Mazz from the cervix. Cytological tests: Methods of conducting and interpretation of research results

13.07.2020

The timely diagnosis of various gynecological diseases is an important component in their successful treatment.

Cytological analysis of cervical cells ("Cervical Cytology"), helps to detect a fairly common oncological disease in time - cervical cancer.

But on this "utility" of this analysis is not exhausted, according to its results, it can be judged on the starting changes in the structure of cells and their functioning, the presence of inflammation and infection.

When conducting cytological analysis, tissue cells are investigated, their number, form, mutual location and other characteristics. The opportunity to detect the greatest value prejudice changes cervical cells.

Since such changes do not show themselves in the general health of the woman, in other ways to discover them is difficult. Material for research is taken by the neighborhood of a completely small amount of tissue from the surface of the cervix with a spatula, spatula, spoon or probe.

The fence passes from three different sections of the cervix (arch, outer surface, canal). The uterus in front of this is cleaned from the selection with a cotton swab. The process passes quickly and painlessly during a woman inspection on a gynecological chair. Usually simultaneously with the scrap tissue from the surface of the uterus, the same way, but using a special brush, the material and from the cervical canal are obtained.

The material obtained with a thin layer is applied to the slide glass. (make smear)And this glass is directed to the laboratory for research. The study itself passes under a microscope. Many clinics are simultaneously conducted by the study of cells by staining According to Papanicolau (dad test), by drying and other ways.

An integrated approach allows you to get more accurate results. Assessment of the state of individual cells and the overall assessment of the material makes it possible to diagnose the disease or say that a woman is healthy. According to the results of the analysis, a cytological conclusion is drawn up. Typically, the doctor receives it after 1-2 weeks after the material fence.

There is an assessment of the results of a cytological study of cervical cervical cells on the already mentioned method Papanicolau.

This method allows to distinguish between the five states of the cellular tissue (the stages of the development of the disease or classes):

To date more popular interpretation of the results of cytological research cervical cells From cervical canal According to the method of Betseda.

This method identifies the presence of various changes in the core of the cell (diskariosis).

Depending on the number of cells with discariosis And their location, you can put this or that diagnosis.

The cytology of the cervix in this interpretation allows you to determine the following states:

Lack of pathological changes
Various atypical cell conditions, including cervical dysplasia (cervical intraepithelial neoplasia)
Carcinoma (cancer) cervix.

These states are indicated by Latin letters. Decipher them and understand what is hidden behind the combinations of Latin letters in the analysis results, will help the table below.

Most commonly encountered are analyzes with designation CIN 1, 2 or 3 .

By this designation is meant displays of the first, second or third severity.

First degree dysplasia It assumes the presence of dischariosis in single, mature cells located disparately or small clusters among normal cells.

Dysplasia second degree - pathological cells more, pathologies are more diverse and detected not only in the surface layer, but also about half the thickness of the epithelial layer.

Third degree - severe changes, about 2/3 epithelial layers are affected.

Availability in a diagnosis Cin. It indicates the need to pass tests for the presence of a human papilloma virus (HPV), since it is in most cases that provokes the development of the cervical dysplasia.

The value of cytological analysis

Given the results that cytological analysis gives it difficult to overestimate. This is one of the simplest, cheap and reliable methods for establishing the prejudice states of the cervix.

Cervical cancer occupies almost half among the cancer in women.

In the initial stages, it flows without symptoms, and until the middle of the 20th century, the prejudice states were almost impossible to diagnose. But with the advent of dad-test in the 40s of the 20th century, it became possible that he saved a huge number of women's lives.

The timely detection of initial changes in cells allows you to relatively simply and efficiently treat dysplasia and other precancerous states.

Doctors advise the cytological analysis of the cervix of the uterus at least once a year.

It is believed that cancer cells are developing quite slowly, so many doctors allow the analysis of the analysis once every 2-3 years. But there are cases when the disease develops very quickly. Such a gap is admissible if the previous two cytological analyzes were negative.

Regardless of the results of previous analyzes, women in the risk group ( hIV carriers, taking steroids, chemistry, etc.) - The analysis must be passed every year or more often, on the recommendation of the doctor.

When the pathology is found in the analysis - repeat it in three months, six months or on the recommendation of the doctor.

Also note that the cytology of the cervix in 5-10% of cases are false negative. Specialists associate this with the wrong fence of the material and improper preparation for analysis.

That the result was reliable, not less than two days a woman needs:

Abstain
Do not conduct a rejection (douching) vagina
Do not use vaginal candles, tablets, creams and other drugs.
Before the direct fence of the material does not urinate 2-3 hours.

Analysis on cytology is impossible:

Compliance with these simple rules will allow a woman to be calm for their health, and in case of detection of any pathologies, effectively and relatively simply to treat them.

Leukocytes in a smear in the overwhelming majority of cases are a sign of the inflammatory process in the organs of the urogenital tract, and both female and male. However, a rare man, especially at a young age he can "boast" that he took a smear if with urogenital system everything is fine. For men, the smear does not belong to mandatory analyzes during dispensarization. Another thing is women. Probably, there are no such, which, at least once a year, are not subjected to similar manipulations. And this in the absence of pathology, but if there are problems, the smears are taken as needed.

Normal and pathology

Material from the urethra of men at the norm is not distinguished by abundance. Single leukocytes, transitional epithelium in a smear, single sticks - that's all that can provide us with a healthy man. The appearance of a large number of leukocytes in a stall smear is usually accompanied by the presence of inflammation perpetrators.(, yeast-like fungi of kind, etc.), which is treated, and then take the analysis again to make sure the success of the measures taken.

As for women, the increased number of leukocytes is observed before menstruation and is considered an absolutely natural phenomenon. In addition, the elevated content itself (the norm - up to 30 cells in the field of view) does not relate to reliable indicators, evidence of the rate of leukocytes is considered the absence of morphological signs of these cells. They are "calm", not destroyed (kernels are preserved), there are no signs of phagocytosis. In addition, sometimes the cause of the detention of a diagnosticity can become incorrectly taken material. An example is the "thick" smear, which is practically not visible due to the fact that the entire field is sewn with clusters superimposed on each other cells (and leukocytes including). Do not risking mistaken, in such cases a woman is offered to pass the analysis again.

