Pap Smear Collection and Preparation: Key Points - CytoJournal (2023)

Pap Smear Collection and Preparation: Key Points - CytoJournal (1)

This Chapter Includes:

  • Brief anatomy of the female genital tract

  • Pathophysiology of the transformation zone (TZ) and the squamocolumnar junction (SCJ)

  • Types of cervicovaginal smears

  • Collection devices

  • Prerequisites and precautions while collecting a Pap smear

    • Basic equipment required for Pap smear collection

    • Do’s and do not for women undergoing Pap smear

    • Do’s and do not of Pap smear collection for the medical personnel

  • Technique of collecting a Pap smear

  • Tips for gynecologists.

INTRODUCTION

The “Pap test saves lives.” In 1940’s, Dr. G. N. Papanicolaou first developed the technique of collecting, fixation, and staining of cervical cells (Pap smear). Today, it has become a revolutionary technique and a method of choice for the diagnosis of precancerous and cancerous changes in the uterine cervix. No other test has been as successful in stamping out cervical cancer, through the detection of treatable precursor lesions, provided screening is done regularly. A long window of opportunity exists during which regular screening, detection, diagnosis, and management of precursor lesions leads to prevention of invasive cancers and related deaths.

The Pap smear can be used as a screening test for:

  • Population screening by organizing camps in urban and rural areas.

  • Opportunistic screening method – meaning that all eligible women visiting any hospital or any gynecology outpatient department for any other reason undergoes a Pap smear.

  • Pap test is included in regular corporate/non-corporate health checkups.

The first two are more commonly adopted in developing countries where organized screening programs do not exist.

Screening using a Pap test – either conventional or liquid-based cytology (LBC) has stood the test of time. A systematically collected smear from the SCJ, well fixed, and well stained is still the best method to detect abnormalities in the cervical epithelium preceding invasive cancer. These abnormalities can be then confirmed through a directed biopsy, collected during colposcopy, and later ablated either by cryotherapy or loop electrosurgical excision procedure/large loop excision of the TZ.

BRIEF ANATOMY OF THE FEMALE GENITAL TRACT

The female genital tract is composed of the vulva, the vagina, the uterus, the fallopian tubes, and the ovaries [Figure 1]. The fallopian tubes, the uterus, and the upper two-third of the vagina develop from two embryonal structures, the Mullerian (paramesonephric) ducts. The caudal portion of the two Mullerian ducts fuses to form the uterus and proximal vagina. The upper part however remains separated to form the fallopian tubes. Imperfect fusion of the ducts results in formation of vagina septus and uterus septus. The fused ducts contact the urogenital sinus forming the lower vagina and vestibule.

Pap Smear Collection and Preparation: Key Points - CytoJournal (2)

Pap Smear Collection and Preparation: Key Points - CytoJournal (3)

Figure 1:: Anatomy of female genital tract and the location of cervical cancer.

The vulva

The vulva is the external portal of entry to the female genital tract. It comprises labia majora and minora, both covered with keratinizing squamous epithelium. The outer surface of labia majora is hair bearing and inner surface contains numerous sebaceous and apocrine glands. The outer surfaces of the labia minora have sebaceous glands, whereas the inner surfaces blend with the vagina. The labia show pigmentation from the age of puberty, diminishing on the inner aspect of the labia minora where only a thin layer of keratin is present. This epithelium extends to cover the vestibule as far as the hymen. Located anteriorly between the labia minora is the female counterpart of the penis, the clitoris, provided with a retractile, prepuce-like structure. Located about 1 cm behind the clitoris is the opening of the urethra, the terminal portion of the urinary tract. The lymphatic drainage of the vulva is to the inguinal lymph nodes, which are the primary site of metastases in malignant tumors of the vulva.

The vagina

The vagina opens into the vestibule of the vulva. Mucin secreting glands are present on either side of the vaginal introitus, including Bartholin’s glands, which are situated in the lower vaginal wall, providing protection and lubrication. The vagina is lined by non-keratinized squamous epithelium. It is hormonally sensitive undergoing cyclic changes in reproductive age group and atrophies with menopause.

The cervix

The cervix is a cylindrical structure of approximately 4 cm in length and 3 cm in diameter. It has outer surface embedded within the vagina called as ectocervix or portio vaginalis visible during vaginal examination. It is covered by stratified squamous epithelium. The rest of it is continuous with the body of uterus. The parts of cervix include ectocervix, endocervix (the canal inside the cervix), external os (opening of endocervix in the vagina), and the internal os (opening of endocervix within the uterus). The endocervix is lined by simple columnar glandular epithelium. The protrusion of the cervix into the vagina creates folds of tissues known as fornices with one anterior, two lateral, and one posterior fornices. Exfoliated cells tend to pool in the secretions collected in these fornices. Inside the endocervix deep infoldings of the mucosa called as plicae palmatae travel up to the stroma forming crypts that look like branching glands. The canal is narrow measuring only 2–3 mm and often filled with mucus plug the physical properties of which changes with the ovulation timing.

