology is more descriptive in nature than establishing an accurate diagnosis, the doctor can afford to write the diagnosis under a question mark (in histology this is not accepted; the pathologist gives an unambiguous answer).

As for histology, this science studies tissues that, when preparing specimens (biopsy, autopsy), are dissected into thin layers using special equipment - a microtome.

Preparation of a histological specimen (fixation, wiring, filling, cutting, staining) is a rather labor-intensive process, requiring not only a highly qualified laboratory technician, but also a long time. The histology (series of specimens) is “reviewed” by pathologists and a final diagnosis is made. Currently, traditional histology is increasingly being replaced by a new, more progressive direction - immunohistochemistry, which expands the possibilities of histopathological microscopic examination of affected tissues.

Gynecological oncocytology (cervix)

A smear is taken during a gynecological examination using a cytobrush, and then the material is placed on glass (for liquid oncocytology, a removable cytobrush is used, which, together with the material, is immersed in a bottle with a special medium). Oncocytology of the cervix, as a rule, is not limited to one smear (vaginal portion of the cervix), since there is a need to study the epithelium of the cervical (cervical) canal. This is because the most problematic area in relation to the oncological process is the junction zone (transformation zone) - the place of transition of the multilayered squamous epithelium of the vaginal part of the cervix (ectocervix) into the single-layer prismatic (cylindrical) epithelium of the cervical canal (endocervix). Of course, it is unacceptable to “slap” both smears on one glass during diagnosis (this is only possible during a medical examination), because they can get mixed up and the smear will turn out to be inadequate.

In a smear from the cervix of a young healthy woman, one can see cells of the superficial and intermediate layer (in various proportions) of non-keratinizing four-layer squamous epithelium growing from the basal cell, which is normally located deep and does not enter the smear, as well as cells of the prismatic epithelium of the cervical canal.

Differentiation and maturation of epithelial layers occurs under the influence of sex hormones (phase I of the cycle - estrogens, phase II - progesterone), therefore, smears in healthy women in different phases of the menstrual cycle are different. They also differ during pregnancy, pre- and postmenopause, after radiation and chemotherapy exposure. For example, the presence of more than 10% of superficial cells in a smear of an elderly woman makes one wary, because their appearance, in addition to inflammation, leukoplakia, vaginal dermatosis, may indicate the development of a tumor of the genital organs, breast, and adrenal glands. That is why the referral for a smear for oncocytology always indicates:

• Woman's age;
• Cycle phase or gestational age;
• The presence of an intrauterine device;
• Gynecological operations (removal of the uterus, ovaries);
• Radiation and chemotherapy treatment (reaction of the epithelium to these types of therapeutic effects).

If necessary (if the hormonal type of smear does not correspond to age and clinical data), the doctor conducts a hormonal assessment using vaginal preparations.

Issues of cervical carcinogenesis

Human papillomavirus

Issues of cervical carcinogenesis are often associated with the penetration into the body of a chronic resistant infection such as high-risk human papillomavirus (HPV). Human papillomavirus (HPV) can be detected only by indirect signs (koilocytes, multinucleated cells, parakeratosis) and even then, after the virus is activated, it leaves the nucleus of the basal cell of the transition zone into its cytoplasm and “moves” to the more superficial epithelial layers . The conclusion “mucosal epithelium with signs of papillomavirus infection” is worthy of special attention, because HPV, for the time being, “sitting quietly”, can lead to the development of a precancerous and then a malignant process.

Thus, the identification and study of this DNA virus is very important in oncocytology, since it relates to the factors of malignant transformation of stratified squamous epithelial cells into cervical precancer - dysplasia (CIN), non-invasive cancer in situ and, finally, into invasive tumor diseases.

Unfortunately, in a smear for oncocytology in women without dysplasia, but with high-risk HPV, the detection of a dangerous virus does not reach 10%. However, with dysplasia this figure increases to 72%.

It should be noted that signs of HPV infection in a smear are most noticeable in mild and moderate dysplasia, but practically do not appear in severe CIN, so other research methods are required to identify the virus.

Dysplasia

A cytological diagnosis of dysplasia (CIN I, II, III) or cancer in situ is already considered bad oncocytology (the term is not entirely correct, more correctly - “bad cytogram”).

