Cytology of the uterus. Cytological examination of the cervical smear

Content

Currently, conducting a cytological examination of the cervix is ​​one of the most effective and accessible methods that help women monitor their gynecological health. Thanks to this analysis, it is possible to find atypical, that is, unhealthy cells, and therefore diagnose the development of cancer at an early stage. This type of analysis was first used in Greece, and has since been used in all countries of the world as one of the early markers of the development of cancer of the female reproductive system.

Cytology in gynecology

Unfortunately, many diseases of the reproductive system in the early stages can occur without visible symptoms. That is why timely examination helps to avoid the development of severe complications. Thus, a cervical smear test should be performed once a year when visiting a gynecologist starting from the age of 19. A detailed interpretation of cytological studies will help to find other disorders that can be caused by various inflammatory processes and infections.

In gynecology, there are two main types of smears that are taken during an appointment:

1. A cytological smear of the cervix and cervical canal, which allows you to diagnose inflammation, dysplasia, and cervical cancer at an early stage.
2. A smear to determine the degree of purity, which is taken from the vagina. When deciphering this analysis, you can obtain information about the presence inflammatory process, flow viral infection, bacterial infection.

The availability of cytological analysis makes it the most popular of all gynecological examinations, including ultrasonography. However, like any technique, it has the right to make mistakes. If certain rules are not followed, 5-10% of false positive and false negative results may be obtained.

Cytological examination of the cervix

A synonym for a cytological smear of the cervix is ​​a Pap test. It is named after the doctor who first used this technique - George Papanicolaou. It was thanks to his research that it was possible to discover that cancer cells can be diagnosed in smears after special staining.

The main objectives of this cytological analysis:

• detection of atypical cells;
• diagnosing the development of precancerous changes - dysplasia or cervical cancer.

When performing a cytology analysis, the following types of cells are studied:

1. Columnar epithelial cells that are taken from the cervical canal.
2. Cell multilayer squamous epithelium located on the vaginal side of the cervix.
3. Cell junction - that is, the transition zone where the first type of cells transitions into the second.

Advantages of the analysis

The resulting transcript of the cytology analysis helps not only to verify your health, but also to begin timely treatment if atypical cells are detected.

The most specific method The study is liquid cytology, when the collected material is immersed in liquid, which ensures maximum accuracy of the result.

Gynecology offers a wide range of examinations that help detect many diseases in the early stages. Most women prefer an ultrasound examination without visiting their local gynecologist. This is fundamentally wrong.

Examination of the cervix is ​​one of the most important diagnostic stages in gynecology. The fact is that ultrasound cannot always diagnose the development of the problem. For example, with ultrasound monitoring it is impossible to see the development of erosion, dysplasia and initial stages cervical cancer.

A cytological examination of a cervical smear is necessary annually.

The main advantages of the analysis are its accessibility, speed of execution, and reliability. It is completely painless, which is important for many women.

Indications and contraindications for

The main task of the analysis is to prevent the development of the oncological process. Unfortunately, the spread of cancer in gynecology is now not uncommon. With timely detection of atypical cells, in most cases it is possible to stop the development of cervical cancer (cervical cancer). CC is currently in third place among other gynecological oncological pathologies occurring in women. The main danger lies in the fact that in the early stages it is completely asymptomatic.

Most gynecologists believe that oncocytology is the “gold standard” for diagnosis and screening.

Thanks to this analysis, it is possible to identify:

• various high and low grade cell abnormalities;
• the presence of pathogenic microflora that can damage the mucous membrane of the cervix.

As a screening test, this test is prescribed in the following cases:

• annual screening for cervical diseases;
• if a woman is planning a pregnancy;
• if over the course of 4 years the woman had a history of more than 3 births;
• the birth of the first child was before 18 years of age;
• if a woman has a frequent change of sexual partner;
• upon entering the postmenopausal period;
• it is planned to install an intrauterine device;
• There is a genetic predisposition to the development of cancer.

The main indications for conducting an unscheduled cytological examination:

• menstruation disorders, for example, its absence, frequent delays;
• presence of signs of HPV infection - condylomas, genital herpes;
• infertility;
• damage to the mucous membrane of the cervix – different kinds erosion;
• long-term use of hormonal medications;
• the presence of abnormal vaginal discharge, which also contains streaks of blood.

After the analysis has been taken, the material is sent to the laboratory, where it is deciphered. On average, it takes 24 hours to study the material and decipher it, however, this time may vary.

There are also a number of contraindications due to which cytological analysis should be postponed:

• presence of acute genital infection;
• pregnancy;
• virginity;
• period of menstruation.

After childbirth, it is allowed to take a cytological examination of the cervical smear only after three months.

Performing scraping

As with any other analysis, taking a smear for cytology requires special preparation so that the resulting transcript is as reliable as possible.

