How long does it take to perform a cytological examination? What does a smear show and why is it taken for oncocytology? Flat epithelium in a smear for cytology

Every day in Russia about a thousand people die from cancer, and in the world this number is more than 20 thousand. It is sad to realize that many patients could have been saved if the diagnosis had been made in the early stages. Therefore, timely detection of cancer is one of the most important tasks of medicine. One of the ways to diagnose cancer and precancerous conditions was discovered in the middle of the twentieth century: it is enough to “ask” the cells of our body.

What does the term “cytology analysis” mean?

As many people know from school courses, cytology is the science that studies the cells of the body. Cytological examination, in turn, makes it possible to detect abnormalities in the condition, structure and functioning of cells and, based on these data, make a diagnosis or monitor the course of the disease, and determine the success of treatment. The cells will “tell” about many problems in the tissues being studied: inflammation, bacteria, infections and various neoplasms.

Cytology analysis has the following advantages:

• high accuracy;
• minimal degree of interference in the body;
• does not require any special preparation;
• low cost of research;
• quick results.

The main disadvantage of cell research is the need to collect material directly from the affected areas of the body. This creates certain difficulties in cases where the location of the inflammation or tumor is unknown, although the symptoms indicate the presence of such a pathology in the patient.

When is a cytological examination prescribed?

As we have found out, cytology analysis is indispensable primarily in identifying tumors and precancerous conditions, but it also allows us to identify many inflammatory, infectious and autoimmune diseases. Therefore, it is successfully used in many areas of medicine: oncology, gynecology, surgery.

Cytological examination is prescribed in following cases:

• for the prevention of diseases. For example, gynecologists recommend taking a cytology test annually for the timely detection of tumors, inflammation and infections;
• for diagnostics. Cytological examination allows us to identify the nature of the pathology, determine the presence of tumors and their nature, and detect concomitant diseases. An analysis for diagnostic purposes is prescribed by a doctor to confirm or refute a preliminary diagnosis;
• for control. During the course of therapy, the patient is prescribed a cytological examination to monitor the dynamics of the disease, make changes to the treatment plan if necessary, and also confirm recovery. For cancer patients, periodic cytology tests help identify relapses.

What biomaterial is being studied?

Since our entire body consists of cells, almost any biomaterial can be used for cytological research. However, as already mentioned, in order to obtain an accurate result, the material must be obtained from the suspected focus of the disease, that is, it must contain affected cells.

Thus, depending on which organ is being examined, the following types of biomaterials are the object of analysis:

• exfoliative- urine, sputum, blood, washing water, scrapings from the cervix, from the surface of ulcers and wounds, glandular secretions, excreta, transudates, exudates, etc.;
• punctates, that is, biomaterials obtained through puncture thyroid gland, lymph nodes, breast, skin, joints, pleural cavity etc.;
• operating material. This group includes impressions and scrapings from removed tissues, as well as from various incisions obtained during surgery.

How is cytology analysis performed?

So, a cytological examination begins with taking biomaterial using one of the above methods. In traditional cytology, the resulting sample is immediately transferred to glass, dried or fixed with a special substance and transferred to the laboratory. Unfortunately, such treatment leads to cell damage, and as a result, frequent false negative results. The emergence of liquid cytology, a research method in which biomaterial is immediately placed in a special preservative solution, helped change the approach. This not only helps keep the cells intact, but also significantly increases the shelf life of the samples.

Please note
Preparation of biomaterial is one of the most important aspects in increasing the accuracy of the study. The accuracy of the traditional cytology method is only 34.5–89%, while liquid-based cytology provides results with an accuracy of up to 98%. Therefore, before analysis, be sure to clarify what method the study is being used.

After fixing the sample or preparing the preparation using the liquid method, smears are usually stained in one of the following ways:

• Papanicolaou test (PAP test) - the most common coloring method in the world. Effective in identifying cancer and viral diseases(eg HPV).
• according to Romanovsky - in Russia it is most often used in the Leishman modification. As a result of this staining, the cell nucleus is more clearly visible, which makes it possible to identify bacteria and protozoa.