PATHOPHYSIOLOGY OF THE TZ AND THE SCJ– [Figure 2]

Pap Smear Collection and Preparation: Key Points - CytoJournal (4)

Pap Smear Collection and Preparation: Key Points - CytoJournal (5)

Figure 2:: (a) Cervical changes after puberty (ectropion) (a1) and histopathology of normal squamocolumnar junction (SCJ) (H and E) (a2). (b) Islands of metaplastic changes within the ectropion in cervix leads to formation of new SCJ (b1). Histopathology showing metaplastic squamous epithelium overlying the glands (H and E) (b2). (c) Macroscopically rounded nodules on ectocervix (blue arrows), which are distended mucous glands (nabothian follicles). Black arrow is showing the new SCJ after the healing of ectopy (c1). Histopathology showing the distended mucous glands (blue arrow) (H and E) (c2). (d) Entry of human papillomavirus through breach in the squamous epithelium. (e and f) Position of SCJ and transformation zone before and after menopause, respectively.

The SCJ is the point at which the cervical squamous and glandular epithelium meet. The location of the junction is more dependent on the age of the patient. Before puberty, the junction is normally at the external os. After puberty, the cervix changes its shape and the endocervical mucosa is exposed on the portio vaginalis, where it is visible as a red zone known as ectropion or eversion. It is sometimes mistakenly called an erosion, although no actual ulceration is present and the condition is essentially physiological [Figure 2a1 and a2, b1 and b2, c1 and c2].

Healing of the exposed endocervical epithelium (ectopy) occurs under the influence of acidic pH of the vagina. The glandular epithelium undergoes metaplastic change to squamous epithelium by differentiation of the reserve cells to a more sturdy squamous epithelium leading to the formation of a new SCJ [Figure 2b1 and b2]. This can also be due to recurring infections and repeated trauma of parturition.

The SCJ is of crucial significance for cervical cancer pathogenesis. The area between the native SCJ/or previous SCJ and the newly formed SCJ is known as the TZ. The reparative/regenerative changes that take place within the TZ and especially at the newly formed SCJ make this region prone to not only infections but also to the entry for the human papillomavirus [Figure 2c1 and c2]. Most of the precancerous and cancerous changes take place within the TZ and at the SCJ. Hence, the collection of cells from this area is of crucial importance. Glands with orifices obstructed by the metaplastic process are prone to distend with mucus, even becoming visible macroscopically as rounded nodules on the ectocervix, known as nabothian follicles [Figure 2d].

After the menopause, the cervix shrinks and the SCJ recedes higher up into the endocervical canal [Figure 2e and f]. The reliability of cervical cytology for the detection of precancerous lesions strongly depends on the proper sampling of the TZ and SCJ, immediate wet fixation, and staining of the smear.

TYPES OF CERVICOVAGINAL SMEARS

  1. Pancervical smear: This is the most common and widely accepted method of collection. In this, cells are collected from the complete SCJ and the adjacent TZ. However, fallacies remain in the adequate sampling of cervices of:

    1. Postmenopausal women (in whom the SCJ recedes higher up in the canal) [Figure 2f]

    2. Nulliparous women with pinpoint external os

    3. Patients who have undergone lower segment cesarean section (LSCS) and thereby have a pinpoint external os

    4. And when endocervical brush alone is used as a sampler. In the latter case, the brush may not collect cells from the SCJ and TZ

  2. Posterior vaginal pool smear: This helps in studying cells rolling down the entire female genital tract including cells from ovarian tumors

  3. Lateral vaginal wall smear: It is collected from the junction of upper one-third and lower two-thirds of vagina. It is recommended for hormonal assessment

  4. Endocervical smear: It is collected from the endocervical canal only

  5. Vaginal vault smear: It is collected from patients who have undergone hysterectomy

  6. Blind vaginal smear: It is collected from nulliparous, virgins, or patients having stenosed vagina

    (Video) Cervical Cytology #1

  7. Endometrial aspiration smear: It is collected from patients complaining of postmenopausal bleeding or dysfunctional uterine bleeding (DUB) or suspected of having endometrial carcinoma.