Table: Maps for women

V - Material from Vagina, C - Cervic Channel (cervical cervical), U - Urethra

Flora and cytology - what is their difference?

If men's analysis take only from the urethra, then women research objects more: urethra, vagina, cervical neck, cervical canal. True, sometimes they take aspirate from the uterine cavity and also make stars, but this is considered a biopsy material that browsing the cytologist. He makes conclusion. Aspirates are not taken with preventive inspections, this analysis is used exclusively with a diagnostic purpose for identifying cancer and precancerous diseases of the chief conductive body in women. In addition, if the aspirate is pouring formalin, and then apply it on glass and paint, it will turn out to be a histological drug that is considered the last instance in the diagnosis of malignant neoplasms.

Probably, many have heard expressions: "smear on the flora", "smear to cytology". What does all of this mean? What are they similar and what are their difference?

The fact is that in the smear on the flora on a large increase with immersion, the doctor may consider cells, to discover trichomonas, yeast, diplococci, garardnerell and other microorganisms representing rich biocenosis of the female sexual sphere. But he will not be able to determine the morphological changes of the epithelium, since these are different directions of laboratory diagnostics, where cytology occupies a separate niche. The study of the cell composition of some material requires, except for certain knowledge, also special training. The study of pathological changes of the cell and the kernel theoretically gives very little, here, as they say, you need an easy eye.

Deciphering the analysis in both cases (flora and cytology) is engaged in the doctor, we only have to get acquainted with some concepts to, facing such a problem, do not be afraid and not to be panic.

Cytological research

The tasks and functions of cytology are much wider, therefore, wider and its capabilities. The doctor exploring the material focuses on the state of the epithelial cells. In order to identify pathological processes (inflammation, dysplasia, malignant neoplasms) and at the same time notes the flora. Most often the study is subject to vaginal portion of the cervix, represented by a multilayer (four-layer) flat epithelium (MPE) and the cervical channel. When the cervical channel is properly taken from the cervical channel under the norm, the prismatic (cylindrical) epithelium, single leukocytes and a depleted microflora, which could have fallen from the underlying departments (from the vagina, for example), clearly seen.

It should be noted that the cytological drug is more informative, since the method of staining (according to Romanovsky-Gymzem, Pappenheim or Papanicolau) gives a clearer picture. Cells are viewed first on a small magnification to estimate the overall condition of the drug, and then on a large (with immersion), in order to consider not only the epithelium itself, but also changes in the core characteristic of one or another disease. In a word, a cytologist sees the flora, inflammation, and in most cases its cause and changes that lifted this inflammatory process. As well as the estimated signs of infections representing special difficulties in diagnosis, prematubolic and tumor states of the epithelium.

Video: About the smear on oncocytology

Indirect signs of some STIs in cytology

As for the smear on the STI, it is desirable to explore it as a cytological drug. Taken on the flora and painted with methylene blue stroke is the most primary, affordable and cheap, and therefore the most common method of diagnosis in gynecology. However, unfortunately, it does not give the necessary completeness of the picture to diagnose the STD and their consequences.

In addition to all possible inhabitants, which in infecting or violation of biocenosis are visible in the smear on the flora (trichomonade, yeast, leptotrix), in the material under study (cytology), it is possible to detect indirect signs of the presence of microorganisms, which to identify with microscopic methods are very problematic:

The behavior of giant multi-core MPE cells, sometimes quite bizarre form, often having signs of paracratosesis and hyperkeratose (oroging), indicates a possible defeat;
Cells in the form of "Sovic Eyes" with coarse-grained cytoplasm are characteristic of;
When it is possible to detect coilocyte atypius (MPE cells with large nuclei and the enlightenment zone around the kernel);
The taverns of the carrier in the cells of the metaplazized epithelium characteristic of and playing during screening studies are indicative.

Of course, it is impossible to make a diagnosis of herpetic, cytomegalovirus or papillomavirus infection during cytological analysis, but it can be assumed, and this is already a basis for a further, more in-depth examination in a particular direction (, etc.). Thus, cytology allows you to narrow the range of diagnostic search, avoid unnecessary analyzes, save time, as well as promptly begin therapeutic activities.

How to properly prepare for analysis?

Since the simplest and most affordable method of identifying the inflammatory processes of the urogenital path, both in men and women, is a smear on the flora, he needs to pay more attention and teach the reader a little in the records listed in the form.

However, before applying a visit to the doctor, patients should know some uncomplicated rules:

A couple of days before the analysis, it is necessary to eliminate not only sexual contacts (sometimes in a female smear you can see spermatozoa), but also any interventions of the type of sinking, the use of drugs of local destination (candles, creams, tablets);
Do not go on a similar study during menstruation, for menstrual blood will interfere with viewing the drug, where the doctor will see it mainly;
On the day of the survey, it is necessary to calculate the time so that it is for the last time to survive in 2-3 hours, since urine can wash all the "information";
7-10 days before the analysis, stop the reception of pharmaceutical preparations, especially antibacterial action or smear only a week after the end of treatment;
Another rule that women often ignore: not use intimate hygiene tools. Of course, it is very difficult to refrain from such procedures in general, as experts recommend, but at least it is possible to restrict clean warm water. Men The last toilet of the external genital organs is carried out in the evening on the eve of the visit of the doctor.

By completing these tips, a person goes to the reception, where he will take a smear, paint and look under the microscope. The doctor will deal with the doctor, and the patient will receive a conclusion in the hands, and it is probably interesting to know what all these numbers and words mean.

Video: Preparation for the smear

What can be seen in a stroke from the urethra of men?

Probably, the reader guessed that the analysis of the analysis in men is unlikely to leave pleasant memories, because the object of research is not so available, so there will indeed be an unpleasant feeling that may not leave a person for a few more hours. Sometimes in order to avoid this, the doctor prescribes a patient a prostate massage, which is carried out a few days before the PER RECTUM procedure, that is, through the rectum.

However, if the burning and soreness in the sexual term continues to remind themselves for several days, and they also added to these phenomena and simply similar to the doctor. But if everything went well, then maybe men will calm the fact that in their smear, taken from the urethra, everything looks much easier, if, of course, normal analysis:

Leukocyte rate - up to 5 cells in sight;
The flora makes single sticks;
The general background dilutes the epithelium of urethra (mainly transitional) - approximately 5-7 (up to 10) cells;
Not a large number of mucus not playing any role;
Some other times in the smear there may be a conditional pathogenic flora in single copies (streptococci, staphylococci, enterococci), but in order to differentiate it, it is necessary to paint the smear in gram.

