A smear for atypical cells deciphering the cytogram of inflammation. Cytology smear

Women's health requires the constant intervention of narrow medical specialists. When a woman is pregnant, she consults a gynecologist; when she gives birth, obstetricians come to the rescue. During professional examinations of the fair sex, mammologists and the same gynecologists must examine them. Health is priceless, which is why we care about it so much. Recently, a disease such as cancer is destroying more and more bright hopes for a great future. Oncology of the uterus or mammary glands is dangerous because in the early stages it cannot be determined if you do not periodically come for examinations.

Science cytology to aid diagnosis

Cytology is not entirely medical science. Rather, it is more biological, but it is important for the diagnosis of various diseases. This science deals with the study of the structure and basic functions of living cells. Under the microscope, the entire cycle of the cell's existence is determined. From its very inception to aging and death. Special meaning pays attention to the reproduction of living cells, the presence of organelles, the emergence of any pathological processes in their functioning.

Medicine actively uses the developments of this science for its diagnostic purposes. Today, cytological examinations of scrapings from the cervix are widely used. Knowledge of the structure and structure of cells makes it possible to develop innovative technologies in the treatment of dangerous diseases. Cytology has become a branch of laboratory research. It does not give any predictions, but is only descriptive. Oncocytology has become a new section - a science that helps to diagnose neoplasms as soon as they appear.

Cytological research in gynecology

With pathologies of the cervix or suspicion of them, a cytological examination of a smear is performed. Before the beginning and end of the treatment of gynecological diseases, as well as during the usual routine medical examination, a smear for cytology is mandatory. This study assesses the condition of the cells of the cervix and other female organs.

For the first time such an analysis was performed in the thirties of the last century. And the first classification of cells taken for cytological research was published in 1954. It was changed several times, and its present version was developed in 1988. According to this version, the cells of the cervix are divided into different classes that characterize the degree of atypicality, ranging from normal and ending with invasive cancer. These data are of great diagnostic value and allow choosing the most effective therapy.

Examination of cervical cells using a smear

A smear is taken during colposcopy or vaginal examination. The procedure itself is performed under a microscope. Epithelial cells tend to constantly renew, that is, slough off. They appear in the lumen of the cervix and in the vagina. The structure of these cells is such that microscopy can identify both healthy and atypical elements.

One of the simplest and most minimally invasive research methods, which is not accompanied by discomfort, is the Pap test. This procedure detects the possibility of degeneration of cervical cells into cancer.

Also, using this test, you can diagnose a tumor process in other female organs, for example, in the uterus or ovaries. Unfortunately, the dad test is not always accurate. There have been situations when, after several negative results, a woman was still diagnosed with cervical cancer. But, perhaps, such incidents happened due to the wrong taking of the material. Malignant transformation begins from the lower layers and gradually grows upward. If we take only the surface layer, then only malignant changes at the final stage can be noticed.

Scraping for cytological examination

The material for cytological examination of the smear is taken with a brush and a special spatula, with which the cells located in layers are scraped with pressure. During this procedure, a lot of material from the cervix gets onto the glass, the structure of which does not change.

This process is completely painless. The cells are scraped off in several places and put on a glass slide. After that, the drug is fixed with a special solution and stained with dyes. Then the smear is sent for research.

The result of a cytological examination may indicate the presence of atypical cells, which occur with severe inflammation or cancer.

How is the examination of cervical cells carried out?

Cryocauterization is absolutely not a dangerous and painless procedure. It consists in the fact that the affected areas of the cervical tissue are frozen with a special probe. Then they flake off.

Also, after a cytological examination of the cervix with the help of scraping, the gynecologist can prescribe such additional procedures as laser therapy and excision of the pathological area with a loop.

The article describes one of the main methods for diagnosing cancer. The essence of the cytological study is explained, the norms for the indicators are given and the decoding of the analysis results is explained.

Probably, in the modern world, there is no adult person who, in one way or another, has not encountered such a concept as oncology. According to the statistics of the Ministry of Health, every day this diagnosis kills about a thousand of our compatriots, at the same time, the number of victims from cancer every week on the whole planet exceeds one hundred and forty thousand people. In connection with such deplorable statistics, scientific medicine considers the research of oncological diseases a priority in order to prevent and treat them. The most common way to identify cancer health problems is to examine cells suspected of being affected by the disease.

What is cytological analysis

As the biology teacher explained, cytology is a branch of biology aimed at studying the cells of the human body. Analysis for cytology is a method for identifying all kinds of pathologies in the cellular structures of the internal organs of the body. The results obtained with the help of cytological analysis provide information about the state of health of the organs, the stage of the course and the nature of the possible disease. By analogy, the analysis for histology provides information about diseases of the tissues of the body.