The resulting sample is then examined under a microscope. During the examination, the doctor identifies abnormalities in the number, structure and location of cells and records the findings in the conclusion. For example, for a Pap test, type 1–5 of cell changes is indicated, where 1 means normal, that is, the absence of pathologies, and 5 means the presence of a large number cancer cells in the epithelium.

The conclusion at the bottom of the analysis form is usually formed using the generally accepted Bethesda terminology system, in which each indicator is indicated by an abbreviation. The system is a global standard and will be understandable to doctors in most countries.

How long does it take a microbiologist to perform an analysis?

As already mentioned, cytology analysis is carried out quite quickly: as a rule, the period is up to five days. In some cases (depending on the method and the biomaterial being studied), the result can be obtained the very next day.

At the same time, the study itself does not last long, but the clinic may delay the receipt of the analysis form by the patient for up to a week or more (this usually happens if the hospital does not have its own laboratory - this is also worth paying attention to when choosing a diagnostic center).

How to read the cytology results form

Most patients, having received test results in their hands, strive to study them on their own, without waiting for consultation with a specialist. Of course, you shouldn't do that.

We will provide only a list of basic values ​​​​according to Bethesda:

We provided a transcript of the PAP test above.

Remember that the interpretation of cytology test results should be carried out by an experienced specialist, taking into account data from other studies. Self-diagnosis and, especially, self-medication are absolutely unacceptable, because your life and health are at stake.

Cytology analysis is a simple, quick and inexpensive way to examine the body for cancer, inflammatory processes and infections. However, its accuracy depends greatly on preparation. medical workers, taking biomaterial, from the research method and the quality of equipment in the laboratory.

Thursday, 03/01/2018

Editorial opinion

You should not treat the appointment of a cytological analysis as a confirmation of the diagnosis, you should not worry ahead of time, avoid the procedure, and even more so, try to develop a course of treatment yourself. If for some reason you do not want to go to the hospital to donate biomaterial, pay attention to the service of sampling at the patient’s home - many laboratories and diagnostic centers now offer this.

Number of diseases reproductive system women are increasing every time. When a woman visits a gynecologist, the doctor takes samples to determine the nature of the microflora. To determine cancer, a smear is taken for cytology. All women must undergo the study once a year.

Cytology smear: description and significance of the procedure

Cytology smear - diagnosis of changes in the cells of the cervix and vagina

Cytological examination is a highly informative and reliable method diagnostics, thanks to which you can obtain information about the condition and possible changes in.

A cytological smear or Pap smear is a microscopic examination that helps identify possible pathologies cervix. This is a simple, painless procedure. For study, cells are taken from the surface of the neck. This non-invasive diagnostic method allows you to identify the causative agents of some.

With the help of cytological examination, atypical cells indicating dysplasia can be identified. Dysplasia is usually understood as a change in the structure of all layers of the cervical epithelium. This disease can lead to the development of a cervical tumor.

This study is mandatory for diagnosing possible changes in the structure of the cervix, as well as choosing effective method treatment.

Typically, a malignant process begins to develop from the lower layers of the epithelium. Over time it progresses. As a result, if a scraping was taken from the surface layer, then a diagnosis can be made when the disease is at the last stage.

Unlike a histological examination, during which a single tissue sample is examined, for a cytological examination all the cells waste from the cervix are taken. When a precancerous condition is detected, invasive research methods are prescribed to clarify the diagnosis.

Purpose of analysis

A smear is taken for cytology in the following cases:

• Planned pregnancy
• Cervical erosion
• Vaginal discharge
• Irregular periods
• Condylomas
• Herpetic rashes in the vagina
• Change of sexual partners
• Obesity

A cytological examination is prescribed before the installation of an intrauterine device, as well as when long-term use hormonal drugs.For prevention purposes, women should undergo a cytology smear annually. The study is prescribed as soon as the girl begins to be sexually active.