In the case of the inflammatory process, the smear changes:

A large number of leukocytes appears in the smear, sometimes not subject to counting;
Cokkovaya or cocco-bacillina flora displaces sticky;
The preparation contains microbes that caused inflammation (trichomonas, gonococci, yeast, etc.);
Chlamydia type microorganisms, urea- and mycoplasm under a microscope is hardly possible to see, just like to distinguish pathogenic diplococci, causing gonorrhea, from pairwise lying enterococci or Enterococcus Faecalis chains (enterococci) from streptococci, therefore, in such cases to clarify the type The pathogen, the study is complemented by the culture method or practically universal and popular PCR (polymerase chain reaction);
For a rare exception in a male smear, an intestinal wand can be found (blatant violation of hygienic rules!), Bringing in the intestine, but caustic, getting into the urethra of the man. For its differentiation, additional laboratory research methods are also necessary.

It is similar to both female strokes, since the diplococci found can not be by neasery and gonorrhea do not cause. By the way, Escherichia Coli, Enterococcus (Enterococcus Faecalis), Streptococci staphylococci and other microorganisms in women's strokes are much more often due to the structure of female genital organs.

Ecosystem of the female urogenital tract

Leukocytes in a smear, taken in gynecology at least on the flora, even on cytology, not the only cells present in the preparation. In addition, they only act as a consequence or reaction to the events occurring in the ecosystem (vibrations of the hormonal background, inflammation). For example, their increase in various phases of the cycle is due to hormonal influence, so when the material is fenced in the direction form, the date of the last menstruation is indicated.

The diagnostic criterion of the inflammatory process is considered not only a large number of LE, "escaped" to the place of "hostilities", but also the state of their nuclei. When leukocytes react, they are trying to absorb the "enemy", phagocytic, but at the same time they begin to collapse. Destroyed cells are called neutrophilic leukocytes, however, in decoding analysis, such a phenomenon is not specified. A large amount of neutrophilic leukocytes, together with abundant cocco-bacillina or kokkkkiloi, serves as a basis for confirming the presence of an inflammatory process.

The ecosystem of female genital organs includes microorganisms that occupy certain niches, which are: the epithelium of the vagina, cervix, cervical canal, rich in endocervical glands. These anatomical formations provide conditions for the vital activity of certain microorganisms. Some of the inhabitants are mandatory (bond), others come from outside due to certain circumstances and cause various inflammatory epithelium reactions.

In addition, the equilibrium in the ecosystem is capable of breaking various factors that negatively affect the body of a woman (both internal and external), which lead to the fact that the microbes living in small quantities begin to oust the natural inhabitants representing a sticking flora, and borrow dominant position. An example of this is the population of the gardnerell vaginal environment, which, for a number of reasons, displaces lactobacilles (doderelast sticks). The result of such a "war" is widely known.

Norm in gynecological smear

Microscopic beings that live in the sex paths of a woman is distinguished by variety, but the norms still exist, although sometimes it is quite difficult to determine them, but we still try to do it. Thus, in a smear, taken in gynecology can be detected:

Leukocytes whose norm in the urethra is up to 10 cells in sight, in the cervix and its channel - up to 30 cells. During pregnancy, these indicators are changing upward;
The view of the epithelial in the smear depends on the place of the material of the material: the cheek urethra, the vagina is laid out with a multilayer flat epithelium (MPE), which we get in the preparation. A stroke from the cervical canal will be represented by cylindrical (prismatic) epithelium. The amount of cells changes in different phases of the cycle, in general, it is believed that, at the norm, their content should not exceed 10 units. However, all this is very conditional, because for accurate diagnostics it is necessary to take into account morphological changes of cellular structures (core, cytoplasm, the presence of "naked nuclei"), that is, to conduct a cytological analysis;
The mucus in the drug is considered a mandatory, but moderate, component, because the glands of the cervical canal and the vagina are distinguished. The mucus looks like a mucus in the menstrual coclaus ovulatory phase, it crystallizes and forms patterns similar to the leaves of the plant, which are called the "Symptom of Fern" (cytology);
Normal smear, as a rule, is represented by sticking fluores (lactobacillia) and single coccal.

Conditional pathogenic flora - not always the norm

In addition to lactobacilli - the main representatives of the normal microflora of the sex tract, on which the important function of the "self-cleaning of the vaginal environment" is entrusted, in the smear can be found in small quantities and other, and pathogenic, microorganisms:

All these microflora representatives can live, not interfering with anyone, or cause inflammation under certain conditions. By the way, even lactobacillas in excessive amounts and in abundant bacterial flora are able to provoke the inflammatory process - lactobacillosis, manifested by itching, burning, discharge. The disease, of course, is not fatal, but very painful.

Pathogenic "guests"

The presence of pathogenic microorganisms transmitted mainly during sexual contact, almost always entails trouble. Local inflammation caused by the pathogen may spread to other organs and systems and (often) go to chronic if you do not cure on time.

This phenomenon is particularly dangerous during pregnancy, since many pathogens are able to have a very negative impact on the fetus, so poor smear during pregnancy is a guide to action, and immediately immediate. What microorganisms can threaten the reproductive system of a person by sexually transmitted? Probably, we will not surprise anyone, calling them, but once again still will not prevent reminding the dangers that microscopic beings carry.

gonokokk - Caudito

Thus, the pathogenic microflora of sex tract belongs:

What is the degree of purity?

The smear to the degree of purity of the vagina takes as an ordinary smear on the flora, but they estimate somewhat differently. In gynecology, the IV degree of purity is distinguished:

I degree - the phenomenon is quite rare, the smear is clean, only chopstick flora, single leukocytes and flat epithelium cells in optimal quantities;

II degree - Among chopsticks can "slip" single coccis or mix other non-pathogenic microorganisms, too, in single specimens, this degree is the most common among healthy women in the gynecological plan;

table: Vaginal Purity Evaluation Standards

III degree - It is characterized by a conditional pathogenic flora and yeast-like mushrooms, showing a tendency to actively reproduce. This may indicate the development of an inflammatory response to the presence of an excessive amount of conditionally pathogenic microorganisms. This analysis involves an additional examination of a woman;

IV degree - Signs of an explicit inflammatory process: abundant coking or cocco-bacillina (mixed) flora, possibly the presence of trichomonade, gonococcal or other pathogenic microorganisms. In such cases, additional laboratory studies are appointed (bacteriological, PCR, etc.) to search for pathogen and further treatment.

