What does a cytological examination mean in gynecology. What does a cytology smear show? Positive results: types of pathologies

Oncological diseases of the organs genitourinary system more and more women are being diagnosed every day. However, with the advent of new drugs and therapeutic procedures, a cure for cancer is quite possible.

But the prognosis of the pathology largely depends on at what stage of the disease the medication was started. Therefore, one of the keys to successful treatment is early diagnosis. However, when considering a doctor's prescription form, the question arises, cytology - what is it?

In gynecology and other branches of medicine, this is one of the methods for studying the cellular structure to identify changes specific to malignant neoplasms. This analysis was introduced into wide clinical practice by the Greek physician George Papanikolaou in the middle of the last century. Since then, the cytological examination of cervical cells has been called the PAP test.

Its main goal is to identify atypia, in other words, cells that have either already undergone malignant transformation, or have all the prerequisites for such changes. The reasons for the development of such disorders are not fully known.

However, the risk factors for their occurrence are:

hereditary predisposition;
infection with the human papillomavirus (HPV), if it proceeds with the formation of genital warts in the genital area;
frequent inflammatory lesions of the cervix and urogenital tract;
poor examination results on the vaginal flora, the detection of elevated concentrations of pathogenic bacteria, relatively recently, the connection of chronic often recurrent vaginosis with the development of atypia has been proven;
frequent sexually transmitted infections;
the first birth at too early an age (before adulthood).

In addition, a cytology test is indicated for the following categories of women:

infertility;
chronic miscarriage;
preparation for conception;
frequent relapses of genital herpes;
recurrent symptoms of a violation of the bacterial flora of the vagina;
taking oral contraceptives or other hormonal drugs;
malignant neoplasms of various localization;
period of menopause;
visible changes in the structure of the cervix during a gynecological examination using mirrors;
bleeding from the vagina, not associated with menstruation;
the upcoming installation of intrauterine contraceptives.

The degrees of atypia are correlated with the results of the Pap test. So, all possible changes in the structure of cells are divided into several stages:

First. Any violations of the structure are completely absent.
Second. It means that during the study, cells with pathophysiological signs of the inflammatory process were detected. A woman is recommended to conduct further diagnostics to determine the pathogen and cause of the infection.
Third. The study demonstrates the initial changes in the cellular structure. This does not yet mean cancer, but indicates a high risk of developing it. Histology and a number of other tests are additionally shown for confirmation. Further diagnostics is carried out on the basis of the results obtained.
Fourth. The first signs of malignant cell transformation appear. As a rule, when oncology is detected at this stage, the prognosis is favorable (they may prescribe therapy with Tarceva). However, additional studies are indicated to confirm the diagnosis.
Fifth. The results of cytology clearly indicate malignant degeneration of tissues.

Some patients confuse a cytological study with a histological one. This is not surprising, since the exact difference between these methods of analysis is known to physicians of a narrow specialization. In a nutshell, histology involves the examination and examination of an appropriately prepared tissue section. Cytological analysis is the examination of individual cells for pathological changes.

As a result of the PAP test, mortality from cervical cancer in the United States alone has decreased by almost 70% (according to data given at the end of the 1980s). However, a significant drawback of this analysis technique is the high frequency of false negative results (up to 50%). This probability of error is associated with a violation of the technology of sampling, destruction of cells and the ingress of foreign impurities in the process of transferring biological material to a glass slide.

But medical science does not stand still, and currently the Pap test is carried out using liquid cytology methods. The essence of this method is that after taking a sample, the material is placed not on glass, but in a special solution of reagents. The sealed vial is sent to the laboratory for further analysis.

This liquid protects the material from bacterial invasion, completely preserves morphological properties cells, creates optimal conditions for further transportation. In the clinical laboratory, the drug is centrifuged to remove blood and foreign matter. Then the specialist prepares a cytological preparation in which the cells are evenly distributed on the glass slide, in a thin layer.

Oncocytology smear: used biological preparations, preparation and sampling technique

The material for further cytological examination is:

biological fluids. It is rarely used to diagnose cervical cancer. Similar samples are obtained as a result of prostate massage (juice is released from the urethra), processing internal organs during diagnostic minimally invasive operations. To determine the pathologies of the respiratory tract, sputum is taken for analysis. In some cases, a urine test is possible.
Punctates. The material is obtained as a result of a diagnostic puncture, for which appropriate needles are used. Depending on the indications, articular, cerebrospinal, in pregnant women, amniotic fluid, neoplasm cells, muscle tissue of internal organs, and membranes of the heart are taken.
Fingerprints and scrapings. In this case, biological material is obtained by applying a glass slide or scraping tissue from an open wound during a surgical operation, the cervix during a biological examination, ulcers, fistulas.

for 2 - 3 days, do not douche the vagina, but simply wash yourself using appropriate means for intimate hygiene;
three days before the examination, stop using various drugs in the form of ointments, suppositories, tampons, spermicides intended for insertion into the vagina;
3 - 4 days before the analysis, it is necessary to strictly refrain from sexual contact;
2 - 3 hours before the visit to the doctor, do not go to the toilet.

The sampling of material for analysis is carried out as follows:

The woman is asked to transfer to the gynecological chair.
To provide access to the cervix, the doctor uses a dilator.
Using a special tool that looks like a small brush, the doctor makes a scraping from the surface of the cervix and cervical canal. In some cases (according to indications), the doctor uses an aspirator designed to obtain mucus from the cervical canal.
The resulting sample is placed in a special test tube and labeled accordingly.

Often, in the process of taking material for a cytological examination, the gynecologist also makes a smear to analyze the composition of the mixed bacterial flora of the vagina, to identify pathogens of sexually transmitted infections. Currently, to facilitate the procedure for taking samples and deciphering the data obtained, gynecologists use ready-made test systems ThinPrep PAP Test or SurePath PAP Test. The use of the latter is recommended by the American FDA, as during clinical research it showed more reliable results.