Dysplasia is a morphological concept. Its essence boils down to a disruption of the normal layering in multilayered squamous epithelium and the release at different levels of the layer of cells such as basal and parabasal (cells of the lower layers that do not normally appear in a smear of a young healthy woman) with characteristic changes in the nucleus and high mitotic activity.

Depending on the depth of the lesion, there are weak (CIN I), moderate (CIN II), severe (CIN III) degrees of dysplasia. It is almost impossible to distinguish the preinvasive form of cancer (carcinoma in situ) from severe dysplasia in an oncocytology smear. Cancer that has not left the basal layer (cr in situ) can be difficult to differentiate from CIN III during histological analysis, but the pathologist always sees invasion, if it exists and the fragment of the neck in which it occurs is included in the preparation. When identifying the degree of dysplasia, the cytologist takes the following criteria as a basis:

• A weak degree (CIN I) is assigned if 1/3 of basal type cells are detected in smears of a young healthy woman in the absence of signs of inflammation. Of course, mild dysplasia will not develop into a malignant tumor overnight, but in 10% of patients it will reach a severe stage in less than 10 years and in 1% it will transform into invasive cancer. If there are still signs of inflammation, then when deciphering the smear, the doctor notes: “Inflammatory type of smear, dyskaryosis (changes in the nucleus)”;
• A moderate degree of dysplasia (2/3 of the field is occupied by cells of the basal layer) should be distinguished from the cytological picture in menopause (to exclude overdiagnosis of CIN II), but on the other hand, the identification of such cells with dyskaryosis in reproductive age gives every reason to make a diagnosis: CIN II or write : “The changes found correspond to moderate dysplasia.” Such dysplasia develops into invasive cancer in 5% of cases;
• Oncocytology of the cervix well captures the pronounced (severe) degree of dysplasia. In this case, the doctor writes in the affirmative (CIN III) and urgently sends the woman for further examination and treatment (the risk of developing cancer under such circumstances is 12%).

cervical dysplasia

Oncocytology of the cervix shows not only the inflammatory process and dysplastic changes in the stratified squamous epithelium. Using cytological analysis, it is possible to identify other neoplastic processes and malignant tumors in this area (squamous cell carcinoma, glandular hyperplasia with atypia of dysplasia type I, II, III, cervical adenocarcinoma varying degrees differentiation, leiomyosarcoma, etc.), and according to statistics there is a coincidence cytological interpretation smear and histology findings are noted in 96% of cases.

Inflammation

Although the cytologist’s task is not to examine the smear for flora, the doctor nevertheless pays attention to it, since flora often explains the cause of inflammation and reactive changes in the epithelium. The inflammatory process in the cervix can be caused by any microflora, therefore a distinction is made between nonspecific and specific inflammation.

Nonspecific inflammation occurs:

• Acute (up to 10 days) – the smear is characterized by the presence of a large number of neutrophilic leukocytes;
• Subacute and chronic, when in the smear, in addition to leukocytes, lymphocytes, histiocytes, macrophages, including multinucleated ones, appear. It should be noted that a simple accumulation of leukocytes cannot be perceived as inflammation.

The cytological picture of specific inflammation is determined by the influence of specific pathogens that enter the body and begin their development in the genital organs of the new host. These could be:

Thus, inflammation can be caused by the presence of various pathogens of a bacterial and viral nature, of which there are about 40 species (only a few of them are given as an example above).

table: norms of smear results for women, V - material from the vagina, C - cervical canal (cervix), U - urethra

As for opportunistic bacterial flora and leukocytes, the whole point here is their number in each phase of the cycle. For example, if a cytologist clearly sees an inflammatory type of smear, and the cycle is coming to an end or has just begun, then the presence of a large number of leukocytes cannot in any way be considered as a sign of inflammation, because the smear was taken from a non-sterile area and such reactivity only indicates that menstruation will begin soon ( or just finished). The same picture is observed during the period of ovulation, when the mucus plug comes off (there are many leukocytes, but they are small, dark, immersed in mucus). However, with a truly atrophic smear, which is typical for older women, the presence of a large number of surface cells and even a small flora already indicates an inflammatory process.

Video: smear for oncocytology and how to take it correctly

A mandatory procedure when visiting a gynecologist is to take biological material to assess the condition 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 examination and interpretation of which is carried out in a laboratory setting, is highly informative.