Smear on flora, although it is considered simple methodsBut has great opportunities. First stage B. laboratory diagnostics Diseases of the urogenital tract, sometimes, the problem solves the problem and allows you to immediately begin to therapeutic measures, the quality of which is subsequently the same smear and will be controlled, so it is not recommended to avoid such an accessible procedure. It does not require a lot of costs, and the answer does not have to wait long.

What shows the smear to cytology, when to pass it and why

A smear on cytology, what it is what it shows, why gives up and who is shown? Why is this study appointed all healthy women who are not virgins? Is it possible and how dangerous to pass the smear to cytology during pregnancy, at its various timing?

Description of analysis, deadlines for the delivery and features of the procedure

It is taken away from the vagina, namely from the cervix and from the cervical canal in order to find either the exclusion of dysplasia and cancer. Analysis of the savage on cytology is shown to absolutely all women, regardless of whether they live in sexual life. The regularity of the delivery is determined standard - 1 time per year. However, the frequency may be greater if a woman has dysplasia and (or) HPV viruses oncogenic types with ectopia. After all, as you know, the cancer of the vagina part of the uterus is provoked by the human papilloma virus. That is, the smear on the cervical cytology is particularly important for women belonging to a given criterion in the risk group. It is usually recommended to perform a more accurate type of study - dad-test.

Futive mothers it is not necessary to take this analysis - the result of a smear on cytology can be found after delivery. However, sometimes it is necessary if the dysplasia was previously found, for example. But this is in exceptional cases. In general, this analysis is not in this period of life of a woman's mandatory, since the taking of a smear of cytology can be tangible (do not forget that a strong blood flow occurs during the nails tooling the child) and almost certainly it will bloody - very unpleasant psychological Factor for the future mother.

In order to get a clear answer to the question, there is or no risk of developing an oncological process, you need to follow the rules.

1. Let's start with when you take a smear to cytology - necessarily in the absence of an inflammatory process, otherwise it is useless, it will not be considered reliable.

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

3. It is important and how they take a smear to cytology, should do it with a special tool. It is important to pick up the cells not the epithelium that is constantly updated, but the layer of deeper. For this purpose, special brushes are used. The fence should be carried out from the site where the ectopia is located (if there is) or other, suspicious to atypius.

When need treatment

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

At the first degree, it is usually enough colposcopy, and if there are no obvious pathological changes, it is recommended to observe the gynecologist and periodically, at least 1 time per year, to pass the stagger from the vagina to cytology.

At the II degree, the biopsy of the cervical cervix is \u200b\u200busually appointed, and depending on its result (histology), "ignition" can be carried out by the pathological site. In the future, the doctor repeatedly looks again that shows a smear to cytology so that if necessary, to quickly take measures.

During dysplasia III, the degree surgically remove the affected part of the cervix and conduct histologic analysis. Sometimes such a heavy dysplasia regresses, but may also turn into oncology, as this is already a precancerous state. So, this operation is both diagnostic, and therapeutic.

It should be said that not only the cytology of smear from the cervical canal is crushed in the absence of sex infections and inflammation, but all surgical manipulations are carried out. Otherwise, there is a possibility to put an infectious pathogen in the uterus, and this is fraught with serious complications.

If the gynecological smear on cytology shows inflammation, then the woman is recommended treatment, usually with a preliminary surrender of the analysis on the vagina microflora to find the pathogen of the inflammatory process, and then repeat the procedure for the collection of cells from the cervix.

And only when the smear on cytology is the norm - you can relax and go to the usual "schedule" preventive testing of tests. The croak of the cervical part of the uterus develops slowly, such preventive inspections is sufficient for a healthy woman, even the one that is infected with HPV 16 and 18 types - the oncogenic.

Content

A smear on cytology, traditional or liquid, is one of the most important links of screening diagnostics Preiodine and cervical cancer. The introduction of the method in the cytological screening programs allowed many countries to reduce the mortality from cancer of the cervical separation department.

Thanks high level Informativeness, simplicity and easy operation, safety for the patient, smear to cytology or dad-test is widely used in mass preventive inspections, and has established itself as an indispensable method for detecting patients with background and precancerous cervical diseases.

Mail to cytology allows you to identify patients In the preymptomatic phase of cancer or dysplasia, apply gentle treatment methods at a short time, and not disrupt reproductive plans.

The smear on cytology has low sensitivity, so the perfect version of the patient's diagnostic examination on the subject of background and precancerous pathologies is a combination of several techniques:

colposcopy;
biopsy with histological examination of tissue;
PCR for human papilloma viruses or its improved Digene Test version.

A comprehensive technique provides 100% accuracy of results with high-quality taking material and its correct assessment.

It is known that the cause of the malignant tumor of the cervix is \u200b\u200bat least 15 types of human papilloma virus, and two of them are 16 and 18 - initiate a tumor in 70% of cases. Therefore, the diagnosis of diseases of the cervical department should include strokes from the cervical canal on HPV. When the virus is detected in the smear, appropriate therapy is carried out, which significantly reduces the risks of the development of precancerous pathologies.

The advantage of a combined survey, which includes not only a smear to cytology, but also a HPV test is the possibility of preventing the formation of adenocarcinoma - a malignant tumor, which is not determined when the cytological method is met.

Dates and testimony for testing

The first smear on cytology, as a rule, young women hand over in 18 years. However, such an analysis is often started to perform from 21 years. The frequency and timing of the excavation of the smear does not depend on the intensity of the sex life of the girl.

The frequency of passing the smear:

starting from 18 years (21 years) up to 64 years old should be carried out once a year;
patients over 65 years old perform analysis once in 3 years, subject to absence atypical cells earlier;
once in the half a year, the smear must be carried out in violation of the menstrual cycle, the presence of HPV, dysplasia 1 degree and ectopia, complicated by infections, when monitoring the therapy of the pathologies of the cervix.