Cytological analysis: possible complications, interpretation of results, estimated cost, further examination

Subject to the technique of sampling material and preparation for the examination, the risk of complications is minimal. The procedure is painless, with only mild discomfort. In isolated cases (in the presence of infection on the mucous epithelium of the vagina), a recurrence of bacterial vaginosis is possible.

The results of cytological analysis are presented in the form of a Latin abbreviation. It denotes the following:

NILM 1, there are no violations;
NILM 2(may also be marked reactive), a similar result means the presence of signs of an acute inflammatory process;
ASC - US and H, these letters indicate the presence of an infection, if there is a Squamous atypia NOS mark, the exact causative agent of the pathology is unknown, if KA is indicated instead of the last letters, we are talking about HPV;
L and H SIL(sometimes referred to as CIN 1 and 2), correspond to mild and moderate dysplasia, usually indicated in a pair in the decoding form, which indicates the absence of pronounced changes, but attention should be paid to the predisposition to their appearance;
H SIL and CIS(on some forms there is an abbreviation CIN 2 and 3). Denotes moderate and severe cervical cell dysplasia;
SA(sometimes indicate Squamous cell carcinoma), such a result indicates the presence of signs of cancer.

These indicators can be conditionally divided into several classes. The first is diagnosed in a perfectly healthy woman. The second is one of the varieties of the norm and usually indicates the presence of some kind of infectious inflammation.

The third class serves as a reason for further examination, since in this case a tendency to the onset of malignant changes is revealed. The fourth can be attributed to actually precancerous conditions, and the fifth is put in the presence of atypical cells. Sometimes a zero class is indicated in the analysis decoding form, which indicates the unsuitability of the sample for the examination.

However, even a positive cytology result does not mean an accurate diagnosis of cancer. To confirm, a number of examinations are prescribed, namely:

colposcopy;
histology (biopsy);
blood test for the presence of specific markers;
research on carcinogenic viruses, AIDS;
Ultrasound and tomography of the pelvic organs.

But even with a negative result of the analysis for cytology, it is necessary to re-examine once a year, especially if there are risk factors for the oncological process.

Cytological analysis can be done in any modern laboratory. In some cases, the laboratory assistant does not have sufficient skills to take biological material, so the patient is given ready-made test tubes with the reagent. The doctor takes the desired sample, places it in a laboratory glassware and sends it for analysis.

The analysis is performed for about 8-10 days. Some clinics, for an additional fee, provide the opportunity to obtain results in a shorter time. The standard cost of liquid cytology ranges from 1500 rubles.

In general, cytological analysis is a highly sensitive, safe and accurate method for the early diagnosis of malignant transformations in the cervix. Such a study allows you to identify pathology at the initial stage and quickly begin therapy. This significantly increases the likelihood of a favorable outcome of cancer, reduces the level of drug load, and helps to avoid surgical intervention. Also, for the effective treatment of oncology, an innovative tool has been developed Nivolumab (you can read more about it), Nexavar, Lomustin, as well as drugs based on olaparib. Doctors recommend that all women over 35 have this test annually.

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is a cytology smear?

smear for cytology is a method of laboratory examination under a microscope of cells scraped from the cervical canal. The study is carried out in order to identify cells with signs of pathological changes of a tumor, inflammatory, atrophic nature and is used for early diagnosis cervical cancer.

A cytology smear is recommended for screening for the first time three years after the onset of sexual activity. In Russia, it is customary to take smears for cytology without fail from all women during a routine examination, starting at the age of 21. It is optimal to take such a smear every year during a preventive examination until the age of 65. Women over 65 can have a cytology smear every 2 to 3 years, as their risk of developing the cervix is reduced. However, if pathological changes are found in the smear, the doctor may prescribe a more frequent Pap test, for example, once every 3 to 6 months, until the result becomes normal.

Scheduled delivery of a smear for cytology every year does not mean that a woman has cervical cancer. It's just that this smear is a screening study, like fluorography, which must be done periodically for the early detection of cancer or precancerous changes in the cervix, so that it can be done as much as possible. effective treatment in the early stages, when the disease is relatively easy to defeat. Be sure to take a smear for cytology at least once a year for women and girls who are carriers of the human papillomavirus of oncogenic types ( HPV 16, 18, 31, 33, 45, 51, 52, 56, 58 or 59), as they have a higher risk of developing the cervix than the average for the female population.

What is another name for a cytology smear?

Cytology Pap smear is the most commonly used name for the test and can also be referred to by names such as uterine cytology smear, oncocytology smear, cytology smear, cervical smear cytology, cervical canal smear, Pap smear, Pap smear, Pap -test, Pap smear, Pap smear.

What does a cytology smear show?

The main purpose of a smear for cytology is to identify such pathological changes in the cells of the epithelium of the cervix, which over time can lead to the development of a malignant tumor. If cancer cells are detected in a large number in a smear, then this simple analysis allows you to identify the tumor at an early stage and carry out the necessary treatment as soon as possible. In addition to its main purpose, a smear for cytology also allows you to generally assess the condition of the mucous membrane of the cervix and, on the basis of this, make a presumptive diagnosis, which is then confirmed by other additional examination methods.

If the result of a cytology smear is negative, then it is also called normal or good, as this indicates the absence of pathologically altered cells in the cervix and pathogenic microorganisms ( e.g. herpes viruses, human papillomaviruses, etc.), capable of provoking inflammatory processes.

If the smear result is positive, then it is also called bad or pathological, as this means that cells of an abnormal structure were found, which are not normally present. Pathological cells can have different characteristics, depending on which the cytologist determines the nature of pathological changes in the tissues of the cervix ( e.g. erosion, leukoplakia, dysplasia, inflammatory processes, infections, cancer, etc.).