COLLECTION DEVICES [Figure 3][1]

Pap Smear Collection and Preparation: Key Points - CytoJournal (6)

Pap Smear Collection and Preparation: Key Points - CytoJournal (7)

Figure 3:: (a) Cotton swabs for collection of smear from the transformation zone, (b) Ayer’s spatula, (c) Szalay’s spatula of different sizes. (d) Cytobrush, (e) Cervex brush.

A host of collection devices is available for collection of cells from the cervix, for example, the Ayer’s spatula, the Szalay plastic spatulas of different sizes, cotton swabs are also used at some centers and cytobrushes and brooms of different varieties and sizes are available in the market. Any one of these may be used as per the personal choice of the gynecologists, requirement of that particular cervical lesion, and also the cost and availability of the device. The basic aim is to augment sampling of the complete TZ as well as the SCJ and cause least possible trauma to the cervical and endocervical epithelium during its use. However, each of these devices has its own advantage and disadvantage.

  1. Cotton swab [Figure 3a]: The applicator sticks are thin bamboo sticks, approximately 12 inches long

  • Ayer’s spatula [Figure 3b]: It is a bifid wooden or plastic spatula with one end longer than the other. It is the most commonly used device. Similar such device is Szalay’s spatula [Figure 3c].

Disadvantage: Occasionally traumatic to the cervical/ endocervical epithelium and also if the tip is not fit properly into the external os of the cervix, it may fail to scrape cells from TZ. Causes bleeding when cervix is inflamed.

  • Endocervical brushes: It includes cytobrush and Cervex brush.

    1. Cytobrush [Figure 3d]: It is used for sampling of cells from the endocervical canal. It has a narrow tip covered with delicate bristles and is easy to introduce in the endocervical canal

    2. Cervex brush [Figure 3e]: It is a broom-like device composed of soft plastic filaments. The central bristles of the broom are inserted into endocervical canal whereas lateral bristles bend against the ectocervix.

PREREQUISITES AND PRECAUTIONS WHILE COLLECTING A PAP SMEAR

Basic equipment required for Pap smear collection [Figure 4]

Pap Smear Collection and Preparation: Key Points - CytoJournal (8)

Pap Smear Collection and Preparation: Key Points - CytoJournal (9)

Figure 4:: Equipment required for Pap smear collection.

  1. Sterilized dry bivalve Cusco speculum

  2. Clean glass slides labeled with a diamond pencil

  3. Sterilized cotton tipped applicator/sticks/Ayres spatula or a Cervex brush

  4. A wide mouth specimen bottle with fixative (absolute alcohol) or commercial instant spray fixative

  5. Normal saline

  6. Glass marking diamond pencil

  7. Hanging drop slide and 22 × 22 mm glass coverslips to check for Trichomonas vaginalis

  8. Curved metal cannula or a disposable plastic endometrial aspirator (in case of endometrial cytology).

Do’s and do not for women undergoing Pap smear: Instruct the women

  1. To come during the postmenstrual period or best between the 14th and 28th day of cycle (premenstrual period)

  2. Not to come when there is active bleeding. First 3–4 days of menstruation are best avoided although not a contraindication

  3. To avoid intercourse on the previous day as the contamination with semen material like sperms [Figure 5] can obscure squamous cell morphology and large seminal vesicle cells can mimic atypical squamous cells, as these cells are large and bizarre looking with large polypoid smudged nuclei and almost black chromatin. The clue to identify these cells is presence of cytoplasmic golden brown lipochrome pigment and accompanying sperms

  4. To avoid douching with any antiseptic solution

  5. To avoid use of pessary

  6. Not to insert any vaginal tablets as a part of ongoing treatment (need to be withheld or smear collection is done after completion of treatment)

  7. Not to come if a per vaginal examination is done in the past 24 h

  8. Or a cervical biopsy or cryotherapy or any other procedure has been done in the past 6 weeks. Regeneration atypia in squamous cells can be a cause of overinterpretation of epithelial abnormalities.

Pap Smear Collection and Preparation: Key Points - CytoJournal (10)

Pap Smear Collection and Preparation: Key Points - CytoJournal (11)

Figure 5:: Liquid-based cytology preparation: Smear showing clumps of sperms obscuring the squamous cell morphology (×40).