The analysis allows us to determine the hormonal level of the reproductive system, the amount and composition of vaginal discharge, the bacterial content of microflora in women, prevent inflammatory processes, identify developmental pathologies, the presence of neoplasms and infections that are sexually transmitted.

Diseases of the female reproductive system are dealt with by a specialized branch of medicine - gynecology.

There are many reasons for patients to apply: undergoing a medical examination for employment, pregnancy, painful or unpleasant cramping sensations 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 cervical and urethra, vagina, in virgins - rectum.

Papanicolaou cytology analysis makes it possible to timely detect the papilloma virus, precancerous conditions of the epithelium, and cervix. It is recommended that all females with hereditary cancer diseases and those over 21 years of age undergo a Pap test.

A bacteriological research method, bacterial 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 through sexual contact. Provides complete information about the bacterial composition of the internal microflora.

The effectiveness 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, what can and cannot be done before the procedure.

Preparation for a microscopic examination involves avoiding strong antibiotics 2 weeks before the expected analysis and visiting the bathroom the day before. You should try not to go to the toilet 2 hours before the test.

It is better to do diagnostics not before, but during menstruation and in the first two days after.

To increase the sensitivity of the test, microflora culture is carried out in the absence of treatment with antibacterial drugs and douching. Be sure to follow a special diet 2-3 days before the bacteriological analysis: limit foods that provoke fermentation or intestinal upset.

Refrain from sexual intercourse with your partner and do not wash yourself 24 hours before data collection.

3-5 days before the prescribed PCR diagnosis, taking any antibacterial and contraceptive drugs is prohibited. It is necessary to avoid sexual intercourse for 36 hours. It is advisable not to shower the day before the PCR and on the eve of the test. The material is taken during menstruation and for 1-2 days after its end.

How to take a smear from women

The technique for collecting material is usually carried out in the morning in the gynecology department or directly in the laboratory itself. Taking vaginal discharge and areas for examination is prescribed only for women who are sexually active. In girls, it is taken more carefully from the lateral vault of the vagina to prevent damage to the hymen, and from the intestines, secretion.

All manipulations take place on a 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 material is collected 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.

Microflora smear: interpretation

It is impossible to independently draw a conclusion about how good or bad a smear is without the appropriate knowledge. Using special notations, it is very easy to decipher a microscopic examination of a smear. Depending on the location of the biological material taken, they are distinguished: vagina - “V”, cervix - “C” and 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 antibacterial therapy. Norm: “++”, “+++” rods, the number of cocci does not exceed “++”.

Gram-negative bacteria gonococci - “Gn”, trichomonas vaginalis - “Trich”, yeast of the genus “Candida”. Corresponds to diseases such as gonorrhea, trichomoniasis and candidiasis.

The presence of key cells and E. coli, if they are listed in the microflora, indicates that the patient has bacterial vaginosis.

Flora smear: normal in women

All patients, without exception, from the age of 14 until the onset of menopause, correspond to the same standard, obtained as a result of laboratory microscopic examination.

Leukocytes. Providing protection for the body from penetrating viruses, bacteria and infections, they can be in the field of view, 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 number indicates insufficient production of the hormone estrogen.

Mucus. A small amount or no quantity is allowed. Maximum daily norm secretions of the glands of the cervical canal - 5 ml.

Gram-positive rods, “Gr.+”. Lactobacilli and Doderlein bacilli must be present in large quantities. 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 detected.

Gonococci with the symbol “gn”, Trichomonas, chlamydia, key and atypical cells, fungi, yeast, Candida are absent. If they are detected in the results, the patient is prescribed additional testing for gonorrhea, trichomoniasis, chlamydia, bacterial vaginosis, and thrush.

Smear for purity level

To avoid complications during pregnancy, pregnant women are advised to determine the degree of purity of the gynecological smear. Normally, in a healthy woman, 95-98% of the vaginal microflora consists of Bacillus vaginalis or Lactobacillus bacillus Doderlein. They produce lactic acid, which helps maintain acidity 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 decreased immunity, microflora indicators can change.