Positive features of the analysis for cytology:

• Large percentage of reliability;
• Does not require surgical intervention;
• Simplicity of the procedure for collecting material - the analysis can be taken directly during a scheduled gynecological examination;
• Relatively low research cost;
• High processing speed - the result, as a rule, can be obtained the very next day.

The main problem of the method of cytological research is the compulsory understanding of the affected areas of the disease. That is, even when symptoms appear, it can be difficult to identify the specific area of \u200b\u200btissue whose cell sample needs to be examined for abnormalities.

When is the cytology test done?

From the above it follows that cytological examination is of great importance in the diagnosis of cancerous and precancerous diseases. At the same time, this method helps to determine the presence of inflammation of internal organs, to timely identify developing autoimmune diseases and viral infections.

In various medical fields (gynecological, oncological, surgical), cytology analysis is used for the following purposes:

• Preventive. For example, to monitor the condition of the female genital organs, it is recommended to undergo a cytological examination at least once a year.
• Diagnostic. Cytological examination makes it possible to confirm or deny a possible diagnosis, which corresponds to the results of a visual examination or another less detailed examination. Analysis for cytology reveals structural abnormalities of cells, causes of deviations and features of the course of diseases of internal organs.
• To track the effectiveness of a therapeutic intervention. During the treatment of the disease, it is important to monitor the state of the body in order to correct the direction of therapy in time or state the fact of recovery. In oncology, it is very important to regularly undergo a cytological examination, since with its help it is possible to timely identify tendencies for relapse.

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What is the subject of cytological analysis?

The human body is a multifunctional cell formation, therefore, samples of all tissues and organs are used for analysis for cytology. The only thing necessary condition - For a successful test, the sample must be obtained from the diseased tissue site.

In connection with the source of the sampling of the material, the following classification of cytological analyzes is distinguished:

• Exfolative - analyzes, the object of study of which is the discharge obtained from various internal organs.
• Puncture - analyzes for which a surgical operation is performed - puncture. The puncture can be taken from the thyroid and mammary glands, lymph nodes, skin, joints.
• Operating rooms - analyzes, the biomaterial for which are areas of tissues and organs removed from the body during the operation.

How is a cytological examination performed?

A sample for analysis for cytology is taken from tissues and organs, the origin of which is described in the previous paragraph. The obtained biomaterial sample is placed on a glass slide and prepared for microscopic examination by removing moisture from the sample and adding a staining reagent. Such preparation can lead to partial death of the studied cells and, as a result, to distorted analysis results.

Not so long ago, the method of liquid cytology began to be used in laboratory activities. This method involves the direct immersion of the obtained sample in a special preservative, which prolongs the life of cells and protects them from external factors.

It's important to know!

The method of processing the sample for the study is the main factor in the reliability of the results. So, according to statistics, the method with drying a sample of biomaterial on a glass slide gives the correct result in 35-90 percent of cases. At the same time, the liquid method of processing biomaterial increases the reliability of the analysis up to 98%. Therefore, when choosing a diagnostic center, it is worth giving preference in favor of a more modern approach to cytological research.

• Physical indicators (cell structure, dimensions, geometric shape);
• The orientation of cells in the structure of a substance relative to each other;
• The number of cells in the field of view of the microscope;
• The presence or absence of various physiological cell abnormalities.

Decoding the results of the analysis for cytology. Normal indicators

The result of the analysis is presented to the patient as a table of the contents of the elements identified in the cell by microbiological research. Deciphering the results is simplified through the use of international bethesda systems, which assumes the same recording of the obtained indicators, compared with the normal ones, for different laboratories.

Index	What does
NILM	No malignant tumors were found. Norm
AGC	Abnormal result. Found pathologies in glandular cells
AGC, favor neoplastic	Abnormal result. Pathology in glandular cells similar to neoplasticity
AGUS-NOS	Abnormal result. Found pathologies in the cells of the glands of an unknown nature
AIS	Abnormal result. Adenocarcenoma in the cervical canal
ASC	Abnormal result. Squamous epithelial cells found
ASC-US	Abnormal result. Squamous epithelial cells of unknown nature found
ASC-H	Abnormal result. Squamous epithelial cells found, possibly HSIL present
CIN 1- 3	Abnormal result. Revealed neoplasia in the cervical canal of various stages
CIS	Abnormal result. Carcinoma detected
SIL	Abnormal result. Flat intraepithelial cells found
HSIL	Abnormal result. Flat intraepithelial cells found in high concentration
LSIL	Abnormal result. Found flat intraepithelial cells in negligible concentration
NOS	The result is characterized as undefined
VaIN	Abnormal result. Revealed neoplasia in the vagina
VIN	Abnormal result. Intraepital neoplasia in the vagina revealed

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What is a cytology smear?