(Video) Preparing a cytology smear

Do’s and do not for the medical personnel engaged in Pap smear collection

  1. In addition to sociodemographic details, the cytology requisition form must include

    1. Contact details such as mobile number and address

    2. Age of the patient

    3. Clinical history in short like parity, last child birth, biopsy, previous cytology or histopathology reports, and colposcopy findings (if any)

    4. Date of last menstrual period and menstrual history

    5. History of contraception such as use of intrauterine device, oral pills, and barrier contraceptives

    6. Per speculum and per vaginal findings

    7. Exact anatomical site of smear and type of device used

  2. Do not use lubricated Speculum. The lubricant jelly can cause artifacts in the smear

  3. Smear is collected as the first step after inserting and positioning of the speculum and before any vaginal examination is done. The glove powder can come as contaminant in the smears and may mimic abnormal cells like koilocytes [Figure 6]

  4. Use spatula of suitable size and shape as per the size and shape of the cervix.

  5. Smear should not be collected immediately after curettage or biopsy

  6. The glass slide, speculum, and spatula should be absolutely dry as the presence of water or moisture on these destroys the cells and hampers cellular details

  7. Immediate wet fixation is mandatory [Figure 7]

  8. Slides must be fixed, that is, dropped immediately in the bottle containing the fixative to avoid air drying artifacts in the smear. Partial or complete air drying of cells because of delay in fixation leads to poor staining of nucleus and the cytoplasm. A bottle of absolute alcohol needs to be kept ready or LBC vial has to be ready at hand so that there is no delay in immersing the slide in alcohol or brush in the vial respectively

  9. If for any reason there is delay in fixation of the smear, do not put it in alcohol. Instead it is safe to allow the Slide to DRY COMPLETELY and sent to the laboratory (wrapped in a paper). This also avoids the hurry and worry of immediate wet fixation that sometimes leads to the spillage of alcohol from jars.[2]

  10. Smears should be uniformly thin and the material collected should be evenly distributed.

  11. Avoid smearing purulent material alone on the slide [Figure 8a and b]. Too many inflammatory cells obscure morphologic details of epithelial cells and also result in altered staining of the squamous cells [Figure 9a]

Pap Smear Collection and Preparation: Key Points - CytoJournal (14)

Pap Smear Collection and Preparation: Key Points - CytoJournal (15)

Figure 7:: Immediate wet fixation of slide in a Coplin jar containing 95% absolute alcohol is the most crucial step.

Pap Smear Collection and Preparation: Key Points - CytoJournal (16)

Pap Smear Collection and Preparation: Key Points - CytoJournal (17)

Figure 8:: (a) Inflamed cervix with purulent discharge on the surface, (b) same cervix after treatment of infection showing a well-demarcated squamocolumnar junction.

Pap Smear Collection and Preparation: Key Points - CytoJournal (18)

Pap Smear Collection and Preparation: Key Points - CytoJournal (19)

(Video) Impression smear making

Figure 9:: (a) Conventional Pap smear showing plenty polymorphonuclear leukocytes and altered staining in the form of polychromasia of squamous cells when the purulent material is spread on the slide. (b) Normal Pap smear showing leukocytes in a streaming pattern with normal squamous cells and a leukocyte free background.

Note: Leukocytes are however present even in normal Pap smears [Figure 9b]. The healthy white discharge comprises of leukocytes and is seen in the conventional Pap smear in a linear or circular fashion (used to prepare the smear). The background shows squamous cells free of polymorphs. The polymorphs are healthy and do not show degenerative changes like cytoplasmic vacuolation that is seen in an inflammatory smear.

TECHNIQUE OF COLLECTING A PAP SMEAR [Figure 10][3]

Pap Smear Collection and Preparation: Key Points - CytoJournal (20)

Pap Smear Collection and Preparation: Key Points - CytoJournal (21)

Figure 10:: Diagrammatic representation of the method of Pap smear collection.

  1. Explain the procedure to the patient and take a verbal or informed consent

  2. The patient is instructed to sleep in a lithotomy position – ideally on a PV table

  3. A Sim’s speculum or a bivalve Cusco’s speculum is inserted in the vagina and the cervix is exposed with gentle maneuvering of the speculum. Use of Cusco speculum makes one “hands free.”

  4. The long end of the tip of any of the spatulas mentioned above or the tip of the brush is put in the endocervical canal and fixed gently but firmly and then rotated clockwise through 360° 2–3 times [Figure 11a and b] and 5 times if the Cervex brush of Surepath [Figure 11c] is used. With the cytobrush and Cervex brush –reverse rotation during the procedure is strictly prohibited as it may leave behind those cells that are collected in the previous rotations

  5. The material is spread in a circular or linear fashion in the central 2/3rd area of the glass slide leaving the edges of the glass slide free of material [Figure 12a and b].