• 1st degree Normal vaginal cleanliness is pH 3.8-4.5. The environment is acidic. Leukocytes and epithelial cells - no more than 10.
• 2nd degree. Slightly acidic environment: pH=4.5-5. There is a slight increase in gram-positive cocci and Candida fungi.
• 3rd degree. Pathogenic microorganisms are activated, mucus appears, and epithelial indicators exceed the norm. Neutral acidity level, pH=5-7. There are over 10 leukocytes. Mucus, key cells are present, gram-negative and gram-positive microorganisms multiply in favorable microflora conditions.
• On the last one, 4 degrees, cleanliness is low. pH values ​​reach 7.5. Doderlein's rods are either completely absent or found in single quantities. The vagina is filled with pathogens.

Bacteriological research

The variety of composition, in addition to Lactobacillus bacillus Doderlein, which is an integral part of the vaginal microflora of the examined woman, does not begin to be studied immediately. Sowing the collected biological material onto a specially created favorable environment for its subsequent growth, development and reproduction takes time.

Bacteriological culture of flora can be assessed through a microscope, provided that the number of representatives of microorganisms increases.

• 0 class. Observed during treatment with antibiotics. The pathogen is absent.
• I class. The number of bacteria does not increase or increases moderately.
• II class. Mixed nature of microflora. Up to 10 colonies of bacteria Gardnerella vaginalis or Mobiluncus, the causative agents of gardnerellosis, are detected.
• III class. There are about 100 colonies. The microflora is predominantly inhabited by Gardnerella and Mobiluncus. Symptoms of bacterial vaginosis appear.
• IV class. Lactobacilli are absent, immunity is weakened. Diagnosis of acquired infectious disease- aerobic vaginitis.

Cytological examination

The probability of detecting areas of altered epithelium, papilloma virus and oncological tumors is quite high after 30 years of age and the beginning of sexual activity.

The correct interpretation of the PAP test depends on the presence or absence of cancerous, atypical cells.

• NILM. The clinical picture is without features, CBO. Leukocytes and bacteria are released in small quantities. Primary candidiasis or bacterial vaginosis is possible. The epithelial layer is normal.
• ASC-US. Atypical areas of unknown origin were found in epithelial tissue. A repeat analysis is carried out after 6 months to look for chlamydia, dysplasia, and human papillomavirus.
• LSIL. To confirm a precancerous condition caused by atypical cells, a biopsy and colposcopy are prescribed. Weak signs of changes in the epithelium.
• ASC-H. Pronounced damage to the squamous epithelium. 1% of patients are diagnosed with the initial stage of cervical cancer, the remaining 98-99% have grade 2-3 dysplasia.
• HSIL. Concomitant symptoms preceding cancer of the squamous epithelium and cervix were identified in more than 7% of the women examined. 2% have cancer.
• AGC. Atypical condition of the glandular epithelium. Diagnosis: cervical or endometrial cancer, advanced form of dysplasia.
• AIS. Squamous cell carcinoma, cervical cancer.

PCR analysis

The molecular biological method of PCR diagnostics is distinguished by its high sensitivity and reliability of the data obtained. By creating earlier samples of the isolated and copied DNA section, comparisons are made with the resulting biological material.

Testing for infections using PCR makes it possible to quickly find the causative agent of a disease in the female genital organs by obtaining a positive or negative result.

The polymerase chain reaction facilitates the determination of chlamydia, ureaplasmosis, thrush, trichomoniasis, HPV, HIV, and the search for the causes of difficult pregnancy and hormonal disorders.

The disadvantages of PCR are cases of false data due to incorrect tests and possible mutation of the pathogen's DNA.

Description

Determination method Microscopy

Material under study See description

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

Normally, 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. Cellular composition depends on the presence/absence of the menstrual cycle and its phase. Flat epithelium performs a protective function.

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

The transformation zone is the area at the junction of stratified squamous and cylindrical epithelium in women of reproductive age, which mainly coincides with the area of ​​the external pharynx. 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 border line is actually localized within the external pharynx. According to statistical data, precancer occurs from the transformation zone.

Material for research. In a referral for cytological examination of biological material, clinical data, diagnosis, characteristics and place of receipt of the material, and data on the menstrual cycle must be indicated.

Smears are taken before bimanual examination and colposcopy. The instruments used must be sterile and dry, since water and disinfectant solutions destroy cellular elements.

During a preventive examination (cytological screening) of women, it is advisable to obtain cellular 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.