Preparatory stage

The preparation is very simple and does not require much effort from the woman. The procedure itself goes very quickly and does not cause severe discomfort or unpleasant sensations.

1. It is necessary to exclude douching, a hygienic procedure, one or two days before the expected date of the analysis.
2. You should abstain from sexual intercourse for two to three days.
3. Do not use sanitary tampons, various tablets, creams or suppositories.
4. Immediately two hours before the test, you should refrain from urinating.

You should also know that performing a gynecological smear from the cervix and menstruation are incompatible things. The optimal time for taking the test is considered to be 10-12 days of the cycle.

Technique

To obtain a complete transcript that will be reliable, the technique of taking material is very important.

1. The material is collected by a gynecologist in a gynecological chair. To do this, the woman takes off the lower part of her clothes and lies down on a chair.
2. In order to improve visualization, the gynecologist uses a special expander - a speculum.
3. The doctor inserts a special brush into the cervical canal, which allows the collection of endocervical tissue. The resulting tissue is smeared on a special glass slide, which must be blotted. If the gynecologist sees a specific area that interests him, then an additional scraping may be taken.
4. Next comes fixing and drying the smears.
5. Upon admission to the laboratory, the laboratory technician evaluates the amount of material taken, the thickness of application, correct fixation, and degree of purity. If any of the points does not suit the laboratory technician, he may ask you to take a smear again.

Do not worry if, after receiving the transcript, the doctor asks to retake a smear. This happens in about 20% due to incorrect technique laboratory errors or errors.

Decoding

Currently, in gynecological practice, the interpretation of a cervical smear using the Papanicolaou method is used. This technique divides cell structures into five different categories.

• The first stage is the absence of cellular changes.
• The second stage is a small amount of abnormal epithelium, which was subject to an inflammatory process. This option is normal and requires anti-inflammatory treatment;
• The third stage is the presence of a local accumulation of atypical cells that have changes in the structure of the nucleus or cytoplasm.
• Fourth stage- the presence of a clear transformation of cells that have an increased nuclear mass, atypical chromosomes and cytoplasm. These changes indicate the beginning of the development of cancer.
• The fifth stage is a large number of atypical cells.

Only a gynecologist should decipher the result. You should not resort to self-diagnosis and prescribe the wrong treatment.

In some cases, only one smear interpretation is not enough to make an accurate diagnosis, prescribe additional research, which help to accurately establish the presence or absence of an oncological process: extended colposcopy and biopsy.

A cytogram is a cytological study that determines the state of the epithelial cells of the cervix. That is, it is a smear-imprint that is taken in the area of ​​the cervix to reveal inflammation of the cervical canal, ovaries, fallopian tubes, uterus and other parts of the woman's reproductive apparatus. After analyzing for cytology, you need to pass a smear on the vaginal flora with the determination of sensitivity to antibiotics.

Girls after 21 years of age should have a cytology smear every three years as a preventive measure. Regular examinations can only be stopped after age 70, if all test results have been negative within the last 10 years. An unscheduled examination is carried out in the following cases:

How to take material for a cytogram

To obtain scrapings, use special Cervix-Brash brushes or an Eyre spatula. The material is collected using light pressure from the instrument to capture cells from the deep layers of the cervix.

The reliability of the results depends on:

• qualifications of the gynecologist and his ability to correctly take material for analysis;
• experience and attentiveness of the laboratory technician who will analyze the smear and make a conclusion.

If scraping from the cervical canal was performed incorrectly, then after the procedure the patient will experience bloody issues and painful sensations.

For more accurate results in modern gynecology they use new technology. Its essence lies in mixing the material with a special solution, due to which the epithelial cells are mechanically separated from foreign impurities (blood, mucus, pathological secretions).

During the study, epithelial cells taken from the cervix are highly clear and the number of false negative tests is significantly reduced.

Depending on the number of atypical cells in the smear, 5 classes of cervical condition are distinguished:

1. class - epithelial cells have a normal structure, cytogram without pathology;
2. class - diagnostics detect fungi, chlamydia, viruses in a smear;
3. class - among normal epithelial cells in the field of view of the microscope there are single atypical cells, this condition is called;
4. class - a single smear is detected, suspicion of oncology is diagnosed and the patient is prescribed additional;
5. class - indicates a high probability of cervical cancer; cancer cells are found in large numbers in the smear.

To obtain an accurate result, before taking the test, you must abstain from sexual intercourse, use of a tampon, vaginal suppositories and douching.

A cytogram of cervical inflammation allows you to determine the type of causative agent of the infectious process in the woman’s genital tract and prescribe adequate therapy. In case of inflammation, not only a microscopic examination of the smear is carried out, but also culture on nutrient media. This allows you to accurately determine what caused the pathology and how to solve the problem quickly and effectively.