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

It is recommended to take a smear for cytology for a screening examination for the first time three years after the onset of sexual activity. In Russia, it is customary to take smears for cytology on a mandatory basis from all women during a routine examination, starting from the age of 21. It is optimal to take such a smear every year during a routine examination until you reach the age of 65. Women over 65 can have a smear for cytology every 2 to 3 years, since their risk of developing the cervix is \u200b\u200breduced. However, if pathological changes are found in the smear, then the doctor may prescribe a more frequent Pap test, for example, every 3 to 6 months, until the result becomes normal.

The planned 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 a fluorography, which needs to be done periodically for the early detection of cancer or precancerous changes in the cervix, so that the maximum effective treatment in the early stages, when the disease is relatively easy to defeat. Women and girls who are carriers of the human papillomavirus oncogenic types must be sure to take a smear for cytology, at least once a year ( HPV 16, 18, 31, 33, 45, 51, 52, 56, 58 or 59), since their risk of developing the cervix is \u200b\u200bhigher than the average for the female population.

What else is a smear for cytology called?

A smear for cytology is the everyday most common name for a study, which can also be denoted by such names as a smear for cytology of the uterus, a smear for oncocytology, cytological smear, cervical swab cytology, cervical swab, Pap smear, Pap smear, Pap test, Pap smear, Pap smear.

What does a smear show for cytology?

The main purpose of a smear for cytology is to identify such pathological changes in the epithelial cells of the cervix, which over time can lead to the development of a malignant tumor. If cancer cells are detected in a smear in large numbers, then this simple analysis allows you to identify a tumor at an early stage and to carry out the necessary treatment as soon as possible. In addition to its main purpose, a smear for cytology also allows, in general, to assess the state 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 smear for cytology 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 ( for example, herpes viruses, human papillomaviruses, etc.), capable of provoking inflammatory processes.

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

Liquid cytology smear

Liquid cytology is a method of making a smear on a glass slide from a scraping from the cervix, which, like a regular smear for cytology, allows you to identify precancerous and cancerous changes in the tissues of the cervix and, accordingly, diagnose malignant neoplasms of the cervix in the early stages. In principle, we can say that liquid cytology is a type of Pap smear for cytology.

For the production of liquid cytology, the doctor scrapes the epithelial cells of the cervix with special sterile instruments ( brush), after which it washes all the material from the brush into a sterile container with a special liquid designed for long-term preservation of cells in a normal state. Then this container with the liquid is sent to the cytology laboratory, where all the liquid is centrifuged to obtain a sediment from the cells at the bottom of the tube. The liquid 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 is their nature ( for example, atypia with low or high grade, etc.).

Currently, in the USA 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 cytology has a number of advantages over a simple smear for cytology, and that is why the method has become the "gold standard" for diagnosing precancerous and cancerous lesions of the cervix. The advantages of liquid cytology in comparison with a conventional smear for cytology include factors such as the ingress of all scraped cells into the solution, long-term preservation of cells in a normal, undried form, minimal admixture of mucus, blood, destroyed cells and inflammatory elements, as well as the ability to cook more than one , but a few thin strokes. Due to these advantages, the method of liquid cytology gives a lower percentage of false negative results than a classic smear for cytology. But a smaller number of false negative results should not be taken for greater accuracy, since problems with conventional smears are caused not so much by the low information content of the biomaterial itself, but by the improper sampling and distribution of scrapings over the glass by a gynecologist.

And if a gynecologist prepares a smear for cytology with high quality, then its informative value may turn out to be even higher compared to liquid cytology, since it contains more different cellular elements. Indeed, in an ordinary smear for cytology, there are background elements that allow the cytologist to assess the cellular environment and identify not only tumor degeneration of mucous membrane cells, but also an inflammatory and infectious process in the tissues of the cervix. That is, the study of an ordinary smear for cytology, if, of course, it is made correctly, makes it possible to obtain a wider range of information in comparison with liquid cytology. That is why, in most cases, in the countries of the former USSR, doctors still prefer the results of a regular 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 point 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 uninformative, since the number of cells is not enough to clarify the nature of pathological changes.

In the second point 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 the 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 found.

In the absence of pathological changes of a malignant nature, the conclusion also indicates that they have not been identified.

If the smear contains pathological changes in the cells of a malignant nature, then their type must be indicated in accordance with the Bethesda classification:

• ASC-US - atypical cells of squamous epithelium of unclear meaning ( such cells are not completely normal, but, as a rule, they are not cancerous, and their pathological condition is caused by the human papillomavirus);
• ASC-H - atypical changes in squamous epithelium, including possibly HSIL ( such cells are abnormal, but usually they are not cancerous, but indicate the presence of precancerous changes that may never progress to a malignant tumor);
• LSIL - defeat of a low grade of malignancy inside the cells of squamous epithelium cells are abnormal in size and shape, but these violations of their structure are usually caused not by cancer, but by the human papillomavirus);
• HSIL - defeat of a high degree of malignancy inside the cells of squamous epithelium ( cells have pronounced disturbances in shape and structure and are highly likely to reflect a precancerous process in the cervix);
• CIS - carcinoma insitu ( early stage cancer);
• AG-US - atypical cells of the glandular epithelium of unclear meaning ( the cells of the glandular epithelium are abnormal, but most likely they are not cancerous);
• AIS - endocervical carcinoma insitu ( 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 ( fungi, Trichomonas, etc.), if, of course, they were found.