  6. For LBC preparation, the Cervex brush is broken away or detached from the stick and tip of the Cervex brush is dropped in the LBC vial containing fixative [Figure 13a and b]

  7. The conventional smear is immediately fixed in absolute alcohol. Delay in fixation causes air drying artifacts and there is clouding of morphological details

  8. However, if there is shortage of alcohol or constant failure to provide “good quality wet fixed smears,” then the smear may be totally air dried. The air dried smears are rehydrated in the laboratory

  9. For spray fixing of the slide, spray should be kept at an angle of 45° and at a distance of 6 inches from the slide [Figure 14]

Pap Smear Collection and Preparation: Key Points - CytoJournal (22)

Pap Smear Collection and Preparation: Key Points - CytoJournal (23)

Figure 11:: The method of Pap smear collection. (a) Long end of the Szalay’s plastic spatula is seen fixed firmly in the endocervical canal and rotated clockwise through 360°, (b) The long end collects cells from the squamocolumnar junction even if it is higher up in the canal. (c) Soft bristles of Cervex brush of SurePath fit snugly on the contours of the cervix and when it is rotated 5 times through 360°, it collects cells from the complete transformation zone and also from the endocervical mucosa lining the canal.

Pap Smear Collection and Preparation: Key Points - CytoJournal (24)

Pap Smear Collection and Preparation: Key Points - CytoJournal (25)

Figure 12:: (a and b) Material is spread in a circular or linear fashion on a glass slide for preparing conventional smears.

Pap Smear Collection and Preparation: Key Points - CytoJournal (26)

Pap Smear Collection and Preparation: Key Points - CytoJournal (27)

Figure 13:: a. SurePath TM ( superscript TM)LBC vial. b.Head of Cervex brush being detached. c. LBC vial with brush dropped into the fixative.

Pap Smear Collection and Preparation: Key Points - CytoJournal (28)

Pap Smear Collection and Preparation: Key Points - CytoJournal (29)

(Video) Impression Smear for Cytologic Evaluation

Figure 14:: Spray fixation. Spray the slide before it gets dry. Note the angle and the distance of the spray.

The requisition form must mention the mode of preservation of the slide as the steps in the processing of the smear in the laboratory are different depending on the mode of fixation of the smear.

Tips for the gynecologists

The clinician or the paramedical personnel are the best judge as to whether or not the cervix can be scraped, for example, when it is highly inflamed and angry looking or covered with copious purulent discharge as seen in Figure 8, it is better to call the patient 6 weeks after treatment with antibiotics. Repair of the epithelium leads to clear visualization of the SCJ and TZ and there are less chances that the smear will be unsatisfactory for evaluation due to obscuring inflammation or blood and less number of squamous cells. However, a fair judgment needs to be taken that the patient will return after a course of antibiotics, lest we may lose the chance of screening a high-risk patient.

Similarly when attempting to collect smear from a post-menopausal woman [Figure 16], or from a patient of prolapse uterus [Figure 17], if the cervix is dry and the epithelium is thin and parchment like [Figure 18], scanty material is scraped and transferred on the glass slide. In such a situation, local application of estrogen cream is advised for at least 3 weeks before taking a repeat smear. This enhances both – the maturation of the epithelium and exfoliation of cells.[4]

Pap Smear Collection and Preparation: Key Points - CytoJournal (30)

Pap Smear Collection and Preparation: Key Points - CytoJournal (31)

Figure 15:: Colposcopic appearance of Inflamed and angry looking cervix after application of 5% acetic acid. The smears from such a cervix show partial or totally obscuring blood and inflammatory cells.

Pap Smear Collection and Preparation: Key Points - CytoJournal (32)

Pap Smear Collection and Preparation: Key Points - CytoJournal (33)

Figure 16:: Liquid-based cytology preparation: The atrophic smear at times shows less number of squamous cells and significant amount of granular cytolytic material in the background. This is because of dryness of the squamous epithelium.

Pap Smear Collection and Preparation: Key Points - CytoJournal (34)

Pap Smear Collection and Preparation: Key Points - CytoJournal (35)

Figure 17:: Liquid-based cytology preparation: Smear from prolapsed cervix, showing scanty cellularity and anucleate squames mostly singly and in compact clusters.

Pap Smear Collection and Preparation: Key Points - CytoJournal (36)

Pap Smear Collection and Preparation: Key Points - CytoJournal (37)

Figure 18:: Hemorrhagic spots beneath the dry and thin epithelium of an atrophic cervix.

References

  1. Koss LG, Melamed MR. The normal female genital tract In: Koss L, Melamed M, eds. Koss’ Diagnostic Cytology and its Histopathologic Bases (5th ed). Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 183-225.

    [Google Scholar]
  2. Koss LG, Melamed MR. Laboratory techniques In: Koss L, Melamed M, eds. Koss’ Diagnostic Cytology and its Histopathologic Bases (5th ed). Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 1569-634.