In the case when the cytogram showed inflammation, it is no longer informative in relation to oncology. Therefore, after anti-inflammatory therapy, it is necessary to take a repeat cytology test.

Cytogram during pregnancy

When a woman is carrying a baby, a change occurs not only in her hormonal background, but also directly in the microflora of the vagina. As a result, the body's resistance (resistance to diseases) decreases and the development of fungal infections and inflammatory processes is noted.

Attention! A cytological examination of a smear during pregnancy allows you to determine the state of the microflora, the presence of atypical cells, pathogens, as well as assess the general condition of the mucous membrane of the genital tract and, in the presence of inflammation, determine the degree of its development.

During pregnancy, a smear for flora and cytology is taken three times (if no abnormalities are detected):

1. At the time of registration of a pregnant woman at the antenatal clinic.
2. At 30 weeks during the registration of a pregnant woman’s exchange card.
3. At 36-37 weeks to assess the woman’s body for the upcoming birth of a child and monitor the condition of the birth canal.

The vaginal condition assessment is analyzed as follows:

• 1st degree – vaginal pH is acidic, lactobacilli predominate in the smear, there is no inflammatory process;
• 2 and 3 degrees - the pH of the vagina changes to the alkaline side, minor changes in the cellular composition are noted, the woman is diagnosed with a mild inflammatory process;
• Stage 4 – vaginal pH is alkaline, the amount of lactobacilli is reduced, pathogenic microorganisms are found in large quantities in the smear and an inflammatory process is diagnosed.

If during the study a diagnosis of vaginosis or is established, then the pregnant woman is prescribed a course of treatment, after which the smear must be taken again. In the case when a high level of leukocytes and pathogenic microbes is present in the smear in the last weeks of pregnancy, the woman in labor is sent to hospitalization in a special department for pregnant women with pathologies.

In the last months of pregnancy, the number of intermediate, parabasal and superficial cells in the cervical canal increases. They are detected in a smear for flora and cytology. The greater the number of such cells, the closer the onset of labor.

How to eliminate cervical inflammation

If vaginal candidiasis (thrush) is detected in a woman, treatment is carried out with local antifungal drugs. In this case, the doctor prescribes exactly the remedy that will negatively affect the vital activity of pathogenic microorganisms.

Video: cervical smear

Video: necessary and unnecessary tests in gynecology

In the vast majority of cases, leukocytes in a smear are a sign of an inflammatory process in the organs of the urogenital tract, both female and male. However, it is a rare man, especially at a young age, who can “boast” that he had a smear taken if everything is in order with the genitourinary system. For men, smears are not mandatory tests during medical examination. Another thing is women. Probably, there are no such people who are not subjected to such manipulations at least once a year. And this is in the absence of pathology, but if there are problems, then smears are taken as needed.

Norm and pathology

Normally, material from the male urethra is not abundant. Single leukocytes, transitional epithelium in a smear, single rods - that’s all that a healthy man can provide us with. The appearance of a large number of leukocytes in a smear of the stronger sex is usually accompanied by the presence of the culprits of inflammation(, yeast-like fungi of the genus, etc.), which is treated, and then analyzed again to ensure the success of the measures taken.

As for women, an increased number of white blood cells is observed before menstruation and is considered an absolutely natural phenomenon. In addition, the increased content itself (the norm is up to 30 cells in the field of view) is not a reliable indicator; the absence of morphological signs of these cells is considered evidence of the norm of leukocytes. They are “quiet”, not destroyed (the nuclei are preserved), there are no signs of phagocytosis. In addition, sometimes the reason for the diagnostician’s confusion may be incorrectly taken material. An example is a “thick” smear, which is practically invisible due to the fact that the entire field is dotted with clusters of overlapping cells (including leukocytes). Without the risk of making a mistake, in such cases the woman is offered to take the test again.

Table: normal smear results for women

V – material from the vagina, C – cervical canal (cervix), U – urethra

Flora and cytology - what is their difference?

If in men the analysis is taken only from the urethra, then in women there are more objects of study: urethra, vagina, cervix, cervical canal. True, sometimes they take an aspirate from the uterine cavity and also make smears, but this is considered biopsy material, which is reviewed by a cytologist. He also draws a conclusion. Aspirates are not taken during routine examinations, this analysis is used solely for diagnostic purposes to detect cancerous and precancerous diseases of the main reproductive organ among women. In addition, if the aspirate is filled with formaldehyde, and then applied to glass and stained, you will get a histological preparation, which is considered the last resort in the diagnosis of malignant neoplasms.

Probably many have heard the expressions: “smear for flora”, “smear for cytology”. What does all of this mean? How are they similar and how are they different?