How often should a cytology smear be done?

It is recommended to take a smear for cytology for all women as part of a preventive examination once a year from the age of 21 to the age of 65. However, the age of the beginning of the smear test for cytology may be shifted, since this analysis is first done three years after the onset of sexual activity. For example, if a girl began to have sexual intercourse 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 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 to 65 has had a negative smear for cytology for three years in a row ( "Good" smear), then the next time you can take the analysis after 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, of course, after the course of treatment prescribed by the doctor. In such situations, with pathological results of a smear, the doctor recommends taking it once every six months until a normal result is obtained three times in a row. After that, you can take the smear again 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, regardless of the results, it is recommended to take a smear for cytology once every six months.

It must be remembered that a smear for cytology must be taken to 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 taking a smear for cytology

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

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

• the presence of changes visible to the eye on the cervix ( 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;
• carriage without clinical symptoms of herpes viruses, human papilloma or cytomegalovirus;
• conducting radiation and chemotherapy.

Preparation for taking a smear for cytology

Before taking a smear for cytology, it is necessary to go through a 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 consist in meeting the following requirements:

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

You also need to know that no cytology smear is taken during menstruation, therefore, to take the analysis, you need to wait 2 - 3 days after the end of menstruation. In addition, it should be remembered that if a woman underwent a colposcopy, biopsy or gynecological examination, then a smear for cytology can be taken in this case, 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 genitals, 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, having properly prepared.

Taking a smear for cytology ( procedure)

A smear for cytology can be taken from the fifth day of the menstrual cycle until 5 days remain until 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. It is not recommended to take a smear in the middle of the cycle, since at this time a large amount of mucus accumulates in the cervical canal, which interferes with the normal collection of epithelial cells. However, if necessary, a smear for cytology is taken on any day of the cycle, except for the period of menstrual bleeding.

For taking a smear, the doctor prepares the necessary materials - sterile gloves, a backing diaper, a gynecological speculum, a tool for collecting a scraping ( brush, spatula, etc.), saline, glass slides, smear fixative.

Further, before taking a smear, the doctor asks the woman to urinate ( pee), after which he will offer to lie down in the gynecological chair on a padded sheet and fix the legs in the stirrups. When a woman takes the same position as for a gynecological examination, the doctor inserts a Cuzco speculum into the vagina, with which the walls of the vagina move apart to expose the cervix and make it available 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 instrument at his disposal for taking a smear for cytology ( air spatula, Volkmann spoon, screen, endobrash) and introduces it shallowly into the cervical canal. After insertion into the cervical canal, the doctor rotates the instrument around its axis 360 degrees to scrape off epithelial cells, which will subsequently be examined by a cytologist 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 obtained 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 surname, 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 in some women, taking a smear causes a sensation of pressure on the cervix. However, a woman never experiences pain when observing the technique of taking a smear.

After smear for cytology

After the doctor takes smears for cytology, a woman can lead her usual, habitual lifestyle, including having sex, using a variety of means introduced 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 bleeding may appear, which indicates that the cervix is \u200b\u200beasily damaged and its structure is abnormal. In such cases, one must expect and be mentally prepared for the pathological result of the analysis. However, you do not need to take any special actions to stop the bleeding, it will go away on its own. It is advisable only to refrain from sexual intercourse and introducing anything into the vagina until the bleeding ends.

How many days does a smear take for cytology?

Since for the analysis of a smear for cytology, it must be pre-processed, namely, fixation, staining, drying and only then studying 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 stages of 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 burden falls on cytologists, since doctors of this rare specialty have to look at a large number of smears during the working day, because smears from various medical institutions come to cytological laboratories ( both public and private). The cytologist is one for several hospitals and clinics, and can study only a limited number of smears during the day, of which much more is received for research. Therefore, all received smears are immediately processed and stained by the laboratory assistant, after which he puts them in a queue in the order of arrival, and the cytologist looks through the material as the queue reaches him. Due to this, the result of a smear for cytology can be ready, at least in 2 - 3 days, and maximum in a month.

Cytology 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. Taking a smear for cytology during pregnancy, without waiting for childbirth, should be taken by 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 delivery of a smear for cytology until after childbirth.

If the doctor prescribed a smear for cytology for 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 bear 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 the treatment that the woman will undergo during pregnancy, which will increase the likelihood of a successful birth through natural routes.