Smear by liquid cytology method

Liquid cytology is a method of making a smear on a glass slide from scrapings from the cervix, which, like a regular smear for cytology, allows you to detect precancerous and cancerous changes in the tissues of the cervix and, accordingly, diagnose malignant tumors of the cervix at an early stage. In principle, we can say that liquid cytology is a kind of Pap smear for cytology.

For the production of liquid cytology, the doctor scrapes the cells of the epithelium of the cervix with special sterile instruments ( with a brush), after which it washes all the material from the brush into a sterile container with a special liquid designed to keep the cells in a normal state for a long time. This container of liquid is then sent to the cytology laboratory, where all of the liquid is centrifuged to pellet the cells at the bottom of the tube. The fluid is drained, and smears are made from the cell sediment on glass slides, which are then stained and examined under a microscope. Depending on the characteristics of the cells present in the smear, the cytologist indicates whether there are pathological changes and what their nature is ( e.g. atypia with low or high grade, etc.).

Currently, in the United States and European countries, it is liquid cytology that is the "gold standard" in the diagnosis of precancerous and cancerous changes in the tissues of the cervix. Scientists believe that liquid-based cytology has a number of advantages over a simple cytology smear, which is why the method has become the “gold standard” for diagnosing precancerous and cancerous lesions of the cervix. The advantages of liquid cytology compared to a conventional smear for cytology include factors such as getting into the solution of all scraped cells, long-term preservation of cells in a normal, not overdried form, minimal admixture of mucus, blood, destroyed cells and inflammatory elements, as well as the ability to prepare more than one but a few thin strokes. Due to these advantages, the liquid cytology method gives a lower percentage of false negative results than the classic cytology smear. But a smaller number of false-negative results should not be taken as greater accuracy, since problems with conventional smears are due not so much to the low information content of the biomaterial itself, but to incorrect sampling and distribution of scrapings on the glass by a gynecologist.

And if the gynecologist prepares a smear for cytology with high quality, then its information content may turn out to be even higher compared to liquid cytology, since it contains more various cellular elements. Indeed, in a conventional smear for cytology, there are elements of the background that allow the cytologist to assess the cellular environment and identify not only the tumor degeneration of mucosal cells, but also the inflammatory and infectious process in the tissues of the cervix. That is, the study of a conventional smear for cytology, if of course it is correctly made, makes it possible to obtain a wider range of information compared to liquid cytology. That is why, in most cases, in the countries of the former USSR, doctors still prefer the results of a conventional smear for cytology to the method of liquid cytology.

The results of liquid cytology are indicated by the cytologist according to the Bethesda classification. In the first paragraph of the conclusion of cytology, the doctor indicates the adequacy of the material in terms of quality and quantity. If the material is adequate, then you can read the further conclusion, since it is quite informative. If the material is inadequate, then the analysis is considered non-informative, since the number of cells is not enough to determine the nature of pathological changes.

In the second paragraph of the conclusion, the cytologist gives a description of the biological material, in which he necessarily indicates the epithelial-cellular composition of the smear and the presence of pathological changes in it.

If there are benign pathological changes in cells in the smear ( degenerative, reparative, hyperkeratosis, dyskeratosis, parakeratosis, radiation changes, enlargement of nuclei of squamous metaplastic epithelium), they are also necessarily described in detail. In the absence of such benign changes in the epithelial cells in the conclusion, the cytologist indicates that they were not detected.

In the absence of pathological changes of a malignant nature, the conclusion also indicates that they were not detected.

If there are pathological changes in malignant cells in the smear, then their type must be indicated in accordance with the Bethesda classification:

ASC US- atypical squamous epithelial cells of unknown significance ( such cells are not completely normal, but they are usually not cancerous, and their pathological condition caused by the human papillomavirus);
ASC-H- atypical changes in the squamous epithelium, including possibly HSIL ( these cells are abnormal, but they are not usually cancerous, but indicate the presence of precancerous changes that may never turn into a malignant tumor);
LSIL- a low-grade lesion within squamous epithelial cells ( cells are abnormal in size and shape, but these abnormalities in their structure are usually caused not by cancer, but by the human papillomavirus);
HSIL- a high degree of malignancy inside squamous epithelial cells ( cells have pronounced disturbances in shape and structure and are highly likely to reflect a precancerous process in the cervix);
CIS– carcinoma in situ ( early stage cancer);
AG-US- atypical cells of the glandular epithelium of unclear significance ( glandular epithelial cells are abnormal, but most likely not cancerous);
AIS– endocervical carcinoma in situ ( precancerous or cancerous cells inside the cervix at an early stage).

Finally, in the last paragraph of the cytological conclusion, the identified pathogenic and opportunistic microbes are indicated ( fungi, Trichomonas, etc.), if, of course, any were found.

How often should a cytology smear be done?

A cytology smear is recommended for all women as part of a preventive examination once a year from the age of 21 until the age of 65. However, the age at which a cytology smear is started may shift, since this analysis is first done three years after the onset of sexual activity. For example, if a girl began to have sex at the age of 15, then she needs to take a smear for cytology not from the age of 21, but from the age of 18, etc. Women over 65 years old need to take a smear for cytology once every 2 to 3 years, since in old age the risk of cervical cancer is slightly lower than during sexual activity.

If a woman aged 21-65 has had a negative Pap smear for three years in a row ( "good" smear), then the next time you can take an analysis in 2 - 3 years. But if a woman has a pathological smear for cytology, then it is recommended to take it again after 3 to 6 months, naturally, after passing the course of treatment prescribed by the doctor. In such situations, with pathological smear results, the doctor recommends taking it every six months, until a normal result is obtained three times in a row. After that, you can again take a smear once a year.

If a woman has suffered from genital herpes at least once in her life, takes oral contraceptives, or has obesity, uterine bleeding, warts on the genitals, frequent change of sexual partners, then she, regardless of the results, is recommended to take a smear for cytology every six months.