Procedure: preparation and execution

A smear for cytological examination should be taken after the end of menstruation. The procedure is not performed during inflammatory processes in the body and during menstruation. If a woman has undergone a gynecological examination or colposcopy, then a PAP test is performed no earlier than 2 days after these manipulations.

2 days before the study it is necessary to exclude sex life, you cannot douche and use vaginal suppositories and creams.

The procedure for collecting a smear for cytological examination is carried out as follows:

• the woman sits in a gynecological chair and the gynecologist inserts a special device into the vagina to access the cervical canal
• taken with a special spatula or cytological brush from the cervical canal, into the vagina and
• After the examination, the doctor takes a smear precisely on the suspicious and inflamed area
• Next, the material is applied to a glass slide and sent to the laboratory.

The duration of the procedure does not exceed 15 minutes including a gynecological examination.The laboratory technician stains the resulting material using the Papanicolaou method. Based on the reaction of cells with dyes, a conclusion is made about a possible inflammatory process or precancerous condition.

In addition to the PAP test, liquid cytological testing is performed.

The interpretation here is deeper: it is placed in a special solution, where it is examined under a microscope. Carrying out a liquid test simultaneously with a regular smear for cytology allows you to achieve reliable results.

Interesting video - Cytological studies in gynecology.

After a smear, in rare cases, a woman experiences discomfort. Sometimes after the procedure you may experience spotting and pain in the lower abdomen. These symptoms disappear after a few hours. In these cases, you should use personal hygiene products. To avoid pain and discomfort, you should abstain from sexual activity for a while.

However, if after taking a smear, spotting, abdominal pain, fever, then you should immediately call an ambulance. Such a reaction can occur if scraping is performed incorrectly or if there is an advanced inflammatory process of the mucous membrane.

How long does a smear take and interpretation of the results?

The examination is performed under a microscope and results can be obtained 1 day after taking a smear. During the study, the shape and size of the cells are determined and based on this it is possible to diagnose precancerous or cancerous condition. If the result is of poor quality, then the collection of material for research must be repeated.

Cytological smear results:

• At the first stage of the Pap test, the result is negative. Normally, there are no atypical cells.
• Subsequent stages are assessed as positive. At the second stage there is morphological changes cells and the inflammatory process. This stage requires careful examination to identify the causes of inflammation. Usually identified.
• At stage 3, single epithelial cells with structural abnormalities are detected. Some cells have enlarged nuclei, indicating development. In the future, this can lead to a malignant process. In this case, the woman must undergo a second smear, biopsy and undergo histological examination. The diagnosis is made only after additional examination.
• Stage 4 is urgent. The smear reveals cells that resemble malignant ones. Additional examination involves colposcopy and biopsy with sampling of a suspicious area.
• At stage 5, the smear shows large number cancer cells and this indicates cancer. The woman should urgently contact an oncologist for further treatment.

It should be remembered that based on a cytology smear, one cannot draw a conclusion about the condition of the uterus or. Therefore, it is recommended to go through.With constant preventive examination and smear collection for cytological examination, the likelihood of developing serious illnesses is significantly reduced.

Every year the number of diseases that attack women upon the onset of puberty increases. When visiting a gynecologist, the doctor takes a smear from a woman to check the woman’s microflora and identify diseases. The study can also reveal neoplasms that the woman may not have known about. And to identify the nature of the tumor, a smear is taken from women for cytology. In the article we will find out what the research shows and how long the analysis takes.

What does a cytology smear show? This question is asked by every woman who is sent for a cytological analysis. This test is a highly informative analysis that allows you to diagnose cervical diseases and vaginal pathology.

The procedure itself is absolutely painless and simple. Cells are taken from the plane of the cervix, which are subject to further study. Using the cytological method of examination, atypical cells are determined that may indicate dysplasia (cellular modification) of the cervix.