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

Material for cytological diagnosis is obtained in various ways: aspiration and scraping of the contents of the posterior vaginal vault, cervix, or obtaining a smear-imprint. The resulting biological material is applied in a thin layer to a glass slide and dried in air. The glass must be marked indicating not only the name/code, but also the location where the cellular material was collected (cervix, cervical canal). The markings on the slide and in the direction for cytological examination must correspond to each other.

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

Literature

1. Petrova A. S. Cytological diagnosis of tumors and pretumor processes. Medicine, 1985. - p. 296.
2. Prilepskaya V.N. Diseases of the cervix, vagina and vulva. - M.: MEDpress, 1999. - p. 406.
3. Shabalova I. P. Cytological atlas. Moscow, 2001. p. 116.

Preparation

Conditions of preparation 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 cellular material for research within 24 hours after sexual intercourse, vaginal sanitation, or insertion of medications into the vagina.

Indications for use

Smears for cytological examination 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, cellular material is taken specifically. The frequency of cytological examination is determined by a gynecologist (at least 2 times a year). (Order No. 430 “On approval of guidelines for organizing the work of antenatal clinics” dated April 22, 1981 of the USSR Ministry of Health).

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

Advantages of the method:

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

Disadvantages of the method:

1. impossibility of establishing signs of infiltrative growth (cellular, 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 endocervical sampling is the most important factor 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

Interpretation of research 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. The doctor makes an accurate diagnosis using both the results of this examination and the necessary information from other sources: medical history, results of other examinations, etc.

It should be remembered that the cytological research method, 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 a study of anamnesis, observation of clinical manifestations and histological examination data).

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

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

Interpretation of the result

Possibilities of cytological diagnosis of some diseases of the cervix and options for interpreting the results of cytological examination:

Endocervix. Normally, with correctly obtained cellular material from the transformation zone (ZT) - the junction zone of squamous and cylindrical epithelium - the smear contains cells of squamous and cylindrical epithelium without changes. Cytological conclusion: the obtained material contained cells of squamous and columnar epithelium without any features. The presence of a small number of metaplastic epithelial cells is an indication that the material is derived from ST. In the absence of the above description, the smear was not taken from the CT and it cannot be said that the patient does not have a risk of cervical cancer. Such smears are common in postmenopausal women and patients who have undergone cervical treatment that has moved the boundary line into the cervical canal. Depending on the patient's medical history, this may be a reason to re-sample material.

The clinical diagnosis in the direction of polyps of the cervical canal, and the corresponding cytological picture allows the cytologist to give a conclusion; the cytogram corresponds to the clinical diagnosis of polyps of the cervical canal. If there is no clinical diagnosis, and the cellular composition is represented by large accumulations of columnar epithelial cells, the cytologist gives a descriptive answer with the assumption of hyperplasia of columnar epithelial cells or a polyp of the cervical canal.

Ectocervix. In reproductive age, the cellular composition of imprints from the vaginal part of the cervix is ​​normally represented by squamous epithelial cells, predominantly of the superficial or intermediate type. The wording “in the obtained material there are squamous epithelial cells of the surface layers without any features” indicates that the obtained biological material consists of squamous epithelial cells of the surface and intermediate layers in various combinations in accordance with the phase of the cycle. At the beginning of postmenopause (normally), squamous epithelial cells of the intermediate layer are noted in the smear. In some women, throughout their entire subsequent lives, an intermediate type of smear is observed (squamous epithelial cells of the intermediate layer), sometimes with the presence of cells of the superficial layer, which is apparently associated with the function of the adrenal glands and active sexual life. The presence of squamous epithelial cells of the surface layer (estrogenic type of smear) in the preparation in the first 5 years of menopause should be alarming regarding ovarian neoplasms and 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) implies a defect in the mucous membrane of the cervix caused by various diseases(syphilis, traumatic injuries, consequences of radiation therapy, cervical cancer, etc.). The term cervical ectopia (pseudo-erosion) means displacement of the tall columnar epithelium onto the vaginal part of the cervix. Provided that there is a clinical diagnosis of “cervical erosion/ectopia” in the direction and correct collection of biomaterial from the ectocervix (cellular material is represented by squamous epithelial cells of all layers in various combinations, accumulations of columnar epithelial cells, elements of inflammation), the cytological conclusion has the following form of answer: the cytogram corresponds (does not contradict) the clinical diagnosis - cervical erosion.