It must be remembered that a cytology smear should be taken by all women who have a cervix. That is, even if a woman underwent an operation to remove the uterus, but the cervix was left, then she needs to take a smear for cytology, since cancer may well develop on the cervix against the background of the absence of the uterus itself.

Indications for the delivery of a smear for cytology

As part of a preventive examination, a cytology smear is usually taken once a year by women aged 21–65 years and once every 2–3 years by patients over 65 years of age.

However, in addition to such preventive delivery, a smear for cytology can be prescribed by a doctor unscheduled for the following indications:

presence in the cervix visible to the eye changes ( erosion, leukoplakia, etc.);
genital warts present on the genitals, skin of the perineum and anus ( genital warts and papillomas);
herpes on the genitals, skin of the perineum or in the anus;
menstrual irregularities;
obesity;
taking oral contraceptives;
frequent change of sexual partners;
carrier without clinical symptoms herpes viruses, human papilloma or cytomegalovirus;
radiation and chemotherapy.

Preparation for the delivery of a smear for cytology

Before taking a smear for cytology, it is necessary to go through the preparatory stage, which is necessary in order for the results of the analysis to be informative and accurate.

Preparation for the delivery of a smear for cytology should be to fulfill the following requirements:

Within 24 - 48 hours before taking a smear, refuse any sexual intercourse, including using condoms.
Within 24 - 48 hours before taking a smear, do not douche the vagina.
At least two days better than a week) before taking a smear, do not inject any drugs into the vagina ( suppositories, tampons, creams, ointments, etc.) or vaginal means ( sex toys, moisturizing sprays, ointments, contraceptive gels, etc.).
For 48 hours before taking a smear, wash the external genitalia with exclusively warm water without the use of soap, shower gels or any other hygiene products.
For 48 hours before taking a smear, do not take a bath, but wash yourself in the shower.
Do not take antibiotics or any other antibacterial drugs for three days before taking a smear.

You also need to know that a cytology smear is not taken during menstruation, so you need to wait 2 to 3 days after the end of your period to pass the analysis. In addition, it should be remembered that if a woman underwent a colposcopy, biopsy or gynecological examination, then in this case it is possible to take a smear for cytology at least two days after any manipulations in the vagina.

It is undesirable to take a smear for cytology against the background of an active inflammatory process in the genital organs, since in this case its result will be distorted and uninformative. It is advisable to treat the inflammatory process, and only after it subsides, take a smear, properly prepared.

Taking a smear for cytology ( procedure)

A smear for cytology can be taken starting from the fifth day of the menstrual cycle and until the moment when 5 days remain before the expected date of the next menstruation. However, it is optimal to take a smear in the period 2-4 days after the end of menstruation and up to 12-13 days of the cycle. In the middle of the cycle, it is not recommended to take a smear, since at this time in the cervical canal accumulates a large number of mucus, which interferes with the normal collection of epithelial cells. However, if necessary, a smear for cytology is given on any day of the cycle, except for the period of menstrual bleeding.

To take a smear, the doctor prepares necessary materials- sterile gloves, underclothes, speculum, scraping tool ( brush, spatula, etc.), saline solution, glass slides, smear fixative.

Further, before taking a smear, the doctor asks the woman to urinate ( pee), after which he will offer to lie in a gynecological chair on a bedsheet and fix his legs in stirrups. When a woman takes the same position as for a gynecological examination, the doctor inserts a Cusco mirror into the vagina, which pushes the walls of the vagina apart to expose the cervix and make it accessible for manipulation.

Next, the gynecologist wipes the cervix with a sterile swab moistened with saline to remove mucus. If a mucous plug is visible in the cervical canal, then the doctor also removes it with a cervical brush or scraper. After that, the doctor takes any sterile tool at his disposal to take a smear for cytology ( Eyre spatula, Volkmann spoon, screen, endobrush) and introduces it shallowly into the cervical canal. After insertion into the cervical canal, the doctor rotates the instrument around its axis by 360 degrees to scrape off the epithelial cells, which the cytologist will subsequently examine under a microscope. Next, the instrument is carefully removed from the vagina so that it does not come into contact with anything. This completes the procedure for taking a smear for cytology for a woman.

And the doctor, after removing the instrument from the vagina, smears the resulting scraping of cervical cells on a glass slide with a uniform thin layer and fixes it according to the rules of the cytological laboratory. The last name, first name, patronymic and age of the woman are signed on the smear, after which the glasses are sent to the laboratory for research.

The process of taking a smear for cytology in most women does not cause any sensations, that is, they do not feel anything. But for some women, taking a smear causes a feeling of pressure on the cervix. However, never with the observance of the technique of taking a smear, a woman does not experience pain.

After a cytology smear

After the doctor takes smears for cytology, a woman can lead her normal, habitual lifestyle, including having sex, using a variety of drugs injected into the vagina, etc. There are no special restrictions after taking smears for cytology, as well as after a routine gynecological examination.

After taking a smear, a slight spotting may appear, which indicates that the cervix is easily damaged and its structure is abnormal. In such cases, one must expect and be mentally prepared for a pathological result of the analysis. However, you do not need to take any special actions to stop the bleeding, it will pass by itself. It is only advisable to refrain from sexual intercourse and the introduction of anything into the vagina until the smearing is over.

How many days do a smear for cytology?

Since for the analysis of a smear for cytology, it must be pre-processed, namely, fixed, stained, dried, and only then examined under a microscope, it is obvious that the result of this study will be ready within a few days after taking the material required for all necessary steps in smear processing. On average, if a cytologist can immediately look at all smears prepared by a laboratory assistant, the result of the analysis will be ready in 2 to 3 days.