The most appropriate period for the implementation of cytology It is the middle of the menstrual cycle. The period before the monthly, as well as after them, is undesirable to carry out a smear due to specific hormonal changes in the neck.

The readiness time depends on the workload of the laboratory, as well as on the type of structure: public or private. As a rule, in state institutions, the result of cytology is ready after 7-14 days, and in private - after 1-3 days.

Features of the procedure of smear on cytology

The material is considered adequate to study if the cytologist detects in it cells of the cervical channel, the vaginal part of the cervix and transformation zone: flat epithelium, intermediate and metaplazized, cylindrical in endocervix, single erythrocytes.

In mandatory, a smear must be obtained from the transformation zone - the site most susceptible to malignant changes. The smear is considered inadequate in the absence of cylindrical epithelium cells, a large number of erythrocytes, leukocytes, with a scant number of cells. If the smear on cytology is too thick or thin, the performance decreases sharply.

The macale taking procedure consists of several stages and has features.

The gynecologist conducts two-way palpation of uterus, cervical and ovaries.
For the most accurate results of cytology, colposcopy should be performed. With repeated increase in the cervix, it is examined for pathological inclusions. After that, the doctor handles the surface with a solution of vinegar and evaluates the result. If there are resistant white staining (acethel epithelium), the smear for cytology takes aiming from these places. Also come when lubricating the cervix iodine and the absence of staining in brown (iodine negative reaction). The smear takes from unpainted places, as this reaction of the coating epithelium is considered pathology.
Tools must be dry and sterile, preferably in individual packaging. Water, disinfectant solutions can destroy cell samples, which adversely affects cytology. Specialists when taking a smear use special tools: CERVIX-BRASH, PAPETTE, modified by Ayra spatulas.
The take-off for the study is taken from the surface of the cervix and the visible part of the channel, including the transformation zone, which is clearly determined during colposcopy. In addition, with a spatula of the smear take from the outer surface, the pickling is performed by scraping from the cervical canal.
The selected material is either applied to the glass (with classical cytology), or immersed in the transport liquid (liquid cytology).
Test tubes and glasses are marked.

During manipulation, a woman can feel easy discomfort. After smear on cytology, there are brown discharge From the genital paths throughout the day.

Pregnant women on gestation period more than 22 weeks Cytology is carried out strictly according to indications, since the procedure may cause complications.

Goals and objectives

A stroke on cytology allows you to identify the prejudice pathology of the cervix - the epithelium dysplasia, in which the risk of developing the preinstal cancer is 20 times higher. The transition 2 and 3 of the dysplasia stages into the preinvasive cancer (in situ) lasts from 3 to 8 years, and after 10-15 years the microenvasive cervical cancer develops.

The most frequent pathologies detected during codology of smears are:

ectopia of cylindrical epithelium;
hyperkeratosis, pararacratosis - disorders of the oroging of a flat epithelium;
ferrous hyperplasia;
chronic cervicitis;
different stages of dysplasia and cancer.

Cytology allows you to identify the displastic process in the cervix epitheliums, which prevents the formation of cancer at a timely manner. The dysplasia of the cervix proceeds asymptomatic to 1 and 2 stages, so the annual smear on cytology contributes to the early detection of hazardous pathology.

Dysplasia 3 stages and preinvasive cancer are most often registered in women who do not attend the gynecologist for 5 years in a row and do not perform smear to cytology.

When analyzing the results of a smear on cytology, it is important to evaluate all diagnostic studies, in particular, histology or biopsy.

Method of liquid cytology

The traditional stroke on cytology has several restrictions that lead to a false negative result (within 2-50%), while the main source of errors when screening and evaluating results is poor quality collection, processing of the material obtained and the qualification of the laboratory assistant.

Therefore, to replace the classic smear to cytology came new method - Liquid cytology. This method was developed in 1996 in the United States. Its essence lies in the immersion of the material from the surface of the cervix and the cervical canal is not on the slide, but in the liquid medium of accumulation. From the resulting suspension using an automatic device, a single-layer drug is prepared, which leads to an increase in the effectiveness of the evaluation of the results. When performing a classic stuffing on cytology, the drug consists of several cell layers, which makes it difficult to correct, the true picture can be distorted.

An important feature of the fluid cytology technique is the collection of material obtained by smear from the cervix, in a special medium that contributes to the preservation of cells, which improves the performance of the study. The structure of cellular elements and their immunogystological characteristics are fully saved. This allows you to process the resulting smear with special reagents and conduct immunocytochemical reactions and hybridization.

After removing the cells from the liquid medium, the color is carried out. Staining is performed by the same ways as with a traditional smear to cytology, for example, according to the Pappenheim method.

Decoding

For the development of many pathological phenomena in the field of the coating epithelium of the cervix, the feature of the anatomy of the organ. In particular, the role plays the relationship of the epithelial of the cervical canal and the vaginal portion of the cervical channel.

As a rule, all atypical processes, and further, and the illumination occurs in the area of \u200b\u200bthe transition of a multilayer flat epithelium, which forms the surface of the neck, into a cylindrical, lining channel from the inside. The cylindrical epithelium is differently called prismatic or ferrous, since its main function is the production of protective mucosa secret to form a traffic jam. The portion of the transition of one type of fabric is called the transition zone or the transformation zone. The smear on cytology should be taken, including this section.

The transformation zone can be located in various places:

on the surface of the cervix In young women, as well as during pregnancy and after delivery;
at the entrance to the cervical canal - in women reproductive phases;
in the depths of the cervical canal - In women of mature age and in menopause.

In 96% of cases, pathological processes occur in the transition site, and in the others - in the region of the cervical canal.

After staining, the cytologist carefully studies the sample under the microscope. At the same time, the specialist assesses:

the type of cells identified and their belonging (flat, cylindrical, intermediate epithelium and metaplazized);
sizes of cell elements;
maturity;
condition of cytoplasm and kernel;
the ratio of the size of the cytoplasm to the kernel;
intensity of division.

To decipher the smear on cytology, various classifications are used to unify. The evaluation of the results on the papanicolau system is widely applied.

The first class of smear means the norm.
For the second class of cytology, inflammatory changes are characterized.
The third class is described by the presence in the smear to cytology of cells containing atypical kernels, cytoplasm - no dysplasia is excluded.
The fourth grade means the presence of atypical cells that do not exclude cancer.
For the fifth grade, large amounts of cancer cells are inherent.