By examining the entire epithelial layers of the uterine cervix, it is possible to determine dysplasia, which leads to neoplasms of the uterus and cervix. A cytological smear allows you to identify pathology in the early stages.

Very often, neoplasms begin to develop in the internal areas of the vagina, progressing over time and becoming completely vital. dangerous disease. A smear from the upper layers of the epithelium can diagnose the disease when the disease has reached its final stage.

Cytological analysis can examine all cells, which distinguishes it from histological method, where individual material is subject to research.

If cancer is suspected, doctors use invasive methods cell checks. There are a number of situations when it is also necessary to take a smear for cytology:

• Planned pregnancy.
• Menstrual fight.
• Infertility.
• Increased body weight.
• Diabetes mellitus.
• Erosion. Frequent disease women.
• Frequent change of sexual partners.
• Installation of the uterine device.

A smear for this type of study may also be prescribed when there has been a long and continuous use of hormonal drugs. Women of all ages are recommended to take this test once a year. It is advisable to begin the study immediately after the woman has had her first sexual experience.

Preparing for the test: How to take a smear correctly

A smear for cytology is taken immediately after the end of menstruation. Doctors recommend not taking the test if there are various replenishments in the body: colds, runny nose, sore throat. Also, you should not take cytology when menstrual bleeding, as this will distort the analysis results. One to two days before taking the test, it is worth following a number of recommendations from the gynecologist:

• You can't have sex for two days.
• Use douching and vaginal suppositories.
• Use lubricants and creams.
• 2 hours before the test you should not relieve yourself.

The test procedure itself does not seem difficult. The patient sits in the gynecological chair, as during scheduled inspection at the gynecologist. Using a speculum, the doctor opens access to the cervix.

What does a cytology smear show, when to take it and why?

Cytology smear, what is it, what does it show, why is it given and to whom is it indicated? Why is this test prescribed to all healthy women who are not virgins? Is it possible and how dangerous is it to take a smear for cytology during pregnancy, at different stages?

Description of the analysis, deadlines and features of the procedure

The discharge is taken from the vagina, namely from the cervix and from cervical canal in order to find or exclude dysplasia and cancer. Cytology smear analysis is indicated for absolutely all women, regardless of whether they are currently sexually active. The frequency of delivery is determined as standard - once a year. However, the frequency may be higher if a woman has dysplasia and (or) oncogenic HPV viruses with ectopia. After all, as you know, cancer of the part of the uterus that extends into the vagina is provoked precisely by the human papillomavirus. That is, a smear for cervical cytology is especially important for women who are at risk according to this criterion. They are usually recommended to also perform a more accurate type of examination - a Pap test.

Expectant mothers do not have to undergo this test - the result of a cytology smear can be found out after childbirth. However, sometimes it is necessary if dysplasia was previously found, for example. But this is in exceptional cases. In general, this analysis is not this period a woman’s life is mandatory, since taking a smear for cytology can be noticeable (do not forget that during pregnancy there is a strong flow of blood to the pelvic organs) and will almost certainly bleed later - very unpleasant psychological factor for the expectant mother.

In order to get a clear answer to the question posed - whether or not there is a risk of developing an oncological process, you need to follow the rules.

1. Let's start with when to take a smear for cytology - it is necessary in the absence of an inflammatory process, otherwise it is useless, its result cannot be considered reliable.

2. The day of the cycle plays a big role. It should be about 12-20, but not immediately after menstruation or while waiting for it to start.

3. It is also important how a smear is taken for cytology; this should be done using a special instrument. It is important to take cells not from the epithelium, which are constantly renewed, but from a deeper layer. For this purpose, special brushes are used. The collection should be carried out from the area where the ectopia is located (if any) or another area suspicious of atypia.

When is treatment needed?

The transcript of a smear for cytology usually contains a description of the cells and changes in them. In this, people who do not have medical education, it's better not to try to figure it out. The main thing is that CIN I, II or III is not written there. This means dysplasia and its degree. In such cases, additional examination is already required.