    [Google Scholar]
  3. Naib ZM. Pap test In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed). Ch. 178 Boston: Butterworths; 1990.

    [Google Scholar]

FAQs

What are the preparations before Pap smear? ›

Avoid intercourse, douching, or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a Pap smear, as these may wash away or obscure abnormal cells. Try not to schedule a Pap smear during your menstrual period. It's best to avoid this time of your cycle, if possible.

What are the 3 types of specimens for Pap smear? ›

Acceptable specimens for the Pap Test include cervical, cervical and vaginal, endocervical, vaginal and/or vulvar scrapings or brushings.

What is Pap smear PDF? ›

A Pap smear, also known as Papanicoloau smear, is a microscopic examination of cells scraped from the cervix and is used to detect cancerous or pre-cancerous conditions of the cervix or other medical conditions.

How are cells collected for Pap smear? ›

Pap test. A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to collect cells from the cervix. The cells are checked under a microscope for signs of disease.

What is the full form of Pap test? ›

The Papanicolaou test (abbreviated as Pap test, also known as Pap smear (AE), cervical smear (BE), cervical screening (BE), or smear test (BE)) is a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix (opening of the uterus or womb) or colon (in both men and women) ...

What is Pap smear used for? ›

The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.

Why is it called a Pap smear? ›

A Pap smear or Pap test is a screening test for cervical cancer. It is named after Georgios Papanikolaou, the doctor who determined its use in detecting early signs that could lead to cervical cancer.

How do you prepare a slide for a Pap smear? ›

Rotate a spatula 360° once to obtain a single sample. Smear the sample onto the labeled slide. Fix the sample immediately (before it is air-dried) using a cytology spray fixative. Hold the fixative 15-20 cm (6 to 8 inches) away from the slide and evenly spray the slide by depressing the plunger 2 or 3 times.

How do you read a Pap smear? ›

A Pap test result can be normal, unclear, or abnormal.
  1. Normal. A normal (or “negative”) result means that no cell changes were found on your cervix. ...
  2. Unclear (ASC-US) It is common for test results to come back unclear. ...
  3. Abnormal. An abnormal result means that cell changes were found on your cervix. ...
  4. Negative. ...
  5. Positive.

What is liquid Pap smear? ›

Liquid-based cytology (LBC) is a new method of preparing cervical samples for cytological examination. Unlike the conventional 'smear' preparation, it involves making a suspension of cells from the sample and this is used to produce a thin layer of cells on a slide.

What is the most current guideline for Pap smears? ›

Cervical cancer testing (screening) should begin at age 25. Those aged 25 to 65 should have a primary HPV test* every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Papanicolaou (Pap) test every 5 years or a Pap test alone every 3 years.

How do you perform a Pap smear spatula? ›

Obtain an adequate sampling from the ectocervix using a plastic spatula by placing the rounded tip of the spatula into the cervix until the curved edge of the spatula rests against the ectocervix. Rotate the spatula 360 degrees.

What are the five categories of Pap smear abnormalities? ›

There are five main categories of abnormal Pap smear results within the Bethesda system:
  • Atypical squamous cells of undetermined significance (ASC-US). ...
  • Squamous intraepithelial lesion (SIL). ...
  • Atypical squamous cells that may or may not be HSIL (ASC-H). ...
  • Atypical glandular cells (AGC). ...
  • Cancer.
3 Jan 2019

Who needs Pap smear test? ›

Women should start Pap smear screening at age 21. Between the ages of 21-29, women whose Pap smears are normal only need it repeated every three years. Women ages 30 and over should have testing for the human papillomavirus (HPV) with their Pap smear. HPV is the cause of cervical cancer.

How much is Pap smear? ›

The cost of a Pap smear varies but not too much. All in all, it should cost less than $100 with insurance in the United States. If you're paying out of pocket, expect the costs to range from $25 to $150. And don't forget there may be medical facilities in your area that offer Pap smears at a lower cost or at no cost.

How many types of Pap smears are there? ›

There are two types of tests: the Pap test and the HPV test. For both, the doctor or nurse collects cells from the surface of the cervix. With the Pap test, the lab checks the sample for cancer cells or abnormal cells that could become cancer later. With the HPV test, the lab checks for HPV infection.

When was the first Pap smear? ›

The Papanicolaou smear, a routine screening test for cancer of the uterine cervix, was reported in 1928, and its efficacy was proved by 1941. Since then, it has been used worldwide as a clinical tool for the early detection of cancer.