One of the popular is the Bethesd system. This classification implies 3 varieties of smears.

Nilm is the norm, namely the lack of intraepithelial malignant changes in the smear. Cytology has a normal result in the aspect of dysplasia and cancer, but does not exclude inflammatory, atrophic and other changes, for example, as a result, the presence of a large number of leukocytes, trichomonads, yeast, bacteria (cockks), viral changes in epithelium cells can be indicated.
ASCUS - a smear to cytology has an indefinite result, atypics of unidentified origin is present.
ASC-N - in the smear there are atypical cells of a flat epithelium, and this find does not exclude a high degree of dysplasia.
Lsil - Changes identified in the smear, talk about a low degree of intraepitial changes associated with human papilloma virus - Dysplasia 1 degree (CIN I).
NSIL means the presence of high-risk changes or 2, 3 dysplasia levels (CIN II, CIN III). In addition, the result of the smear does not exclude the preinvasive cancer (in situ) or microinvasive.

In addition to dysplasia, the smear on cytology determines the cancer changes that are indicated by AGC, AGUS, Cancer in Situ, flat-mellular cancer (High-grade SIL) or iron (adenocarcinoma).

With suspicious smear results on cytology A woman perform a biopsy that confirms or excludes cancer.

After receiving the results of histology, the doctor determines the tactics of further actions. Additional analyzes and surveys are conducted depending on individual situations:

multispiral computed tomography;
MRI with contrast;
bone scintiography;
angiography;
Ultrasound of a small pelvis and abdominal cavity;
x-ray studies;
blood tests on oncomarkers;
diagnostic laparoscopy.

When confirming the initial stages of the tumor, or rather the preinstal cancer or dysplasia 3 of the stage, the conization is performed with the capture of healthy tissues. Techniques are used as radio wave conization, laser, electric stove. Remote cone is examined histologically to assess the quality and completeness of excision. A woman is prescribed a course of immunomodulators and is observed with the purpose of dynamic assessment of the state of the cervix. When the microenvasive cancer is detected or stage 1, an extirpation of the uterus is performed. The second and subsequent stages require not only the removal of the organ, but also chemotherapy, radiation therapy.

In many countries there are uniform programs of cytological screening. In Russia, at the legislative level, it is customary to be examined by all women who have reached 18 years of age, with a smear of creek from cervical and cervical canal.

In the work of gynecologists who carry out assistance in the diagnosis of the pathologies of the cervix, there should be no formalism, sampling for analysis should be carried out taking into account the external changes on the surface of the organ, and the result is evaluated in a complex with all diagnostic methods. The selection of the clinic for screening cervical cancer should be treated scrupulously, since they are often situations when initial changes cannot be identified after analyzes.

The cervical cytology is a laboratory study that determines the Cervix Uteri cell structure (cervical cervix), as well as cervical canal cells. One of the variants of the cervical cervical creek was first applied at the beginning of the 20th century by scientists from Greece Papanikolau (Papanikolaou) for the purpose of early detection and prevention of cancer in gynecology.

Since then, the PAP test is used everywhere along with the new method - ThinPrep (liquid cytology), which allows to determine and effectively treat hidden chronic and precancerous diseases of the cervix.

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Indications for holding

The main task that the cytology of the cervix decides is to prevent the oncological process. Early detection of atypical cells allows you to stop RSM (cervical cancer), which according to statistics is in third place in a number of the most common oncopathologies in women. The danger of the asymptomatic flow of the disease is great, so the main goal of the procedure is the timely identification of precancerous changes in cells. This makes it possible not only to increase the percentage and term of survival, but also confident hope for a prosperous cure. The PAP method in the practice of gynecology is considered one of the fastest and most accurate data on the presence or absence of initial stages of cancer, cancer or background pathologies of neuhroquow ethiology, which can provoke a cancer-threatening cancer. Many doctors call the cervical cytology "Gold Standard" diagnostics and screening observation of such intraepithelial changes and conditions:

A variety of cellular anomalies are high or low.
The presence or absence of pathogenic microflora for diagnosing the state of the mucous membrane of the cervix.
Disorders of the normal rhythm of the menstrual cycle (cycle frequency, its delay or absence).
All types of diseases of viral origin - HPV (human papilloma virus) - Condyloma, Herpes Simplex genital (herpes).
Infartiness (infertility).
Defects of the mucous cover of the cervix (all types of erosion).
Long cycle of therapy with hormonal drugs.
Anomalous discharge from the vagina, including blood, especially after sexual contacts.

The cytology of the cervix is \u200b\u200bnecessary as a screening examination, if:

Pregnancy is planned
Births occur several times in a row (for example, 3-4 times for 4 years).
The first gods occurred at an early age (up to 18 years).
A woman often changes sexual partners.
Scheduled contraception in the format of intrauterine spiral.
Earlier, cytology has never been conducted, or the woman did not examine the last 3 years.
The last fence of the fabric material does not comply with the standards or defined changes in cells.
Inspection of the cervix with a mirror shows visible pathological changes (color, structure).
The woman identified diseases associated with immunodeficiency (HIV).
Family history is burdened by onco-scabers (someone from direct relatives sick or sick at the present time oncabolic).

In general, the annual screening cytological examination must be mandatory for each woman who has reached the age of majority. If the cytology of the cervix shows explicitly pronounced clinical deviations of the cellular material, the survey must be carried out more often - at least 2 times a year or in a complex therapeutic plan.

Preparation

Preparation, which suggests the cytology of the cervix, does not apply to the discharge of complex. The procedure itself occurs very quickly, almost without discomfort and unpleasant sensations, and the preparation lies in the following actions:

Exclude sanitation (hygienic procedures) in the form of scriptures
A few days before the procedure (2-3 days) should adhere to the reference mode in intimate life
Do not use hygienic tampons, tablets, liquids, creams, candles and gels for the vagina
2 hours before the test, the woman needs to refrain from urination

So that the cervical cytology show a reliable result, it is important to know such information:

Pap-test and menstrual cycle are not compatible. The procedure is carried out 3-5 days before the start of menstruation or after them, it is best to do this in 10-12 days of the cycle.
Cytology will not be accurate in any infectious disease, especially in the acute phase, as a rule, the analysis is carried out after basic treatment. The exception is the need to obtain the result CITO, in which case the cytology of the cervix is \u200b\u200bcarried out twice - during the disease and after 2 months for cytological control.
The smear during intravaginal therapy will not be informative, it should be made 5-7 days after the end of treatment.
It is not recommended to make a fence of the fabric material with inflammatory processes into the vagina, whose indicators may be released, itching, burning.