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

Conclusion: a cytogram of endocervicosis occurs if, in the direction for cytological examination, the clinical diagnosis of cervical erosion/ectopia is not indicated, but morphologically, squamous epithelial cells and accumulations of columnar epithelial cells are noted.

It is not always possible to make a cytological diagnosis between superficial endocervicosis (cervical ectopia) and proliferating endocervicosis. A descriptive cytological response occurs when: - squamous epithelial cells and single clusters or single columnar epithelial cells are found in the material obtained from the ectocervix; - cellular material was obtained from the ecto- and endocervix and presented as one mixed smear; - strokes are not painted.

With healing endocervicosis, smears reveal a large number of metaplastic epithelial cells (metaplasia - replacement of one type of epithelium by another). Metaplastic epithelium is a target for the action of the human papillomavirus - an area for the development of precancerous conditions. The presence of a small number of metaplastic epithelial cells in cervical smears is an indicator of a normal physiological process.

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

Leukoplakia of the cervix. When using the cytological method for diagnosing simple leukoplakia (benign lesion of the cervix, underlying disease), hyperkeratosis is revealed, i.e., in the material obtained from the ectocervix, layers (clusters) of squamous epithelial scales were found (there is no nucleus in the cytoplasm of the cell), separately lying squamous epithelial scales, dyskeracites . If there is a clinical diagnosis of “leukoplakia of the cervix,” the cytological report notes that the picture does not contradict the clinical diagnosis of 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 cannot always be detected by cytological research, which is explained by the presence of squamous epithelial scales on the surface of multilayered squamous epithelium, which prevent the production of cellular elements. It is necessary to conduct a morphological examination of a cervical biopsy specimen.

Cervical dysplasia. Dysplastic changes occur in the stratified squamous epithelium of both the exocervix and endocervix. As a rule, changes begin at the junction of squamous and columnar epithelium. Dysplasia can simultaneously develop in several areas of the cervix and cervical canal, often the changes are expressed to varying degrees. Spectrum dysplasia (CIN) is not a single disease. There are two biological entities 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. Often dysplasia-I is difficult to differentiate from reactively changed 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, severe, CIN-III). If the received material contains cells with signs of malignancy, the cytologist gives a conclusion about the cytogram of the malignant neoplasm and, if possible, specifies the form of cancer.

Inflammatory processes of the cervix. Inflammation - a cellular reaction (at the site) - is represented by degeneratively changed epithelium, proliferative changes of a reparative, protective nature, inflammatory atypia. In case of an acute nonspecific inflammatory process, a pronounced leukocyte infiltration (many neutrophilic leukocytes) and incomplete phagocytosis are noted in the smear. The composition of the epithelial cell population may change. Cytological conclusion: cytogram of ecto-/endocervicitis. In subacute and chronic inflammation, eosinophils, lymphocytes, macrophages/foreign body type cells (multinuclear macrophages) join - cytological conclusion: 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 25 - 34 years old.

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.

Mycoplasma, ureaplasma and corynobacteria as the cause of inflammation are observed in a group of young women (under 20 years old). In the age group over 30 years old, the first place among the causative agents of inflammatory processes in the genitals is occupied by anaerobic microorganisms. Mixed infection increases the pathogenicity of each pathogen. In such cases, inflammation causes a pronounced tissue reaction, accompanied by epithelial damage, destruction and dysplasia. This leads to the development of not only colpitis and endocervicitis, but can play a significant role in the formation of cervical ectopia. Incomplete phagocytosis is noted (the phagocytic activity of leukocytes is suppressed). The cytological report 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 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 treatment is possible.

Genital herpes - the herpes simplex virus has a high tropism for epithelial and nerve cells. Relapses are mainly due to persistence of infection in the nerve ganglion. During a cytological examination of the obtained material, changes may be noted in the squamous epithelial cells that are specific to their damage 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 received. It is recommended to exclude the herpes simplex virus.

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

In addition, underdiagnosis in cervical smears may be associated with the presence of koilocytes in the deeper layers of squamous epithelium or the presence of a large overlapping number of inflammatory and flora elements. Cytological conclusion: signs of a viral infection were found in the material obtained. It is recommended to exclude human papillomavirus. Indirect changes characteristic of a viral infection: increased nuclear size, nonspecific multinucleation. Form of cytological response: the received material shows indirect signs of a viral infection. It is recommended to exclude the herpes simplex virus and human papillomavirus.