In the first degree, colposcopy is usually sufficient, and if there are no obvious pathological changes, it is recommended to observe a gynecologist and periodically, at least once a year, take a vaginal smear for cytology.

In grade II, a cervical biopsy is usually prescribed, and depending on its result (histology), “cauterization” of the pathological area can be performed. In the future, the doctor again periodically looks at what the cytology smear shows, so that, if necessary, promptly take action.

For dysplasia III degree The affected part of the cervix is ​​surgically removed and its histological analysis is performed. Sometimes such severe dysplasia regresses, but it can also turn into oncology, since this is already a precancerous condition. So, this operation is both diagnostic and therapeutic.

It should be said that not only the cytology of a smear from the cervical canal is given in the absence of sexually transmitted infections and inflammation, but all surgical procedures are also performed. Otherwise, there is a possibility of introducing an infectious pathogen into the uterus, and this is fraught with serious complications.

If a gynecological cytology smear shows inflammation, then the woman is recommended treatment, usually with a preliminary test for the vaginal microflora to find the causative agent of the inflammatory process, and then repeat the procedure for collecting cells from the cervix.

And only when the cytology smear is normal can you relax and go to the usual “schedule” of preventive tests. Cervical cancer develops slowly, such preventive examinations are sufficient for healthy woman, even the one that is infected HPV viruses Types 16 and 18 are the most oncogenic.

Cytology smear (oncocytological smear, Papanicolaou test, PAP test) is laboratory test, the object of study of which is the epithelial cells of the cervix. The Pap test examines the size, shape, and location of epithelial cells.

Cytological examination of the smear makes it possible to identify pathological changes in the epithelium, the presence of atypical cells and cellular abnormalities, as well as detect precancerous and cancer cells in the mucous membrane of the cervical canal. The PAP test has made it possible to quickly and inexpensively diagnose oncological processes in the early stages. mandatory procedure for all women.

Reliability of cytological smear in pathological processes V epithelial tissue cervix reaches 80%. Since the development of cancer is long-term and takes from 5 to 15 years, regular PAP tests make it possible to timely detect deviations of the mucous membrane from the norm.

In case of identified pathologies, dysplasia, microcarcinoma, a more accurate invasive biopsy method and histology of the obtained tissues of the reproductive organs are used.

Indications for analysis

Depending on the woman’s age, it is necessary to conduct a routine cytological smear analysis with the following regularity:

• at 21-49 years old - once every 3 years;
• at 50-65 years old - once every 5 years.

In addition to a routine examination, a test to prevent cervical cancer is prescribed in the following cases:

• erosion;
• infertility;
• herpes infection in the vagina;
• diabetes mellitus;
• human papillomavirus (HPV);
• with vaginal discharge;
• menstrual irregularities;
• when planning pregnancy;
• before installing an IUD (IUD);
• 1-3 months after birth.

Contraindications

It is contraindicated to collect biological material for cytological studies in the following cases:

• during pregnancy, especially after the 20th week, a cytological smear is not performed, since intervention in the cervix can negatively affect the condition of the fetus;
• with menstrual bleeding;
• with cervicitis;
• in the presence of colpitis (vaginitis) – inflammation of the vaginal mucosa.

Research results cytological analysis made during inflammatory processes genital organs may show a false-positive or false-negative oncocytology result.

Preparation for the procedure

To ensure the reliability of the results of a Pap test using the cytological method, it is necessary to adhere to certain rules of preparation for the procedure.

First of all, a violation of the vaginal microflora is excluded 48 hours before the smear. To do this, you should stop using the funds intimate hygiene, drugs for vaginal use(suppositories, douching), and also exclude sexual contact. Immediately before the procedure, avoid visiting the toilet for 2-3 hours.

As a rule, cytological analysis is performed after treatment bacterial infections. If it was carried out the day before gynecological examination or colposcopy, then a smear for cytology is performed no earlier than 2 days later.