The fact is that in a smear on the flora at high magnification with immersion, the doctor can count the cells, detect trichomonas, yeast, diplococci, gardnerella and other microorganisms that represent the rich biocenosis of the female reproductive system. But he will not be able to determine morphological changes in the epithelium, since these are different areas of laboratory diagnostics, where cytology occupies a separate niche. The study of the cellular composition of some material requires, in addition to certain knowledge, also special training. Studying pathological changes cells and nuclei theoretically gives very little, here, as they say, a trained eye is needed.

The doctor deciphers the analysis in both cases (flora and cytology); we only have to become slightly familiar with some concepts so that, when faced with a similar problem, we do not get scared or panic.

Cytological examination

The tasks and functions of cytology are much wider, and therefore its capabilities are also wider. The doctor examining the material focuses on the condition 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 vaginal portion of the cervix, represented by multilayered (four-layer) squamous epithelium (MPE) and the cervical canal, is subject to examination. With a correctly taken smear from the cervical canal, the normal cytological specimen clearly shows the prismatic (cylindrical) epithelium, single leukocytes and depleted microflora, which could have come from the underlying sections (from the vagina, for example).

It should be noted that the cytological preparation is more informative, since the staining method (Romanovsky-Giemsa, Pappenheim or Papanicolaou) gives a clearer picture. Cells are first viewed at low magnification to evaluate general state preparation, and then on a large one (with immersion), in order to consider not only the epithelium itself, but also changes in the nucleus characteristic of a particular disease. In a word, the cytologist sees the flora, inflammation, and in most cases its cause and the changes that this inflammatory process entailed. As well as indicative signs of infections that present particular difficulties in diagnosis, pre-tumor and tumor states of the epithelium.

Video: about a smear for oncocytology

Indirect signs of some STIs in cytology

As for the smear for STIs, it is advisable to examine it as a cytological preparation. A smear taken on the flora and stained with methylene blue is the most important, accessible and cheap, and therefore the most common diagnostic method in gynecology. However, unfortunately, it does not provide the necessary completeness of the picture for the diagnostic search for STDs and their consequences.

In addition to all possible inhabitants, which, when infected or disrupted biocenosis, are visible in a smear on the flora (Trichomonas, yeast, leptothrix), in the material under study (cytology) one can find indirect signs of the presence of microorganisms, which are very problematic to identify using microscopic methods:

• The appearance of giant multinucleated MPE cells, sometimes quite bizarre in shape, often with signs of parakeratosis and hyperkeratosis (keratinization), indicates a possible lesion;
• Cells in the form of an “owl’s eye” with coarse-grained cytoplasm are characteristic of;
• When you can detect koilocytic atypia (MPE cells with large nuclei and a clearing zone around the nucleus);
• Provacek bodies in the cells of metaplastic epithelium, which are characteristic of and play a role in screening studies, are also indicative.

Of course, it is impossible to make a diagnosis of herpetic, cytomegalovirus or papillomavirus infection by cytological analysis, but it can be assumed, and this is the basis for further, more in-depth examination in a specific direction (, etc.). Thus, cytology allows you to narrow the diagnostic search, avoid unnecessary tests, save time, and quickly begin treatment measures.

How to prepare for the analysis?

Since the simplest and most accessible method for identifying inflammatory processes of the urogenital tract, both in men and women, is a smear on the flora, it is necessary to pay more attention to it and teach the reader to understand a little about the entries entered in the form.

However, before you visit your doctor, Patients should know some simple rules:

1. A couple of days before the test, it is necessary to exclude not only sexual contact (sometimes you can see sperm in a woman’s smear), but also any interventions such as douching, medications local use (suppositories, creams, tablets);
2. You should not go for such a study during menstruation, because menstrual blood will interfere with viewing the drug, where the doctor will mainly see it;
3. On the day of the examination, you need to calculate the time so that you urinate for the last time 2-3 hours before, since urine can wash away all the “information”;
4. 7-10 days before the test, stop taking pharmaceuticals, especially antibacterial drugs, or take a smear only a week after the end of treatment;
5. Another rule that women often ignore: do not use intimate hygiene products. Of course, it is very difficult to abstain from such procedures altogether, as experts recommend, but you can at least limit yourself to clean warm water. Men perform the last toileting of the external genitalia in the evening before visiting the doctor.

After following these tips, the person goes to an appointment, where they will take a smear, paint and look under a microscope. The doctor will do the decoding, and the patient will receive a conclusion, and he will probably be interested to know what all these numbers and words mean.

Video: preparing for a smear

What can be seen in a urethral smear in men?

The reader probably guessed that taking a test from men is unlikely to leave pleasant memories, because the object of research is not so accessible to them, so there will indeed be unpleasant sensations that may not leave the person for several more hours. Sometimes, to avoid this, the doctor prescribes a prostate massage to the patient, which is performed several days before the procedure per rectum, that is, through the rectum.