But in practice, a very large load falls on cytologists, since doctors of this rare specialty have to look at a large number of smears during the working day, because cytology laboratories receive smears from various medical institutions ( both public and private). The cytologist is one for several hospitals and polyclinics, and can study during the day only a limited number of smears, of which there are many more. Therefore, all incoming smears are immediately processed and stained by the laboratory assistant, after which he puts them in a queue in the order in which they are received, and the cytologist looks through the material as the queue reaches him. Because of this, the result of a smear for cytology can be ready in at least 2 to 3 days, and maximum in a month.

Pap smear during pregnancy

During pregnancy, women can take a smear for cytology, since this manipulation is completely safe and painless for both the expectant mother and the child. To take a smear for cytology during pregnancy, without waiting for childbirth, should be given to women in whom the doctor has recorded suspicious changes in the structure of the tissues of the cervix. In all other cases, it is better to postpone the smear for cytology for the period after childbirth.

If a doctor prescribed a smear for cytology to a pregnant woman, and its results turned out to be pathological, this does not mean that she has cervical cancer, and she will not be able to endure and give birth to a healthy child. Most likely, the pathological nature of the smear is due to inflammatory changes or erosion, and in this case, the doctor will prescribe a treatment that the woman will undergo during pregnancy, which will increase the likelihood of successful birth through natural routes.

The smear norm for cytology ( good smear for cytology)

Normally, a cytology smear should have a negative result, which is also called "good" or "normal". In the conclusion of a cytologist to a normal smear, the doctor usually indicates that the cells have a normal structure, signs of anomalies of the nuclei and cytoplasm are not detected, changes in the shape and size of epithelial cells are not detected. Such a normal smear for cytology corresponds to the first stage according to the Pap classification ( CIN-I).

Sometimes, in the results of a normal smear for cytology, the doctor describes in detail the picture of cells from the endocervix ( inside of the cervical canal) and ectocervix ( outer part of the cervix protruding into the vagina). Normally, the endocervix material contains cells of squamous and cylindrical epithelium without pathological changes and without features. There may be a small amount of metaplastic epithelial cells, which is also completely normal and usually occurs in women during menopause or after undergoing cervical treatment ( e.g. cauterization erosion). Ectocervix smears normally contain squamous epithelial cells of superficial or intermediate types without features. In menopause, normally, all epithelial cells can be of an intermediate type, which is a variant of the norm, especially if sexual activity continues after menopause.

Deciphering a smear for cytology

The results of a smear for cytology necessarily describe the cellular composition ( what cells are present in the smear), the state of cells and the nature of pathological changes in them ( in the presence of), as well as a presumptive conclusion about what kind of pathology takes place in a particular case.

A cytology smear can be positive or negative. A negative result is a normal smear when there are no pathological changes. But a positive result is a pathological smear, in which any abnormal changes in the structure and size of cells of any nature are revealed. Below we will consider what specific changes can be detected in cytology smears for various pathologies of the cervix.

Typical patterns of pathological changes in smears for cytology in various diseases of the cervix and genital organs

Cytology smear results may contain the following information:

With polyps or hyperplasia of the epithelium of the cervical canal in the description of the picture of a smear for cytology, the doctor usually indicates a large accumulation of normal cells of the cylindrical epithelium.
For ovarian tumors and uterine fibroids in the ectocervix, normal cells of the squamous epithelium of the surface layer are usually found.
With erosion ( ectopia) or endocervicosis in the smear, cells of the squamous epithelium of all layers, clusters of cells of the cylindrical epithelium, elements of inflammation ( leukocytes, lymphocytes). If erosion or endocervicosis is in the healing stage ( for example, after cauterization, etc.), then a large number of cells of metaplastic epithelium are found in the smear.
With leukoplakia of the cervix ( benign lesion) smear shows areas of hyperkeratosis ( accumulations of squamous epithelium), individual scales of squamous epithelium and discerocytes.
With cervical dysplasia a smear reveals atypical epithelial cells with signs of malignancy ( large nuclei, deformed cytoplasm, abnormal shape and size). Cervical dysplasia may be a sign of an active papillomavirus infection or a precancerous process. Distinguish, a sign of what ( inflammation or precancer) is a dysplasia in a particular case is very difficult. Therefore, if dysplasia is detected, an additional colposcopy with a biopsy of suspicious areas is recommended. Depending on the severity of cell atypia, dysplasia can be of three stages - weak ( CIN–I), moderate ( CIN II) and expressed ( CIN III). Severe dysplasia may be intraepithelial cancer.
With endocervicitis and ectocervicitis ( inflammation of the cervix) non-specific character ( for example, against the background of candidiasis, dysbacteriosis, etc.) a smear reveals degeneratively altered epithelial cells, proliferation phenomena, leukocyte infiltration, incomplete phagocytosis. In a chronic inflammatory process, lymphocytes, eosinophils, macrophages can also be detected.
With mycoplasmosis, ureaplasmosis and corynebacteriosis in the smear, destroyed epithelial cells, cells with large nuclei and deformed cytoplasm, incomplete phagocytosis and pathogenic microorganisms are found. In such cases, the conclusion indicates what type of pathogenic microflora was found ( cocci, sticks, etc.).
For bacterial vaginosis smears for cytology reveal key cells, mixed coccobacillary flora.
With genital herpes in smears, multinucleated squamous epithelial cells are found, having the appearance of a "mulberry".
With papillomavirus infection the smear reveals koilocytes, cells with large nuclei or several nuclei.
With trichomoniasis in the smear, Trichomonas and mixed coccobacillary flora are found.
With chlamydia the smear reveals cells of normal and metaplastic epithelium with inclusions in the cytoplasm ( bodies of Provachek).

What do the various abnormal cells in a cytology smear indicate?

Squamous epithelium in a smear for cytology

Normally, in a smear for cytology, squamous cells should be present in a small amount ( 5 - 15 pieces per field of view), since it is this type of epithelium that covers that part of the cervix that is visible in the vagina.