The smear rate for cytology ( good smear for cytology)

Normally, a smear for cytology 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 abnormalities 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 Papanicolaou 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 ( the inner part of the cervical canal) and ectocervix ( the outer part of the cervix that protrudes into the vagina). Normally, the material of the endocervix contains cells of the squamous and cylindrical epithelium without pathological changes and without features. There may be a small number of cells of metaplastic epithelium, which is also completely normal and usually occurs in women during menopause or after undergoing cervical treatment ( e.g. moxibustion erosion). In smears from the ectocervix, there are normally squamous epithelial cells of the surface 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.

Decoding a smear for cytology

In the results of a smear for cytology, the cellular composition is necessarily described ( what cells are in the smear), the state of cells and the nature of pathological changes in them ( in the presence of), and also gives a presumptive conclusion about what pathology occurs in a particular case.

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

Typical pictures of pathological changes in smears for cytology in various diseases of the cervix and genitals

The following information may be present in the results of a smear for cytology:

• With polyps or hyperplasia of the epithelium of the cervical canal in the description of the smear pattern for cytology, the doctor usually indicates a large accumulation of normal cells of the columnar epithelium.
• With ovarian tumors and uterine fibroids in the ectocervix, normal cells of the squamous epithelium of the superficial layer are usually found.
• With erosion ( ectopia) or endocervicosis in the smear, cells of squamous epithelium of all layers, accumulations of cells of columnar epithelium, elements of inflammation ( leukocytes, lymphocytes). If erosion or endocervicosis is in the healing stage ( e.g. after moxibustion, etc.), then a large number of cells of metaplastic epithelium are found in the smear.
• With leukoplakia of the cervix ( benign lesion) areas of hyperkeratosis are found in the smear ( clusters of squamous epithelium scales), individual squamous epithelium scales and dyskeracytes.
• With dysplasia of the cervix in the smear, atypical epithelial cells with signs of malignancy ( large nuclei, deformed cytoplasm, abnormal shape and size). Dysplasia of the cervix can be a sign of active human papillomavirus infection or a precancerous process. Distinguish, a sign of what ( inflammation or precancer) is dysplasia in a particular case is very difficult. Therefore, when dysplasia is detected, an additional colposcopy with biopsy of suspicious areas is recommended. Depending on the severity of the atypia of the cells, dysplasia is 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) of non-specific character ( for example, against the background of candidiasis, dysbiosis, etc.) in the smear, degeneratively altered epithelial cells, proliferation phenomena, leukocyte infiltration, incomplete phagocytosis are found. In a chronic inflammatory process, lymphocytes, eosinophils, macrophages can also be found.
• 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 is detected ( cocci, sticks, etc.).
• With bacterial vaginosis in smears for cytology, key cells, mixed coccobacillary flora are found.
• With genital herpes in smears, multinucleated cells of squamous epithelium, which look like a "mulberry", are found.
• With human papillomavirus infection Coilocytes, cells with large nuclei or multiple nuclei, are found in the smear.
• With trichomoniasis in the smear Trichomonas and mixed coccobacillary flora are found.
• With chlamydia the smear contains cells of normal and metaplastic epithelium with inclusions in the cytoplasm ( little bodies of Provachek).

What do various abnormal cells in smears indicate for cytology?

Squamous epithelium in a smear for cytology

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

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

If there are many cells of squamous epithelium 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 epithelial cells in a smear for cytology can be detected in benign tumors of the genitourinary system.

Metaplastic epithelium in smear for cytology

Normally, a small number of cells of metaplastic epithelium can be found in a smear for cytology, since such cells are formed in the area where the cylindrical epithelium of the cervical canal is closed with the flat epithelium of the outer part of the cervix, visible in 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 \u200b\u200breplaced by a stratified squamous epithelium. The process of such metaplasia of one type of epithelium in another is benign and can occur due to infectious and inflammatory diseases of the cervix ( herpes, chlamydia, toxoplasmosis, etc.), hormonal disorders, traumatic childbirth, multiple abortions, frequent changes in sexual partners, etc.

Metaplasia is not cancer or even a precancerous process, but it is not the norm either. Therefore, women with metaplasia of the epithelium are recommended to undergo an examination to identify the causes of the degeneration of one type of epithelium into another. Metaplasia is successfully treated, so you do not need to be afraid of this pathology.

Glandular epithelium in a smear for cytology

Normally, cells of the glandular epithelium can be found in the smear, as they are scraped off by the instrument during the collection of material from the inner surface of the cervical canal. A sign of pathology is the proliferation of the 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 the 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 abortion, diagnostic curettage of the uterine cavity or various diagnostic and treatment procedures involving the cervix;
• erosion ( ectopia) 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 is taking place in the cervix ( endocervicitis or ectocervicitis). Moreover, for long-term or chronic inflammations, not a very large number of leukocytes in a smear are 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 pathogenic microorganisms ( for example, Trichomonas, chlamydia, human papillomavirus, etc.), therefore, when leukocytes are detected in a smear for cytology, it is necessary to pass tests for genital infections and bacteriological sowing of the vaginal discharge on the 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 collected soon after the end of menstruation ( within 1 - 3 days), and in this case, the presence of these cells is not a diagnostically valuable fact, since it indicates only recent menstruation and nothing else.