However, if the burning sensation and soreness in the penis continues to remind itself for several days, and these phenomena are also supplemented by similar ones, a trip to the doctor is inevitable. But if everything went well, then perhaps men will be reassured by the fact that in their smear taken from the urethra, everything looks much simpler, unless, of course, normal analysis:

• The norm of leukocytes is up to 5 cells in the field of view;
• The flora consists of single rods;
• The general background dilutes the urethral epithelium (mainly transitional) - approximately 5-7 (up to 10) cells;
• A small amount of mucus that does not play any role;
• Sometimes a smear may contain opportunistic flora in single specimens (streptococci, staphylococci, enterococci), but in order to differentiate it, it is necessary to stain the smear according to Gram.

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

1. A large number of leukocytes appear in the smear, sometimes not countable;
2. Coccal or cocco-bacillary flora displaces rod flora;
3. The drug contains microbes that cause inflammation (Trichomonas, gonococci, yeast, etc.);
4. It is hardly possible to see microorganisms such as chlamydia, urea and mycoplasma under a microscope, just as it is difficult to distinguish pathogenic diplococci that cause gonorrhea from pairwise enterococci or a chain of Enterococcus faecalis (enterococci too) from streptococci, therefore in such cases, to clarify the species The study of the pathogen is supplemented by the cultural method or the almost universal and popular nowadays PCR (polymerase chain reaction);
5. With rare exceptions, E. coli can be detected in a man's smear (a flagrant violation of hygiene rules!), which is beneficial in the intestines, but causes cystitis when it enters the man's urethra. Additional laboratory research methods are also needed to differentiate it.

The same is done with female smears, since the diplococci found may not be Neisseria and may not cause gonorrhea. By the way, E. coli (Escherichia coli), enterococcus (Enterococcus faecalis), staphylococci with streptococci and other microorganisms in female smears are much more common, which is due to the structure of the female genital organs.

Ecosystem of the female urogenital tract

Leukocytes in a smear taken in gynecology, whether for flora or cytology, are not the only cells present in the preparation. In addition, they act only as a consequence or reaction to events occurring in the ecosystem (oscillations hormonal levels, inflammation). For example, their increase in various phases of the cycle is due to hormonal influence, therefore, when collecting material, the date of the last menstruation is indicated on the referral form.

A diagnostic criterion for the inflammatory process is considered not only a large number of Le, “running” to the site of “military actions,” but also the state of their nuclei. When leukocytes react, they try to absorb the “enemy”, phagocytose, but at the same time begin to destroy themselves. The destroyed cells are called neutrophilic leukocytes, but this phenomenon is not indicated in the analysis transcript. A large number of neutrophilic leukocytes, together with abundant cocco-bacillary or coccal flora, serves as the basis for confirming the presence of an inflammatory process.

The ecosystem of the 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 obligate, while others come from outside due to certain circumstances and cause various inflammatory reactions of the epithelium.

In addition, the balance in the ecosystem can be disrupted various factors, negatively affecting a woman’s body (both internal and external), which lead to the fact that microbes living in small numbers begin to displace the natural inhabitants, representing the rod flora, and occupy a dominant position. An example of this is the colonization of the vaginal environment by Gardnerella, which for a number of reasons displaces lactobacilli (Doderlein bacilli). The result of such a “war” is widely known.

Normal in a gynecological smear

The microscopic creatures that live in the genital tract of a woman are diverse, but norms still exist, although sometimes their boundaries are very difficult to determine, but we will still try to do this. Thus, in a smear taken in gynecology you can find:

• Leukocytes, the norm of which in the urethra is up to 10 cells in the field of view, in the cervix and its canal - up to 30 cells. During pregnancy, these indicators change upward;
• The type of epithelium in the smear depends on the location of the material collection: the urethra, neck, and vagina are lined with stratified squamous epithelium (MSE), which we will obtain in the preparation. A smear from the cervical canal will be represented by cylindrical (prismatic) epithelium. The number of cells changes in different phases of the cycle, but in general, it is generally accepted that, under normal conditions, their content should not exceed 10 units. However, all this is very conditional, since for accurate diagnosis it is necessary to take into account morphological changes in cellular structures(nucleus, cytoplasm, presence of “naked nuclei”), that is, carry out cytological analysis;
• Mucus in the preparation is considered an obligatory, but moderate, component, because the glands of the cervical canal and vagina secrete it. Mucus looks interesting during the ovulatory phase of the menstrual cycle; it crystallizes and forms patterns similar to the leaves of a plant, which are called the “fern symptom” (cytology);
• A normal smear is usually represented by rod flora (lactobacillus) and single cocci.