If there are few squamous epithelium cells in a smear for cytology - up to 5 pieces per field of view, then this is a sign of estrogen deficiency in the woman's body and the development of atrophic processes in the mucous membranes of the vagina, cervix, etc.
If there are no squamous epithelium cells in a cytology smear at all, then this indicates a developed atrophy, and in this case the woman has a high risk of cervical cancer in the future.

If there are many squamous epithelial cells in the smear, that is, more than 15 pieces in the field of view, then this indicates an inflammatory process, diffuse mastopathy or primary infertility. In addition, a large number of squamous cells in a smear for cytology can be detected when benign tumors organs of the genitourinary system.

Metaplastic epithelium in a smear for cytology

Normally, a small number of cells of metaplastic epithelium can be found in a cytology smear, since such cells form in the area where the cylindrical epithelium of the cervical canal closes with the squamous epithelium of the outer part of the cervix, visible into the vagina.

However, if there are many cells of metaplastic epithelium or they are located in clusters, then this indicates that the single-layer squamous epithelium on the outer part of the cervix is replaced by a stratified squamous one. The process of such metaplasia of one type of epithelium to another is benign and can occur due to infectious and inflammatory diseases of the cervix ( herpes, chlamydia, toxoplasmosis, etc.), hormonal disorders, traumatic childbirth, numerous abortions, frequent change of sexual partners, etc.

Metaplasia is not cancer and not even a precancerous process, but it is not the norm either. Therefore, women with epithelial metaplasia are recommended to undergo an examination to identify the reasons for the degeneration of one type of epithelium into another. Metaplasia is successfully treated, so there is no need to be afraid of this pathology.

Glandular epithelium in a smear for cytology

Normally, cells of the glandular epithelium can be detected in the smear, as they are scraped off by the instrument during material sampling from the inner surface of the cervical canal. A sign of pathology is the proliferation of glandular epithelium, which the cytologist detects by the accumulation of cells in smears.

Proliferation of the glandular epithelium can occur in completely healthy women during pregnancy or while taking oral contraceptives.

In other situations, the proliferation of glandular epithelium indicates the following diseases:

colpitis ( inflammation of the vaginal mucosa) and cervicitis ( inflammation of the cervix), provoked by various microbes;
hormonal disorders, when an abnormal amount of certain hormones is produced in the body;
traumatic injury to the cervix, for example, during childbirth, during an abortion, diagnostic curettage of the uterine cavity or various medical and diagnostic manipulations involving the cervix;
erosion ( ectopia) of the cervix.

Leukocytes and leukocyte infiltration in a smear for cytology

Since leukocytes in the body perform the function of destroying pathogenic microbes that cause infectious and inflammatory diseases of various organs, their detection in a smear for cytology means that an inflammatory process occurs in the cervix ( endocervicitis or ectocervicitis). Moreover, for long-standing or chronic inflammations, a not very large number of leukocytes in a smear is characteristic, but for recently begun inflammatory processes, on the contrary, the presence of a large number of leukocytes or even leukocyte infiltration is characteristic, when the tissues are literally “stuffed” with them.

Endocervicitis or ectocervicitis can be caused by various pathogens ( e.g. trichomonas, chlamydia, human papillomavirus, etc.), therefore, if leukocytes are detected in a smear for cytology, it is necessary to take tests for genital infections and bacteriological seeding of the vaginal discharge for flora in order to identify the causative agent of the inflammatory process in a particular case and carry out the necessary treatment.

Erythrocytes in a smear for cytology

First, red blood cells in a smear are detected if the smear was taken shortly after the end of menstruation ( within 1 - 3 days), and in this case the presence of these cells is not diagnostically valuable fact, since it indicates only recent menstruation and nothing else.

Secondly, erythrocytes in a smear can be detected when the material is taken incorrectly, when the gynecologist presses too hard on the instrument, injures tissues with it, which causes slight bleeding and, accordingly, erythrocytes enter the smear. In such a situation, the presence of red blood cells in the smear also does not play any role and has no diagnostic value. It is very simple to understand that there was an incorrect material sampling technique - after the manipulation, the woman had bloody discharge from the vagina for several hours.

Thirdly, if the smear was taken correctly and after a sufficient time after menstruation, then the presence of red blood cells in it indicates an inflammatory process in the tissues of the cervix. Moreover, erythrocytes indicate that the inflammation is active and relatively recent, therefore, to eliminate this pathology, the necessary treatment should be completed as soon as possible.

Atypical cells in a smear for cytology

Atypical cells have an abnormal structure, size and shape, that is, they have undergone some kind of transformation. The reason for the transformation and development of cell atypia can be two general pathological processes - either inflammation in the tissues, or tumor degeneration.

In practice, atypical cells in a cytology smear are most often found against the background of an inflammatory process caused by any sexual infections, bacterial vaginosis, etc. In much more rare cases, atypical cells are still a reflection of tumor degeneration in the tissues of the cervix. However, even the presence of atypical tumor cells in a smear is not a sign of cancer, since normally up to a million cancer cells are formed in the human body every day, which are simply destroyed by the immune system. Therefore, in most cases, the presence of atypical cells in a smear for cytology is a reflection natural process when similar elements in the body are formed and subsequently destroyed by the immune system.

That is why, if atypical cells were found in the smear, you should not panic, but simply take tests for genital infections ( to find out which pathogenic microbes could cause inflammation) and additionally undergo a colposcopy with a biopsy ( to make sure there is no tumor in the tissues of the cervix).

You can feel especially calm if the results do not indicate the degree of atypia, but simply say that atypical cells were found, since in such cases the cause is an inflammatory process. If the results indicate the degree of cell atypia, then this is a reflection of tumor rather than inflammatory transformation, but even in such a situation there is no need to worry. After all, the detected atypical cells can only theoretically someday give rise to a cancerous tumor, which in most cases does not happen, since such reborn cells are destroyed by the immune system.