Clarifications of preparation conditions for the procedure can be obtained by the attending gynecologist.

Technique for holding

The cytology of the cervix is \u200b\u200bconsidered a mandatory procedure for a complex gynecological inspection. This is a standard that allows you to promptly identify the risks of many diseases, including oncological.

The gynecologist produces scraping from the outer section of the cervix (extocereswix), as well as from the surface of the vaginal mucosa with a special spatula (Eyra spatula). The cervical channel cells (cervical channel) are taken with an endographic - cervical probe, which allows to obtain a sufficient amount of informative material.

The doctor can also use such tools for the collection of cellular material:

For the smear of the rear axle of the cervix - Ayra Spatula.
Aspiration tool - spirotte, for the fence of endocervical material.
A screech is also intended for the fence of biological material from the cervical canal.
Cervex-Brush is a sterile medical brush for a smear of a smear from the T-zone (cervical and cervical canal surface).
Standard tweezers.
Gynecological mirror.
Cervical double-sided spoon (folkman spoon) for smear on the microflora of the cervical canal and the determination of infectious diseases.

All modern tools are sterile, most of them are used individually for each woman.

Cytology technique:

Inspection on the gynecological chair with the help of mirrors, at the same time the material is taken on cytology. The walls of the vagina are expanding, the shaping procedure (scraping) can deliver short-term light discomfort, but most often cytology passes painlessly.
At the same time, the material for bacteriological research (microflora) is also closed. In conjunction with cytology, colposcopy can be carried out, but this happens only by testimony, usually this procedure is prescribed separately.
Material samples are applied to special glass, fixed, fixed and passed as a laboratory for carrying out accurate microscopic research Using staining. There is a new method of cervical cervix - liquid (ThinPrep), in this case the material is placed in the flask and is also transmitted to the laboratory.

Marking analysis is very important. The laboratory should receive glass with material and special blank, where such information is indicated:

Glass number in accordance with the number of the form of the form.
The name of the medical institution where the procedure was conducted.
Analysis date.
Phoe patient.
Patient age.
Numbers, dates of the last menstrual cycle.
Preliminary (clinical) diagnosis.

The cytology of the cervix does not take much time, the whole procedure lasts no more than 10-15 minutes.

What shows the cytology of the cervix?

The main indicators of cervical cervicals are in two words - a negative or positive result, in other words, the test shows whether there is signs of oncological disease, infectious, bacterial, viral pathology in the smear.

Consider in more detail what the analysis shows:

Negative result means that the epithelium cells are not exposed to pathological processes, the pathogenic flora is not detected, the structure of the cells is not destroyed by viruses
Positive indicators suggest that an abnormal cells are revealed in the cover mucosa, their structure and quantity go beyond the framework of standard standards. Atypical cell elements can be diverse in shape, type and sizes, respectively, the interpretation of the analysis is directly related to these criteria.

In modern gynecological practice, the traditional for use is considered to be the classification of the results from the test of the test, the Papanicolau technique. PAP-SMEAR TEST method suggests detailed description The composition, cell structures, separating them for 5 categories:

Stage I - cell changes were not detected, atypics There are no, which indicates a practically healthy state of the cervix. Cytological picture within the normal range
Stage II - the test discovered some abnormal cell structures with signs of inflammation, which can be considered a relative norm, given the prevalence of inflammatory processes in the sexual sphere. As a rule, additional diagnostic procedures are appointed to the woman to clarify the causes, character, stage and inflammation pathogen.
Stage III - Analysis shows the presence of a small number of locally grouped atypical cells having anomalies in the structure of the kernel or cytoplasm. It is also not a direct indication of threatening pathology, but it may be a signal on the risk of development of the oncoprocess. An additional procedure specifying the PAP test may be a morphological analysis of the tissue material of the cervix (histology). Biopsy helps to exclude risks or confirm the beginning of the pathological process, which can be stopped by timely treatment.
Stage IV-Analysis shows a clear picture of malignant transformations of a small number of cells. As a rule, anomalous cells have too large nuclear mass, cell content (cytoplasm), chromosome also have signs of pathological changes. This stage indicates a possible beginning of onco-scab (dysplasia). Additional examinations - colposcopy, the fence of the material on histology, and repeated cytology are also possible to clarify the diagnosis.
Stage V -test determines quite a large number of modified cells, which indicates the presence of an oncoprocess. In such cases, cytology results are the beginning of a comprehensive diagnostic process aimed at determining the type of oncology, its stage and the vector of therapeutic measures.

Decoding results

Interpret test results may only have a attending physician. Any information extracted in the subsoil of the Internet can only be informational and primary. The following data are publicly available and will help reduce the alarm of women who are afraid of incomprehensible numbers and signs in the analysis.

The cytology of the cervix on the statistic reveals the following:

Each ninth test out of ten determines the norm, that is, the following cytology can be safely carried out after 1-2 years to prevent and screening the state of the cervix. The analysis should be repeated regularly, despite good resultSince it cannot be 100% accurate and does not exclude the risk of disease completely.
Each second from a hundred smears is not informative due to the lack of biological or cellular material. In such cases, cervical cytology repeat
Each twentieth test shows the presence of atypical changes, but this does not speak at all about the developing oncoprocess. Rather, this is a signal and a reason for a more thorough examination and subsequent treatment.
The result of the test can show bad indicators, but it cannot be considered an unequivocal and final diagnosis. To clarify the nature of the pathological process and its forecasts requires additional surveys that the doctor appoints.

Deciphering the results of the cytogram can be carried out by different methods. Classic is the Papanicolau classifier, however, in modern gynecology, it is also taken into account other options for interpreting the test, for example, the American Bethesda System system.