Secondly, erythrocytes in a smear can be detected with the wrong technique of material sampling, when the gynecologist presses too hard on the instrument, injures the tissues, which causes slight bleeding and, accordingly, the ingress of erythrocytes into the smear. In such a situation, the presence of erythrocytes in the smear also plays no role and has no diagnostic value. It is very easy to understand that there was an incorrect technique for taking the material - 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 erythrocytes 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, you should undergo the necessary treatment as soon as possible.

Atypical cells in a smear for cytology

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

In practice, atypical cells in a smear for cytology are most often found against the background of an inflammatory process caused by any genital infections, bacterial vaginosis, etc. In much rarer 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. immune system... Therefore, in most cases, the presence of atypical cells in a smear for cytology is a reflection of a natural process when such elements in the body are formed and subsequently destroyed by the immune system.

That is why, if atypical cells were found in a smear, you need not panic, but simply pass tests for genital infections ( to find out which pathogenic microbes could cause inflammation) and additionally undergo colposcopy with biopsy ( to make sure that 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 are found, since in such cases the cause is an inflammatory process. If the results indicate the degree of atypia of the cells, then this is a reflection of the tumor, not inflammatory transformation, but in such a situation there is no need to worry. After all, the atypical cells found only theoretically someday can give rise to a cancerous tumor, which in most cases does not happen, since such degenerated 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 microflora, but if an infectious and 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-shaped, then, most likely, the infection of the cervix is \u200b\u200bprovoked by corynebacteria. If the flora is coccal or mixed coccal-rod, then the infection can be triggered by Trichomonas, gardnerella, ureaplasma or mycoplasma. Unfortunately, the doctor cannot say exactly which microbes triggered the infection of the cervix, using a smear for cytology. Therefore, if any flora is detected in a smear for cytology, it is necessary to pass tests for genital 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 collected material, then this indicates candidiasis of the vagina and cervix. In this case, antifungal treatment is necessary.

Stages of pathological smear for cytology

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

• First stage - there are no cells with structural abnormalities, the picture is completely normal. Such a smear usually occurs in healthy women ( negative smear).
• Stage two - the smear contains cells with slightly pronounced inflammatory changes. Such a smear is considered a normal variant, since cell changes are associated with inflammation in the vagina or cervix, and not cancerous degeneration. Usually, a second stage smear occurs in women with endocervicitis, mycoplasmosis, ureaplasmosis, trichomoniasis, chlamydia, candidiasis, bacterial vaginosis, vaginitis, genital herpes, and the carrier of the human papillomavirus. 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 - in a smear, single cells with pathology of nuclei and cytoplasm are determined. Such a smear is no longer normal, it usually indicates that individual cells have transformed into tumor cells. However, this stage of the smear does not indicate a serious illness, since such changes are often caused by erosion or polyps of the cervix, and in most cases go away on their own without special treatment. When a stage 3 smear is obtained, the doctor recommends colposcopy and biopsy of suspicious areas of the 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 stage 4 smear is called dysplasia, and it means that there are individual cells in the cervix, from which, theoretically, cancer can develop in the future. However, in reality, most dysplasias simply go away on their own without treatment, and the cancer does not develop. However, for stage 4 smears, your doctor will order a colposcopy and biopsy of the suspicious area to make sure 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 makes it possible to observe 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 undergoes an additional examination in order to identify the stage and type of tumor, which is necessary for subsequent treatment.

Despite the fact that cytology allows you to detect and identify cancer cells, it is possible to establish a diagnosis of cancer or precancerous degeneration of tissues only on the basis of a histological examination of a biopsy. Therefore, even the fifth stage of a pathological smear for cytology is not an unambiguous diagnosis of cancer. Indeed, in order to detect and confirm cancer, it is imperative to do a biopsy with histology, so that, having received a “bad” smear result for cytology, one should not be upset prematurely and draw terrible prospects. It is necessary to wait for the results of histology, because it is very likely that the cancer will not be confirmed, and you will just need to continue taking smears for cytology with a regularity that the doctor will establish.

Atrophic type of smear for cytology

The atrophic type of smear indicates that there is a deficiency of estrogen hormones in the woman's body, as a result of which atrophy of the epithelium of the vagina and cervix occurs. Usually, this 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, leukoplakia of the cervix. With an atrophic type of smear for cytology, it is necessary to undergo an examination and begin the necessary treatment.

Inflammatory smear for cytology

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

To diagnose atypical, onco cells in the study of epithelial tissue samples, a gynecological examination is used, which is called cytology. This analysis allows you to timely detect the inflammatory process, dysplasia, precancerous condition, oncology of the genital tract in the early stages.