Rod or coccal flora in a smear for cytology

Normally, a smear for cytology should not contain any representatives of the microflora, but if an infectious-inflammatory process occurs in the tissues of the cervix, the doctor will see the microbes that caused it under a microscope. So, if the flora is rod, then, most likely, the infection of the cervix is provoked by corynebacteria. If the flora is coccal or mixed coccal-rod, then the infection can be triggered by trichomonas, gardnerella, ureaplasmas or mycoplasmas. Unfortunately, the doctor cannot say exactly which microbes provoked the infection of the cervix by a cytology smear. Therefore, if any flora is detected in a smear for cytology, it should be tested for sexual infections as soon as possible and undergo the necessary treatment.

Fungi in a smear for cytology

Normally, a smear for cytology should not contain any microbes, including fungi. But if they were in the taken material, then this indicates candidiasis of the vagina and cervix. In this case, it is necessary to carry out antifungal treatment.

Stages of a pathological smear for cytology

Depending on what pathological changes were detected in a smear for cytology, a positive result of the analysis is classified into five stages of the development of cervical pathology according to the Papanicolaou method:

First stage- there are no cells with structural anomalies, the picture is completely normal. Such a smear usually occurs in healthy women ( negative smear result).
Second stage- in the smear there are cells with slightly pronounced inflammatory changes. Such a smear is considered a variant of the norm, since cell changes are associated with inflammation in the vagina or cervix, and not cancerous degeneration. Usually a smear of the second stage occurs in women with endocervicitis, mycoplasmosis, ureaplasmosis, trichomoniasis, chlamydia, candidiasis, bacterial vaginosis, vaginitis, genital herpes, human papillomavirus carriage. Therefore, at the second stage of a smear for cytology, the doctor recommends an examination to identify the causative agent of the inflammatory process, followed by treatment.
Third stage- single cells with pathology of nuclei and cytoplasm are determined in the smear. Such a smear is no longer normal, it usually indicates that individual cells have transformed into tumor cells. However, such a stage of the smear does not indicate a serious illness, since such changes are often caused by cervical erosion or polyps, and in most cases go away on their own without special treatment. When you get a stage III smear, your doctor recommends a colposcopy and a biopsy of suspicious areas of your cervix to make sure there is no cancer.
Fourth stage- the smear contains cells with signs of malignancy ( large nuclei, abnormal cytoplasm, chromosomal abnormalities). Usually, a fourth stage smear is called dysplasia, and it means that there are separate cells in the cervix, from which cancer can theoretically develop in the future. However, in reality, most dysplasias simply go away on their own without treatment, and a cancerous tumor does not develop. However, at the fourth stage of the smear, the doctor will order a colposcopy and a biopsy of the suspicious area to make sure that there is no malignant tumor. If cancer is not detected, then the woman continues to regularly, once a year, take a smear for cytology, which allows you to monitor dysplasia.
Fifth stage- the smear contains a large number of tumor cells. In such a case, a presumptive diagnosis of cervical cancer is made, and the woman is given an additional examination to determine the stage and type of tumor, which is necessary for subsequent treatment.

Despite the fact that cytology can detect and identify cancer cells, a diagnosis of cancer or precancerous tissue degeneration can only be established on the basis of a histological examination of a biopsy. Therefore, even the fifth stage of a pathological smear for cytology is not an unequivocal diagnosis of cancer. After all, to detect and confirm cancer, it is necessary to do a biopsy with histology, so, having received a “bad” smear result for cytology, one should not be prematurely upset and draw terrible prospects. You need to wait for the results of the histology, because it is very likely that the cancer will not be confirmed, and you will just need to continue to take smears for cytology at a regularity that the doctor will establish.

Atrophic type of smear for cytology

The atrophic type of smear indicates that the woman's body has a deficiency of estrogen hormones, resulting in atrophy of the epithelium of the vagina and cervix. Usually, such an atrophic type of smear occurs in women after menopause, but it is also possible in young women against the background of atrophic colpitis, vulvar kraurosis, and cervical leukoplakia. With an atrophic type of smear for cytology, you need to undergo an examination and begin the necessary treatment.

Inflammatory cytology smear

As the name implies, the inflammatory type of cytology smear means that there is an active inflammatory process in the tissues of the cervix. Actually, it was precisely because of inflammation that the cytologist could not study the epithelial cells and give a clear answer whether there are cancerous cellular structures or other violations of the structure and size of the cells. And therefore, with too active inflammation, the doctor indicates that there is an inflammatory type of smear, which is completely unsuitable for the purposes of a cytological study. In such cases, you need to undergo an examination to identify the cause of inflammation, carry out the necessary treatment and take a smear for cytology again to get an accurate result.

Cytology of the cervix, what kind of analysis it is, not all women know, while this examination is of great importance in the early diagnosis of precancerous and oncological diseases of this organ. Every non-virgin woman should be tested for cervical cytology once a year, and if the analysis shows an unsatisfactory result, then even more often.

But, unfortunately, it is not always possible to obtain a reliable result; diagnostic errors also occur. So, it is impossible to get a high-quality cytological analysis of the cervix when leukocytes are greatly increased, that is, during an inflammatory process. Thus, a woman is often mistakenly diagnosed with dysplasia.

Also, errors occur due to improper sampling of material by a nurse or doctor. For this purpose, special brushes should be used, which are not available in all antenatal clinics. Without them, doctors take a smear from the cervix for cytology in the form of only the surface layer of the mucous membrane - the epithelium. But this is not true.

It is also wrong to examine in this way a woman in last days menstruation or just before it begins. The middle of the menstrual cycle is considered a favorable period.

It is believed that the results of cervical cytology are not as accurate as those of a similar Pap test, which, unfortunately, is not done in all Russian antenatal clinics, especially in small towns and rural areas.