Trichomoniasis. An inflammatory reaction develops in the presence of a large number of protozoa. For quality research it is important proper preparation patient. Stop using trichomonocidal agents 5 to 7 days before taking the material. The cytological specimen contains signs of acute/chronic inflammatory process, mixed flora, Trichomonas. Cytological conclusion: trichomonas colpitis.

Chlamydial infection. Chlamydia is tropic for columnar epithelium. Often found in women with cervical ectopia. In pregnant 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 the response: cells with cytoplasmic inclusions were found morphologically similar to chlamydial infection. 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. A deficiency of lactobacilli is observed in all patients with PIP, and an increase in representatives of opportunistic flora is noted. The cytological report indicates changes in the flora; if possible, a representative of the opportunistic flora is characterized. The presence of nonspecific vaginosis is noted.

Cytological examination of the cervix is ​​of great importance in the timely treatment of diseases in gynecology.

This examination will make it possible to detect atypical cells of the cervical mucosa in the early stages, examine what condition they are in, and detect inflammation processes.

How is material collected for cytological examination?

A cytological study is the analysis of material taken from the mucous membrane of a woman’s cervix under laboratory conditions. When examining a scraping taken, tissue cells, their shape, size and other indicators are studied. Various changes in the structure of mucosal tissue cells have no manifestations, and therefore this cytological study is of great importance in detecting cancer processes in the initial stages.

A gynecologist takes a sample for research using a special spatula, spoons or probe. Cells for analysis are collected from the outside of the cervix, from the fornix and canal in small quantities. The procedure is carried out on a gynecological chair. A woman may feel slight discomfort, but in general the smear collection process is painless.

Along with the scraping, a sample is taken for laboratory analysis from the cervical canal using a brush.

A smear for cytological examination is taken when there is no menstrual flow, and before the procedure itself the cervix is ​​cleaned with a tampon.

The collected material is transferred to glass and sent to the laboratory where the study will be carried out.

Diagnostic analysis is carried out in several ways, including the Pap test and the Bethesda method. After receiving the data, the treating specialist interprets the cytological examination of the smear. Answers from the laboratory will be ready within 7-10 days after the scraping is submitted.

Answers from cytological examination using the Pap test

• Pathological changes in the structure of cells were not detected, so we can conclude that the woman is healthy;
• Some changes in the cell nucleus, a slight increase in it, indicate that the woman has inflammation and infection in the mucous membrane. Such results are considered normal, because they exclude the presence of atypical cells. But in this case, the doctor may prescribe an additional examination to identify the cause of the enlarged nucleus;
• The presence of minor cellular changes with pathology of the nucleus and cytoplasm indicates the possibility of developing a malignant tumor;
• The presence of a small number of atypical cells that are malignant. With such results, additional studies are mandatory;
• The presence of pathological cells in large numbers, such a process in the cervix is ​​considered precancerous.

Decoding data according to the Bethesda system

Decoding a cytological examination of the cervix using the Bethesda method is considered more comprehensive and provides maximum information.

This method is based on the determination of pathological changes in the cell nucleus. The result depends on the number of abnormal cells and their location. This system can identify diseases such as dysplasia and cervical cancer.

If the test result is negative for the presence of pathologies in the cells, the woman is considered healthy.

Only an experienced specialist deciphers the research results, since the data in the laboratory is recorded in Latin letters.

How often is cytological examination performed?

Gynecologists advise women to undergo examination and cytology tests once a year; cancerous changes in cells usually develop slowly. Early detection of atypical changes in cells will help initiate timely treatment.

Women with HIV or those taking steroid medications and also undergoing chemotherapy are prescribed cytology individually, the frequency of the analysis is determined by the treating specialist.

To obtain reliable results, it is necessary to follow some rules before a cytological examination:

• Four days before taking a smear, you must abstain from sexual contact;
• Do not perform vaginal douching;
• Avoid using medicines and cosmetics intended for the vagina;
• Immediately before visiting a gynecologist, you need to drink about half a liter of water, since a smear is taken on a full bladder.

Cytological examination is an inexpensive and very important examination, because early detection of cancer processes is easily treatable.