Cytology in gynecology is such a non-invasive microscopic examination samples of the structure of the genital tract, allowing to determine atypical cells, inflammation, endometrial dysplasia, cervical cancer at the initial stage.

During the analysis, using special tools, the epithelium is scraped. The resulting biomaterial is applied in a uniform layer to the marked glass, dried, stained with indicators, studied under a microscope.

Cytology in gynecology is an important analysis that allows you to assess the condition of the uterus and determine the presence of atypical cells.

Cellular tissues are taken for a smear:

• columnar epithelium (cervical canal);
• stratified squamous non-keratinized epithelium (vagina);
• transition zone (connection of the vagina and uterine cervix).

Cytology: types of smear

There are two types of research:

• Oncocytological study of the cervical canal, uterine neck, which allows to determine the inflammatory process, changes in the structure of cells and the state of the layers of the genital organs, oncology at the 1st and 2nd stage.
• A smear that establishes the origin and content of the vaginal microflora. Shows the state of the mucous membrane, the presence of viral, bacteriological infections, fungi, pathogenic microorganisms.

Purpose of analysis

Cytology in gynecology is such a study of cellular tissue, indicating the slightest changes in the structure of the epithelium (the appearance of atypical cells). Papanicolaou analysis allows you to detect a deviation from the norm, which threatens to subsequently transform into a malignant neoplasm.

In addition to cancer cells, the PAP test assesses the vaginal mucosa, shows the appearance of inflammatory dysfunctions of an infectious and bacteriological nature. The analysis does not establish the cause of the inflammation; to clarify the type of infection, a smear is additionally performed on the flora.

There are 2 types of results of oncocytological research:

• positive - in the structure of epithelial tissue there are atypical cells that provoke inflammation;
• negative - indicating the purity of the genital structures, the absence of dysfunctional cellular changes.

Indications for analysis

The PAP test is required annually for all women between 18 and 65 years of age. Initial research is carried out after the first sexual encounter.

An unscheduled oncocytological smear is prescribed for:

Contraindications for cytological examination

Restrictions on the PAP test:

• acute inflammatory process of the genitals;
• menstrual bleeding;
• virginity;
• genital infection.

After childbirth, cytological examination is allowed to be carried out after 3-4 months.

The presence of inflammation of genital infections does not give a reliable result due to the large number of leukocytes on the genital mucosa.

During menstruation, an oncocytological smear is not taken. Red blood cells impede the ability to assess the condition of the epithelial tissue.

Taking a smear during pregnancy

During pregnancy, a planned cytological examination is carried out at least 3 times. The task of the PAP test is to study the bioflora of the vagina of the expectant mother, timely detect the presence of infection, the possible development of dysplasia. If a positive result is obtained, a second analysis is carried out.

A planned smear is performed:

• When registering the expectant mother at the antenatal clinic.
• 30 weeks pregnant. Changes in epithelial tissue are monitored.
• At 36 weeks of gestation (preparation for childbirth). The doctor examines the genitals to prevent possible infection of the newborn as it passes through the birth canal.

In the case of a woman's complaints of itching, burning, pain in the vagina, an additional study is prescribed.

Changes in the cellular structure of the genitals make it possible to establish:

• intrauterine fetal death (the appearance of atrophic cells);
• post-term pregnancy;
• the threat of premature birth;
• fetal hypoxia;
• development of the oncological process;
• inflammation, getting a genital infection.

Possible complications after taking a smear

The cytological procedure in gynecology is painless. In such a study, the specialist carefully removes the epithelial tissue, in a circle, in one motion.

Damage to the epithelium can lead to the appearance of erythrocytes in the biomaterial, making it impossible to reliably assess cellular structures. Unpleasant sensations during a smear may occur when installing a gynecological speculum.

After the procedure, the woman is allowed to lead a normal life, play sports, and carry out any physical activity. Sexual contact is not prohibited. In rare cases, painful cramps in the lower abdomen may appear, smearing bleeding.

The reasons for this dysfunction are:

• Rough removal of cells by an inexperienced doctor in violation of the analysis technique.
• Injury to the epithelium. In this case, it is possible to obtain incorrect results of the PAP test.
• The presence of an inflammatory process of the genital organs.

Within 2 days, spasms and blood secretions self-destruct. When these symptoms appear, you should refrain from sexual intercourse. Saving the unpleasant consequences of the analysis for 3-4 days requires seeking medical help. Do not self-medicate.

Rules for preparing a woman for analysis

The preparatory stage should begin 2-3 days before the procedure.

During this time, it is required to refrain from:

The analysis should be taken on the 6-12th day of the menstrual cycle. During bleeding, biomaterial is not removed. Blood distorts the result data.

In the case of a gynecological examination, colposcopy, the PAP test is postponed for 72 hours. An analysis is not prescribed during an acute inflammatory process of the genital area. A smear for oncocytology is performed after the symptoms of the disease disappear. 2 hours before the analysis, you should refrain from going to the toilet.