And briefly on the topic “a smear for cytology from the cervix decoding”, about what should alert. Naturally, if you are being examined by a doctor, he will tell you everything himself. But after all, many women take a Pap test in paid laboratories on their own, and then they themselves have to find out what the cytology of the cervix shows in them and whether they need to be treated.

The following and similar entries in the form should alert:

atypical cells of unclear significance;
low grade changes (HPV, CIN I);
high grade changes (CIN II, CIN III).

All this requires additional examination, and often treatment. HPV means signs of the presence of the human papillomavirus, and, as already known, it is this virus that causes cervical cancer. CIN I means dysplasia (neoplasia) of the first degree. With such a diagnosis, a woman is usually recommended to undergo colposcopy and further observation with smears for cytology about 1 time in six months. Or they take a biopsy from the cervix and then perform a "cauterization" in the case of an existing ectopia, leukoplakia, or other benign neoplasm.

With grade II dysplasia, a biopsy is always taken from the cervix. But at the III degree, conization is performed - the affected area of \u200b\u200bthe cervix is removed. After all, the III degree of dysplasia is the last before cancer. There is a possibility of her regression, but it is better not to tempt fate.

This simple analysis is the best way to protect yourself from cancer.

Cytological examination is one of the most demanded in oncology. With its help, the doctor assesses the condition of the cellular elements and makes a conclusion about the malignant or benign nature of the neoplasm. The features of the structure of cells, the cellular composition of organs, tissues, fluids of the human body are studied. Cytological examination is used in the diagnosis of precancerous diseases and malignant neoplasms of various organs: the cervix and body of the uterus, breast, thyroid gland, lungs, skin, soft tissues and bones, gastrointestinal tract, lymph nodes, etc. For cytological examination, swabs of the vaginal vault are taken and cervix, sputum, urine, exudates from cavities, etc.

When is a cytological examination scheduled?

In most cases, doctors - therapists, gynecologists, oncologists and other specialists - resort to cytological diagnostics if a tumor disease is suspected.

The cytological method is used to study neoplasms in various organs - skin, mammary gland, lungs, mediastinum, liver, kidneys, retroperitoneal formations, thyroid gland, prostate gland, testicle, ovaries, lymph nodes, tonsils, salivary glands, soft tissues, bones, etc.

The greatest distribution of cytological studies received in the field of gynecology. It's affordable and fast method screening, which has proven its effectiveness in the diagnosis of precancerous diseases and early cancer of the cervix.

There are frequent cases when a cytological examination helped to detect cancer of the stomach, lung, Bladder and others at the earliest stages, when X-ray and endoscopic studies did not reveal any changes.

During the treatment of a tumor disease, it is necessary to constantly monitor the effectiveness of the therapy. This requires fast and effective methods diagnostics. Cytological examination in these cases allows you to quickly get answers to most questions that doctors have about the course of the disease. Cytological examination is also widely used after the end of specialized (surgical, chemotherapeutic or radiation) treatment to control the course of the disease and early detection of possible recurrence or progression of the tumor (examination of lymph nodes, pleural exudate, etc.).

The main areas of application of cytological studies in oncology:

Screening, preventive examinations
Diagnosis - establishing and clarifying the diagnosis
Monitoring results during and after therapy

What is the difference between cytology and histological examination?

The difference between a cytological study and a histological study, first of all, is that it is cells that are studied, and not tissue sections. For histological examination, either surgical material or material sampling by trephine biopsy is required. For a cytological study, a smear from the mucous membrane, scraping from the surface of the tumor, or material obtained with a thin needle is sufficient.

Preparation of a histological preparation requires more effort and time than preparation for cytological analysis.

How is cytology performed?

Various biomaterials are used for analysis.

Exfoliative material, that is, obtained by the method of "peeling":

scrapings from the surface of erosions, wounds, ulcers;
scrapings from the cervix and cervical canal, aspirates from the uterine cavity;
secretions of glands, excreta, sputum, transudates, exudates, washings, etc.
Urinalysis for atypical cells

Puncture material:

punctates obtained with a fine needle (fine needle biopsy)
imprints of trephine biopsy material from tumors and various neoplasms

Operating material:

smears-imprints and scrapings from the removed tissue, liquid, washings, and other material obtained during surgical interventions.

Endoscopic material:

material obtained during endoscopic examination

Cytological examination is the most gentle diagnostic method. Usually, the sampling of material for analysis proceeds painlessly, on an outpatient basis, without a traumatic effect on organs and tissues.

The cell material taken for analysis in the cytological laboratory is transferred to glass slides, stained and examined under a microscope.

The cytomorphologist uses in his work a set of signs of cell atypia, critically assessing their presence and severity. The result of the analysis directly depends on the professionalism of the specialist conducting the study: both in terms of preparing the material and in terms of examining it under a microscope.

On the surface of tumor cells there are special proteins - antigens. Moreover, each tumor expresses its own set of antigens. If necessary, using special reagents for immunocytochemical studies, a cytologist can not only establish the presence of malignantly transformed cells in the test sample, but also determine the histotype of the tumor, its organ affiliation, prognostic factors, and sensitivity to treatment.

Advantages of the cytological method:

absolute harmlessness for the patient
painlessness
the possibility of using multiple cytological studies
rapidity
diagnostics of malignant tumors of any localization and at any stage of the process.

Typically, the study takes several hours. Intraoperative cytology can be performed within 10 minutes.

Due to its harmlessness, the cytological method is indispensable for assessing the dynamics of morphological changes in tumor cells during treatment, to determine the therapeutic effect of the treatment. For such patients, it has undoubted advantages over other, more invasive research methods.

Methods of cytological studies are constantly being improved. The development of endoscopic techniques makes it possible to purposefully obtain material for research from internal organs that were previously inaccessible for morphological analysis without surgical intervention.

Thus, cytological examination, due to the combination of high information content, harmlessness for the patient and speed of conduction, in the absence of tissue traumatization, is of great importance in oncology.