Opportunistic flora is not always the norm

In addition to lactobacilli - the main representatives of the normal microflora of the genital tract, which have the important function of “self-cleaning the vaginal environment”, other opportunistic microorganisms can be found in small quantities in the smear:

All these representatives of microflora can live without bothering anyone, or cause inflammation under certain conditions. By the way, even lactobacilli in excess quantities and in an abundant bacterial flora can provoke an inflammatory process - lactobacillosis, manifested by itching, burning, and discharge. The disease, of course, is not fatal, but very painful.

Pathogenic "guests"

The presence of pathogenic microorganisms, transmitted mainly through sexual contact, almost always leads to trouble. Local inflammation caused by the pathogen can spread to other organs and systems and (often) become chronic if not treated in time.

This phenomenon is especially dangerous during pregnancy, since many pathogens can have a very negative effect on the fetus, so a bad smear during pregnancy is a guide to action, and immediate action. What microorganisms can threaten the human reproductive system through sexual transmission? We probably won’t surprise anyone by naming them, but once again it won’t hurt to remind you of the danger posed by microscopic creatures.

gonococcus - the causative agent of gonorrhea

Thus, pathogenic microflora of the genital tract include:

What is the degree of purity?

A smear to determine the degree of vaginal cleanliness is taken like a regular smear for flora, but is assessed somewhat differently. In gynecology, there is IV degree of purity:

I degree– a rather rare phenomenon, the smear is clean, only rod flora, single leukocytes and squamous epithelial cells in optimal quantities;

II degree– single cocci may “slip” among the rods or other non-pathogenic microorganisms may also be mixed in single copies, this degree is the most common among gynecologically healthy women;

table: standards for assessing vaginal cleanliness

III degree– it is characterized by opportunistic flora and yeast-like fungi that tend to actively reproduce. This may indicate the development of an inflammatory reaction to the presence of an excess amount of opportunistic microorganisms. This analysis involves additional examination of the woman;

IV degree– signs of an obvious inflammatory process: abundant coccal or cocco-bacillary (mixed) flora, possible presence of Trichomonas, gonococci or other pathogenic microorganisms. In such cases, additional laboratory research(bacteriological, PCR, etc.) to search for the pathogen and further treatment.

A smear on the flora, although considered a simple method, has great potential. The first step in the laboratory diagnosis of diseases of the urogenital tract, sometimes, immediately solves the problem and allows you to immediately begin treatment measures, the quality of which will subsequently be controlled by the smear itself, therefore it is not recommended to avoid such an accessible procedure. It doesn’t require a lot of expenses, and you won’t have to wait long for an answer.

For the pelvic organs in general and the reproductive system in particular, the process of changing cell structure is the norm. That is why in medicine there are many different tests, the results of which can promptly identify various pathological processes that have just begun to develop.

Cervical cytology is a fairly common diagnostic method in gynecology. Thanks to this study, doctors can determine the presence of atypical cells in tissue structures, indicating an inflammatory, infectious or cancer. Let us consider in more detail why a cytological examination of the cervix is ​​prescribed, as well as what its features are.

In medicine, it is customary to prescribe the diagnostic method in question when there is a need to study the cellular composition of the surface layer of the mucous membrane of organs. For these purposes, during a gynecological examination, biological material is taken (smear or scraping), which is subsequently sent for microscopic examination in the laboratory.

Many girls who have had a cytological examination of the cervix try to understand what it is first. Experts say that this diagnostic method is the main way to determine the pathology when there are characteristic symptoms, but it can also be carried out for preventive purposes if there are no signs of the disease and the woman came for a routine examination.

Cellular changes during cytological examination. Source: medsest.ru

As for the regularity of performing cytology, if the patient has a good level of reproductive health, it is recommended to conduct a study once every 5 years. At the same time, a certain part of doctors is convinced that the first analysis should be done after entering into intimate life, but others advise starting diagnosis at 16-18 years of age.

Cytological examination of the cervical smear makes it possible to identify most gynecological diseases at an early stage, since the majority of them can occur latently for a long time. The procedure itself is quick and painless, so you should not worry that the patient will feel discomfort during it.

Why do they do it?

For diagnostic purposes, as well as during a preventive examination, when a cytological examination is done, the endocervix, ectocervix, as well as the zone where the cylindrical epithelium passes into squamous, are subject to study in the biological material taken.

Specialists pay special attention to various abnormalities in the structure of cells. So, for example, if atypical representatives are found in the material taken, it is necessary to carry out additional diagnostics, the purpose of which will be to confirm or refute the presence of oncology or a precancerous condition.

However, it is worth noting that during the procedure it is possible to identify not so serious conditions. A cytological examination of a scraping from the cervix makes it possible to diagnose dysplasia, hyperplasia, the presence of viruses and bacteria, which can provoke the development of an infectious or inflammatory process.