What is a male Pap smear called? ›

The lesser-known cousin to the cervical Pap smear, an anal Pap test—or more technically, anal cytology—is a screening test that collects cells from the anal canal to determine if you have anal cancer or are at risk of getting it.

What causes an abnormal Pap smear? ›

In most cases, an abnormal Pap test is a result of: A human papillomavirus (HPV) infection. A sexually transmitted infection (STI or STD), such as herpes or trichomoniasis. A bacterial or yeast infection.

What happens after a Pap smear? ›

A Pap smear is very safe, and most people only experience mild cramping during the procedure. Some people experience more intense cramping that is similar to or worse than that during a period. Others may notice that the cramping lasts for 1–2 days after the test. There are typically no other side effects.

Can Pap smear detect pregnancy? ›

No, a cervical screening test detects abnormal changes to the cells within your cervix. It can't detect pregnancy, however if you are pregnant smear tests are not recommended.

Who invented smear tests? ›

Today's Google Doodle pays tribute to the Greek medical pioneer Georgios Papanikolaou, who invented the smear test to detect early signs of cervical and uterine cancer. Mr Papanikolaou was born in the Greek costal town of Kymi on this day in 1883.

How effective is Pap smear? ›

Magnitude of Effect: Regular Pap screening decreases cervix cancer incidence and mortality by at least 80%.

How do you transport a Pap smear sample? ›

  1. TRANSPORT SPECIMEN.
  2. Place specimen in transport bag and seal.
  3. Place the requisition in the pouch outside the sealed bag.
  4. Transport specimens to the laboratory by courier.

What if Pap smear is positive? ›

Abnormal Pap test results: An abnormal test result may also be called a positive test result. Some of the cells of the cervix look different from the normal cells. An abnormal test result does not mean you have cancer. Your health care provider will recommend monitoring, more testing, or treatment.

How many days Pap smear results? ›

Pap smear results. The test results usually take 1–3 weeks to come back. Most test results are negative, but they can sometimes be positive.

Can Pap smear detect infection? ›

The STIs that can be diagnosed by Pap smear are trichomoniasis, HPV infection, herpes genitalis, candidiasis, and bacterial vaginosis.

What are symptoms of HPV in females? ›

But when HPV does not go away, it can cause health problems like genital warts and cancer. Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower.

What is the treatment for abnormal Pap smear? ›

If there are moderate to severe changes in your cervix, your doctor may want to remove the cervical tissue. Typically, your doctor will use the Loop Electrosurgical Excision Procedure (LEEP), or perform a cold knife cone biopsy as a minor surgical procedure.

What is inflammatory smear? ›

Inflammation. If inflammation (redness) is present in the cells on the Pap smear, it means that some white blood cells were seen on your Pap smear. Inflammation of the cervix is common and usually does not mean there is a problem.

What age stop Pap smears? ›

The only sure way to find out if you have cervical cancer is to get a screening test (a Pap test and/or an HPV test). If you are a woman who has not had her cervix removed by surgery (a hysterectomy), keep getting tested until you are at least 65 years old.

Why are Pap smears every 3 years? ›

Women ages 21 to 29 should have a Pap smear every three years to test for abnormal cell changes in the cervix. This is a shift from the “Pap smear once a year” mentality of decades past. Thanks to an abundance of research, we now know that yearly Pap smears aren't necessary for a majority of women.

Why are Pap smears every 5 years? ›

It usually takes around 10– 15 years for cervical cancer to develop as a result of HPV infection that does not clear up, so checking for HPV every five years (through a Cervical Screening Test) is a safe way to identify women who are infected with HPV.

What is a cervix brush? ›

STERIL's Cervical Brush is designed for procuring the cells for PAP cervical cancer screening. The brush end is shaped for the purpose of obtaining, in a single action, a proper cellular yield. The shoulders of the brush are meant to take cellular specimens from the ectocervix and the central extension from endocervix.

How long does a smear sample last? ›

Your cervical screening test sample is sent to a laboratory where it will be tested for HPV. If HPV is found, the same sample will then be examined for cell changes. Your sample will be kept for at least 10 years to compare tests at different times.

Which fixative is used to fix a Pap smear slide? ›

A 95% solution of ethyl alcohol or spray fixative is used to fix the slide. The slides should be labeled in pencil with the patient's name AND date of birth and a properly completed Pap smear requisition should accompany the slide.

What is the percentage of abnormal Pap smears? ›

About 5% of all Pap tests will be abnormal, meaning that the sample contains atypical cervical cells. However, the majority of these cells are not cancerous or even precancerous. An abnormal Pap test result does not mean cancer, but it does require follow-up to rule out the possibility of cancer.