Information on the state of the epithelial tissue of the cervix can be reflected in the following table:

The presence of benign changes	Pathological changes of epithelial tissue: dysplasia, atypics	Invasive cancer
The test revealed trichomonas, Candida, cockflower infection, cell changes, possibly associated with herpes virus The test revealed atiypia epithelial cells associated with inflammation, keratosis, metaplasia, pararacratosis Analysis shows atrophic changes to the epithelium together with an inflammatory process - colpit, hyperkeratosis, metaplasia	ASC-US.Test revealed the presence of flat epithelium cells with atypical changes in unspecified origin Hsil. Analysis does not exclude the high risk of presence of cancer cells Prerostrate changes: dysplasia of various degrees (required by the level of depth of the lesion of epithelial tissue)	Flat stitching invasive cancer Specification of the state, type and stage requires an additional examination at the oncologist
The patient needs an additional examination, observation and complex treatment. Screening cytological control is also needed.	Additional diagnostic procedures are needed. Monitoring the process using the re-cytology of the cervix, colposcopy, biopsy, as well as long-term treatment.	It is necessary to histological examination of the material, it is possible to clarify the diagnosis after surgery Complex long-term treatment

Latin abbreviation in the analysis forge can also be introduced into anxious state, although in fact everything is simply decrypted by the "territory" of the material of the material:

Urethra is the letter U.
Endocerviks, Cervical Channel - S.
Vagina - letter V.

The rest of the information will give you the attending physician.

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Norms of cervical creek

The norm in the cervical creech is considered to be the complete absence of atypical changes in cellular material, as well as a healthy microflora state. "Good" cells must comply with the norms on morphological standards, that is, in size, the contents (structure) and form. The cytogram describes in detail the material taken from the surface layer of the cervix and from the endocervix.

The norms of cytological surveys look like:

The cytology of the cervix contains cells of a single-layer cylindrical epithelium. Alternatively, the test can show the presence of a multilayer (metaplazized) epithelium, this is also considered the norm if the smear was taken into the transition site into the vagina.
Multilayer epithelial cells in a smear from the area of \u200b\u200bthe vaginal part of the neck are also considered the norm if no changes are detected in them.
Any deviations from the norm, changes in cell morphology are described in conclusion and may be indicators of primary inflammatory processes stacked in the framework of the norm.
Deviations from the norms in the dad test does not mean the presence of an oncological process, with the exception of the HSIL indicator. This speaks of a high degree of risk of cancer development.

It should also be borne in mind that there are indicators pointing to benign cell anomalies. This, of course, is not the norm, however, cannot be the reason for enhanced anxiety about oncology.

The list of changes within the relative norms that cytology can show:

Atiphy of inflammatory etiology.
Atypical changes provoked by the papilloma virus.
Mixed atypical changes.
Atypical deviations of unclear nature, requiring clarification.

Processes in which may be deviations from normal boundaries include the following diseases:

HPV - human papilloma virus.
Herpes.
Pregnancy.
Long taking drugs, especially antibiotics.
The use of contraceptive means (candles, tablets).
Contraception with helix.

According to the classification of Trat and Papanicolau, the cervical cervical norm can be considered the first 2 classes out of five, namely:

I - Normal cytological picture
II - ASC-US or the presence of atypical cells of unspecified

Bad cylide cervical cervical

What do bad test results mean?

Bad cytology of the cervix does not necessarily indicate the last stage of cancer. Expanding research can only be given a specialist, that is, a gynecologist. According to the generally accepted classification, poor cytology is pathological changes in the epithelial cervical layer and cervical canal.

According to the generally accepted method, the change is indicated in this way:

0 - The material for the test is unsatisfactory (poor-quality, in small quantities, non-informative due to insufficient patient preparation).
Grade 1 - norm.
Grade 2 - the presence of atypical deviations.
Grade 3 - various degrees of dysplasia.
4th grade is a precancerous state, the initial stage.
Grade 5 - Invasive Cancer.

The most disturbing of the above changes is classified 5, however, any form of dysplasia is also a dangerous signal. Consider types of dysplasia in more detail:

Easy degree of dysplasia is a sign of the inflammatory process. It can not be missed, since inflammation can proceed almost asymptomatic and in the future, go into a more severe form.
Moderate dysplasia is an already threatening signal indicating that the risk of developing the oncoprocess is very large.
The severe degree of dysplasia is practically preconditions.

Untiagnostic dysplasia along with other provoking factors can lead to a truly dangerous state - oncoprocess.

Any woman learning that cervical cytology shows bad result, experiences fear. Let's try slightly reduce its level by informing.

What if the test showed the presence of obvious atypical cells?

First of all, do not get into panic, but listen and fulfill all the appointments of the doctor. The gynecologist usually conducts detailed counseling, both about additional diagnostic procedures and under the prospect of treatment and forecast of the disease.

Events are usually assigned and held:

Re-cytology of the cervix.
Biopsy (histological analysis of the fabric of the affected section of the cervix).
Cervix epithelium scraping.
Deployed blood test.
HPV test.
When revealing dysplasia, it is treated (more often by causthing).
If a concomitant viral infection is determined, they are treated not only to a woman, but also her sexual partner.

Timely diagnosis and adequate treatment give hope for healing, subject to all the appointments of the doctor and regular monitoring of the cervix state.

How many days is the cytology of the cervix?

The cytology of the cervix is \u200b\u200bconsidered a standard procedure, the technology of which is worked out to the smallest detail. The material fence period does not exceed 15-20 minutes, including a general gynecological examination. The analysis is further transmitted to the laboratory, where a longer period of time is already required for accurate and thorough microscopic research. If the pa-test was conducted in all the rules, the material processing process will take about 8 days. The result can be found in the attending physician 2 weeks after the procedure itself, sometimes it happens faster if the analysis is carried out in CITO mode. It also happens that information on test indicators can arrive and later. This is most often associated with additional fences, for example, a biochemical analysis of the secret to the microflora or biopsy according to the testimony.

Histological studies and colposcopy can be assigned to the same day with cytology, and their processing will take a little longer than working on one dad-test. Such comprehensive diagnostic measures allow you to get a complete, deployed picture and make it possible to more accurately determine the course of treatment.

In conclusion, we note that the cytology of the cervix must be a mandatory procedure for each woman. A decrease in the number of cancer cases is still an unresolved task for both doctors and women themselves. Timely, regular inspections, tests and tests will allow you to be confident in our own health. Save all sexual functions in a state of harmony - this task is solved, including with the help of preventive measures, among which the cytology of the cervix is \u200b\u200boccupied.

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