Indications

Gynecologists say that the cytological method of diagnosis is not only quite informative, but also less traumatic for the patient. That is why it is shown to be carried out at the slightest suspicion of any pathological process, and only after that, if there is ambiguity, a biopsy is done.

Cytological examination can be supplemented with a cervical biopsy. Source: zdorov1467.ru

The main indications for the procedure are the following conditions:

1. The need to perform a preventive study, which is done every 5 years for women of reproductive age;
2. The patient has any neoplasms in the uterine cavity and on the neck, for example, fibroids, polyps or fibromas;
3. If there is an assumption or a human papillomavirus infection is diagnosed, the purpose of the study is to determine its strain, since some of them have a high degree of oncogenicity;
4. When processes associated with pathological tissue growth progress in the reproductive organs, for example, hyperplasia, dysplasia, endometriosis;
5. The doctor suspects that the woman has cervical erosion, and also if she was previously diagnosed and treated;
6. The patient complains of pain, swelling, a change in the nature of the discharge, which indicates the progression of the inflammatory process, fungal infection or infectious disease;
7. There is acyclic bleeding of unknown etiology, which often indicates the development of an oncological process, especially after the onset of menopause.

A planned study is indicated for patients who are planning a pregnancy, suffer from infertility, are preparing for the installation of an intrauterine device, are undergoing hormone therapy suffer from obesity and diabetes mellitus, or they have metabolic disorders.

Contraindications

Every woman should not only know what a cytological examination of the cervix is, and in the presence of what diseases and conditions of the body it is performed, but also understand that, like any other medical procedure, it has contraindications.

A smear to determine atypical cells in the mucous membrane of the cervix is ​​not performed in the following situations:

• The woman’s blood clotting ability is impaired, since when biological material is taken, the cervix may begin to bleed;
• During pregnancy this procedure carried out only in extreme cases and during certain periods, so as not to cause harm to the embryo or developing fetus;
• It is unacceptable to perform diagnostics using cytology on virgins, since it is considered inappropriate and not informative, as well as difficult to carry out due to physiological characteristics;
• For patients who have not yet reached the age of majority, the procedure can only be performed with parental permission, so this contraindication is considered a relative limitation;
• The collection of biological material for cytological examination is not performed during menstrual flow, as well as in case of bleeding of unknown etiology;
• It is considered inappropriate to carry out analysis at the time of exacerbation of any genital infection, which is due to high level likelihood of uterine infection.

Gynecologists also draw the attention of women to the fact that a cytological examination of a smear from the cervix is ​​not carried out earlier than 3 months after childbirth, since during this period the reproductive organ is considered injured and the results of the analysis may be biased.

Preparation

In order to get the most useful information from the study, doctors first tell patients how to properly prepare the body. If the procedure is prescribed urgently, then no more than a day is allotted for this, and if planned, then 2 days, during which, first of all, it is necessary to avoid any types of intimacy.

It is strictly forbidden to use medicines products intended for vaginal administration, such as suppositories, tampons, creams and gels. It is also recommended not to overdo it with intimate hygiene, but to wash yourself without using active chemicals. Douching and vaginal irrigation are prohibited.

To obtain the most accurate results of a cytological study, it is best to take biological material before the onset of ovulation in the current menstrual cycle, but after the completion of regular bleeding. Accordingly, the most suitable time is 7-12 days from the beginning of the cycle.

Performance

In most cases, they resort to the traditional method of performing a cytological examination using a smear-imprint. Many women note that the procedure, although unpleasant, is painless, and is performed in a gynecological office during an examination. Biological material must be collected using sterile or disposable instruments, and the duration of all manipulations does not exceed 10 minutes.

Technique for collecting smears for cytological analysis. Source: mymom.ru

The research algorithm is as follows:

1. The patient should undress from the waist down and sit as comfortably as possible in the gynecological chair;
2. After this, the specialist inserts a dilator into the vagina;
3. In certain cases, doctors resort to colposcopic control of the procedure, but if this is not done, it is not considered a violation of technology;
4. Next, a special brush is inserted into the cervical canal, through which biological material is taken;
5. After this, it is placed on a glass slide and labeled;
6. Then biological material is collected from the area where the columnar epithelium turns into a squamous cell form and placed on a glass slide (manipulation is carried out with a special spatula);
7. If there are any suspicious areas, a smear is also taken from them, but with a different spatula and placed on a separate glass slide;
8. After this, the doctor removes the speculum, the woman is allowed to get up and get dressed, the glasses are treated with a fixative, dried and sent to the laboratory.

After performing this method of studying the cells of the mucous membrane of the cervix, doctors do not recommend that patients have sexual intercourse for the next two days. It is also worth saying that there may be individual restrictions, depending on the clinical case, but in general, girls are allowed to lead their usual lifestyle.