What is high risk HPV? ›

High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

Can I get Pap smear on period? ›

Technically, you can get a Pap smear while on your period, but it may be better to reschedule to a time when you aren't menstruating. Depending on how heavy your flow is, it may affect the results of your screening.

Is it normal to bleed after Pap smear? ›

Bleeding or spotting after a Pap smear isn't unusual, even for people without infections, cancer, or other conditions. The delicate tissues of your cervix can bleed after a brush or swab scratches the surface.

Is Pap smear test painful? ›

The Pap smear shouldn't hurt, but it might be uncomfortable. The good news is, it's over quickly.

What should I wear to a Pap smear? ›

According to the Mayo Clinic, doing any of these things within two days of your test may obscure or even wash away potential abnormal cells your doctor will be swabbing for. To ensure your comfort, it's suggested that you wear easily removable clothing to your appointment (like leggings and a simple t-shirt).

Should I shower before a Pap smear? ›

Do not use douche, bubble bath, or use vaginal medicine for three days before Pap test. You may shower, but do not tub bathe 24 hours before the Pap test.

Do I need to shave before a Pap smear? ›

It doesn't take much to prepare for a pap smear. Some women may feel like they need to shave their pubic hair, but it's unnecessary for this test. You should only tackle it if you'll be more comfortable. Your doctor has seen it all, so a little bit of pubic hair won't bother him.

How do you prepare a slide for a Pap smear? ›

Rotate a spatula 360° once to obtain a single sample. Smear the sample onto the labeled slide. Fix the sample immediately (before it is air-dried) using a cytology spray fixative. Hold the fixative 15-20 cm (6 to 8 inches) away from the slide and evenly spray the slide by depressing the plunger 2 or 3 times.

What should I wear to a Pap smear? ›

According to the Mayo Clinic, doing any of these things within two days of your test may obscure or even wash away potential abnormal cells your doctor will be swabbing for. To ensure your comfort, it's suggested that you wear easily removable clothing to your appointment (like leggings and a simple t-shirt).

What is the best time to do Pap smear? ›

The best time to schedule your Pap test is at least 5 days after the end of your menstrual period. A Pap test can be done during your menstrual period, but it is better to schedule the test at another time.

What should I avoid after a Pap smear? ›

Avoid sex and don't use a tampon in the two to three days following a Pap smear if you're experiencing bleeding. The additional pressure may cause bleeding to start again or become heavier.

Is Pap smear painful? ›

The Pap smear shouldn't hurt, but it might be uncomfortable. The good news is, it's over quickly.

How can I relax during a Pap smear? ›

Breathing deeply can soothe your nerves, so try to focus on your breath. Try to relax your pelvic muscles. It may feel instinctual to squeeze your pelvic muscles when you feel pain or discomfort, but squeezing could add pressure to your pelvic region. Deep breathing may help you relax your muscles.

Do doctors care about pubic hair? ›

The truth is that your doctor and their staff do not care if you are clean-shaven or not. They are medical professionals. They know that hair growth is natural and normal. It doesn't hinder their ability to do their job, and it doesn't harm your health.

Is it normal to get wet during a pelvic exam? ›

There is nothing wrong with you. Your body's natural response of lubrication in this particular case has nothing to do with whether you are aroused by your doctor or the examination itself. Also, some women lubricate more than others and that is normal too.

Why is it called a Pap smear? ›

A Pap smear or Pap test is a screening test for cervical cancer. It is named after Georgios Papanikolaou, the doctor who determined its use in detecting early signs that could lead to cervical cancer.

How do you use a Pap smear brush? ›

Obtain an adequate sampling from the cervix using the broom-like device. Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. Push gently and rotate the broom in a clockwise direction five times.

How much is Pap smear? ›

The cost of a Pap smear varies but not too much. All in all, it should cost less than $100 with insurance in the United States. If you're paying out of pocket, expect the costs to range from $25 to $150. And don't forget there may be medical facilities in your area that offer Pap smears at a lower cost or at no cost.

Can I get Pap smear on period? ›

Technically, you can get a Pap smear while on your period, but it may be better to reschedule to a time when you aren't menstruating. Depending on how heavy your flow is, it may affect the results of your screening.

At what age do you get Pap smear? ›

Women should start Pap smear screening at age 21. Between the ages of 21-29, women whose Pap smears are normal only need it repeated every three years. Women ages 30 and over should have testing for the human papillomavirus (HPV) with their Pap smear. HPV is the cause of cervical cancer.

Can a Pap smear cause a period? ›

A person who has a Pap smear a few days before their period may notice light spotting after the test, with heavy bleeding following a few days later. This type of bleeding may be coincidental and not a sign of a serious problem.

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