How to take a smear

When performing a smear for cytology, the immediate object of attention of the gynecologist is the cervical canal - the mucous part of the internal reproductive organs that connects the uterine cavity and vagina.

The length of the cervical canal is, on average, 3-4 centimeters, while the canal is conditionally divided into 3 zones:

• external os or ectocervix - extends into the vagina and is covered with squamous epithelial cells;
• internal pharynx or endocervix - located on the side of the uterus, covered with glandular epithelium;
• transitional, inner part channel.

There are two ways to carry out the procedure:

1. Standard smear for cytology. Using special instruments (Eyre spatula, Volkmann spoon), the gynecologist takes smears from the vagina, external os of the cervix and directly inside the cervical canal. For this, a special cervical brush is used, which does not injure the narrow canal and does not cause any harm. discomfort during the procedure.

The biological material is placed on sterile glass, fixed with a special solution and dried, after which it is sent to the laboratory.

2. Method of liquid cytology (LBC, Liquid Based Cytology). A more modern and accurate way to study the mucous membrane of the cervical canal.

To obtain biological material, the gynecologist uses several types of brushes (endocervical, Wallach brush), after which the tips are removed from the used instruments. Next, the brushes are placed in a bottle (vial) with a special liquid for preserving biological material.

The bottle is labeled and sent to the laboratory. The liquid cytology method allows you to obtain more accurate results and the ability to conduct additional examinations of the epithelium if necessary.

Interpretation of a cytological examination of a cervical smear

First of all, deciphering the cytological analysis consists of assessing the biological material (normal or unsatisfactory quality). If poor quality of the smear is noted, the reason is indicated on the form. As a rule, this may be the presence of additional impurities (escudate, blood, sperm). In this case, you should take a repeat smear for cytology.

There are 2 types of classifications used when assessing the results of a cytological examination of a smear: the Papanicolaou classification and the Bethesda system. Designations of both systems may be present on the smear form, as this increases the diagnostic capabilities of the Pap test.

Papanicolaou classification

The classification of analysis results, developed by Georgis Papanicolaou, consists of 5 classes, each of which has its own assessment based on the number of identified atypical cells.

Bethesda System Classification

The Bethesda System cytological classification is used in the CIS countries in parallel with the Papanicolaou classes, and the analysis form indicates the smear score for both classifications. The advantage of the new system is that there are more detailed descriptions of cellular changes in all areas of the cervical canal.

The results of the cytological analysis also indicate the presence of microorganisms present in the smear. At the same time, microflora in cytology is not an object detailed study Therefore, if there are violations, additional tests are required.

The results of a cervical smear Pap test may indicate the presence of the following microorganisms:

• reproductive organ herpes virus;
• trichomonas (Trichomonas vaginalis);
• chlamydia;
• bacteria that cause actinomycosis (Actinomyces spp.);
• coccal flora in bacterial vaginosis;
• thrush

Also, the oncocytology analysis form may indicate a result such as dysplasia (neoplasia) of the cervix - a change in the structure, size and multilayeredness of squamous epithelial cells. Another name for the pathology is cervical intraepithelial neoplasia (CIN).

There are three degrees of severity of neoplasia:

• CIN I ( mild degree) - pathological changes are weakly expressed and are observed in the first third of the epithelium, while the surface and intermediate layers are not changed;
• CIN II (moderate) - pathology with more pronounced cellular changes affecting the second third of the epithelial tissue;
• CIN III (severe form) - the entire thickness of the epithelial layer is affected and significant structural changes in cells are observed.

When cervical intraepithelial neoplasia is detected, it must be remembered that only CIN III is considered a precancerous condition, for which it is necessary to carry out additional research and treatment.

As a rule, when pathological changes for CIN I and CIN II, no treatment is required if the woman does not have the human papillomavirus, genitourinary infections and complaints, and the vaginal microflora is normal.

In half of the cases of mild and moderate neoplasia, the cervical epithelium returns to normal within two years. In this case, a cytology smear should be performed every 3-6 months to monitor the dynamics of neoplasia.