Atypical cells

Thanks to a correct and timely cytological examination of the cervical smear, the doctor is able to determine the presence or absence of atypical cells. The latter, in turn, differ from normal ones in that they have certain changes in shape, size and morphological structure.

The main distinguishing features are the presence of two nuclei, as well as a reduced and increased number of organelles. However, it is worth noting that even with normal level health, atypical cells may be present in the body in small quantities. At the same time, their ability to divide is suppressed by their own immunity and the pathological, in particular oncological, process does not develop.

Normal and atypical pathological cells in a smear.

An inflammatory cytogram is a set of changes in a smear, indicating the presence of an inflammatory process in the cervix.

A study during which such changes can be detected is called a cytological test (Pap test). In the process of cytological examination, a thorough study of the cellular composition of the resulting preparation is carried out. The number of leukocytes, eosinophils and other formed blood cells is determined, the shape of epithelial cells, the location of chromatin in the nucleus, the relative position of epithelial cells, reactive changes in the obtained material, the presence of microorganisms in the cells that may be the cause of the identified inflammation are studied. These indicators are determined in all layers of the epithelial layer.

The data obtained are used to calculate a number of important indicators that facilitate the interpretation of the analysis: karyopyknotic index, eosinophilicity index, maturation index.

In simple terms, a cytogram of inflammation is a leukocyte infiltration of the cervical epithelium, detected during a cytological examination.

The resulting cytogram of inflammation requires a smear to study the microflora and determine its sensitivity to antibacterial drugs.

After completing the course of treatment, repeated treatment is required. this study to confirm cure.

What diseases can cytology show?

With the help of cytological examination it is possible to determine:

1. The course of the inflammatory process in the cervix.
2. Assume infection of the body with human papillomavirus types 16 and 18, which are provocateurs for the development of cervical cancer.
3. The presence of atypical (cancerous) cells in the cervix.
4. The development of cervical diseases such as erosion and leukoplakia.

How to prepare

To obtain a cytogram that reflects the real state of the cervical cells and minimize the risk of an erroneous conclusion, you should adhere to small restrictions before taking a smear for cytological examination.

Avoid sexual intercourse 2 days before taking a smear.

A woman should not douche or insert any medications into the vagina.
You should also stop taking hormonal drugs if a cytological examination is planned. A gynecologist can tell you in detail how and when it is best to do this.

You should not come for a cytological examination immediately after the end of menstrual bleeding or on the eve of the arrival of your period. Most favorable time To take a smear for a cytogram, the middle of the menstrual cycle is considered, starting from the 13th day after the end of menstruation.
Any inflammatory diseases vagina and cervix should be treated. If a woman has similar diseases, then when taking a smear there is a risk of the inflammatory process spreading into the deeper layers of the inflamed tissue, as well as the risk of purulent inflammation. For these reasons, a smear for cytology is taken only in the absence of manifestations of active inflammation.

In pregnant women, taking a smear for cytological examination is not possible. The fact is that in pregnant women, the cervical canal of the cervix is ​​clogged with a mucus plug, and when taking a smear from the cervical canal, the mucus plug may be damaged. Moreover, the reaction of the uterus after such an intervention can be unpredictable. That is why you should take care of the pregnant uterus and wait until delivery. After childbirth, it is permissible to take a smear for a cytogram only after complete restoration of the birth canal and uterine tone.

How is the material obtained?

For women who are regularly examined by a gynecologist, this procedure will not be fundamentally new. The only difference is that the smear is taken with a special brush, and not with a Volkmann spoon, as during the usual smear procedure.

The brush is inserted into the cervical canal and scrolled several times clockwise and counterclockwise. After this, the taken material is applied to a glass slide and fixed with a special solution to keep the cells from drying out.

Then, the resulting preparation is placed under a microscope for a detailed study of the cellular composition.

What could be the conclusion?

One of the most common options for the conclusion of a cytological study is an inflammation cytogram. It should be said that a cytogram of inflammation is one of the least dangerous conclusions that can be issued during cytology.

In addition to inflammatory changes, the cytogram may contain information about the presence of koilocytes. Koilocytes are cells that appear when a woman is infected with the human papillomavirus. If such cells are detected, the woman must undergo additional tests to confirm the presence of this virus in the body.

The cytogram may reflect the development of leukoplakia (hyperkeratosis) of the cervix. You can suspect its presence even during a smear, since it is visible to the naked eye. Leukoplakia looks like white areas of keratosis on a pink background of the healthy mucous membrane of the cervix.

Atypical cells may also be detected during cytological examination. These are cells that divide quickly and randomly and have irregular shapes and sizes. If such cells are detected, the tissue is taken again for analysis to eliminate a possible error. The appearance of such cells in the cytogram indicates a precancerous condition of the cervix and requires immediate initiation of treatment measures.

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