Analysis tools

To collect material for cytological examination, use:

How to take a smear for cervical cytology

The best period for taking biomaterial for the PAP test is the time from the 5th day after the beginning of the menstrual cycle (from the moment the bleeding disappears) to the 17th day. During ovulation (12-14 days), a large amount of mucus is formed, which makes tissue examination problematic.

The procedure for conducting an oncocytological smear:

1. The patient undresses and sits on a chair for a gynecological examination. A disposable diaper is placed under the woman's buttocks.
2. The gynecologist installs a speculum (gynecological speculum) into the vagina and estimates the distance of the cervix.
3. With the help of a tampon soaked in saline, 3 areas are cleared of secretions (cervical canal, vagina, the junction of the genitals and the uterine cervix). The mucous plug is removed with a brush.
4. Disposable sterile instruments (Eire spatula, Volkmen's spoon, endobrash, tweezers) are placed in the woman's genitals. Gently, by a quick 360⁰ rotation, the cells of the epithelial tissue are separated. If the doctor discovers a questionable area, then an additional analysis is taken.
5. The samples taken are applied in an even layer on a marked slide. The doctor signs the full name, age of the patient.
6. The biological material is dried and transferred to the laboratory for research.
7. The specialist examining the samples evaluates the quality, purity of the tissues, and the technique of the analysis. In case of a questionable result, it is recommended to make a second smear. Up to 20% of PAP tests are repeated annually due to the doctor's failure to follow the procedure for collecting cells. The prepared biomaterial is stained with indicators and examined with a microscope.

The procedure for taking a smear takes no more than 15-20 minutes. Non-invasive, painless. Unpleasant sensations can occur when installing a gynecological mirror. After the removal of the biomaterial, the woman dresses and returns to normal life.

Decoding the results

Cytology in gynecology is such a study, the data of which make it possible to detect a malignant neoplasm at an early stage.

There are 2 PAP test results:

• negative - talking about a woman's health;
• positive - indicating the appearance of atypical cells in the epithelium.

To decipher the analysis data, the Papanicolaou technique is used, which distinguishes 5 stages of changes in the cellular structure:

1. State of the norm. Talking about the patient's health. There are no changes in these samples.
2. A small number of abnormal cells are found. Appearing in the inflammatory process in the genital area caused by bacteria, viral infections. Requires the use of antibiotic therapy.
3. Indicates the presence of a single accumulation of atypical cells with minor damage in the structure of the nucleus, cytoplasm. Diagnoses cervical erosion, polyps.
4. The samples contain a large number of transformed cells with enlarged membranes, disrupted chromosomes, and cytoplasm. Indicates dysplasia, a possible precancerous condition of the genitals. A woman with such an analysis is put under medical supervision, a biopsy, colposcopy is performed.
5. Carcinoma. Oncological disease... The structure of the epithelial tissue is completely changed. A large number of atypical cells. Additional studies and anticancer therapy are immediately prescribed.

Decoding analysis by the Bethesda method:

Designation	Determining the value
Norm	Absence of pathologies, changes in cellular structure. Possible development of bacterial infections, vaginosis, cervicitis
HPV	The smear contains coylocytes - HPV cells. Differ in types. 16.22 are considered the most dangerous, increasing the risk of developing cancer
CIN I	Dysplasia of the 1st degree
CIN II	Dysplasia of the 2nd severity
CIN III	Dysplasia of the 3rd degree. Precancerous condition
Carcinom (pax)	Carcinoma. Oncology.

Terminology of meanings used in cytological research:

Abnormal cells in cytological smears:

Atrophic type of smear - occurs with estrogen deficiency. It is characteristic of premenopausal syndrome, menopause. Requires hormone replacement therapy with progesterone.

Inflammatory PAP test - occurs when a biomaterial is taken during an acute inflammatory process. Not informative.

It needs to be repeated after normalization of the condition and antibacterial therapy. In the absence of any changes in the biomaterial, the value is set - there are no pathological changes. Cytological examination does not give an accurate result.

If a pathology (especially malignant) is detected, it requires urgent additional research:

How many days does a smear take for cytology

Cytology in gynecology (this is a study of the cellular structure of epithelial tissue) is carried out for a period of 1 to 5 days. To undergo the analysis, you must contact the antenatal clinic at the place of residence, to the gynecologist at any paid clinic. The cost of the study is from 1500 to 3500 rubles. depending on the region, clinic, speed of conduct, interpretation of results.

Non-painful cytological analysis in gynecological practice is a non-invasive study of epithelial cells, which makes it possible to detect the presence of atypical cells.

This kind of research is being conducted everywhere. It helps to timely diagnose changes in the cellular structure, prevent and cure cancer at an early stage with minimal risk to a woman's life.

Article design: Lozinsky Oleg

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What is a cytology test and how is it done:

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