Cytology of cervical smear. Cytology in gynecology: how many smears are done and interpretation of the results

The main problem of oncology in general is the diagnosis of the tumor process at the earliest stage and timely treatment malignant neoplasms. For this purpose, modern diagnostic techniques are used, which make it possible to determine the presence of atypical cells in any tissue of the body.

Oncogynecology is an important part of maintaining the reproductive health of the female population. Diagnosis of malignant neoplasms of the genital organs is the main task of this section of medicine. Cytological examination of scrapings of the cervix and cervical canal is an integral part of diagnosing genital tumors in women. But not all women know:

• which specialist prescribes the study;
• why and how it is carried out;
• what results can be obtained;
• how to interpret them.

Women who have been prescribed such an examination are also concerned about other issues. The answers to them can be obtained by reading this article.

What is a cytological examination of the cervix and cervical canal?

Cytological examination is a method laboratory research in medicine, in which the morphological characteristics of cellular elements in a cytological preparation are assessed to determine the presence or absence of a tumor process and other changes. The study is carried out using microscopy of biomaterial obtained and prepared using special methods.

In gynecology, cytology is used to study the surface cells of the cervix and cervical canal. The analysis is prescribed by obstetrician-gynecologists at clinics, hospitals and antenatal clinics and used as:

• screening (mass examination) of patients;
• to establish or clarify a diagnosis;
• control of treatment of an already known disease;
• early detection of treatable diseases.

Anatomy

Behind the labia majora and minora is the vaginal vestibule, behind which the vagina is located directly. It is a hollow muscular organ located in the pelvis. The vagina occupies a position between bladder and the urethra in front and the rectum in back. The distal end is attached to the cervix. The cervix is ​​an anatomical formation in the lower segment of the uterus. The cervical canal of the cervix is ​​an anatomical through hole that passes through the middle of the cervix and directly connects it and the vagina. It may be absent if embryogenesis is abnormal; this condition is called atresia. Normally, the cervical canal is filled with mucus, which protects the uterus from the penetration of microorganisms and other foreign agents.

To understand the essence of a cytological study, it is necessary to understand that in different parts of the reproductive tract the organs are covered different epithelium. On the surface of the vagina and the vaginal part of the cervix there is a flat multilayered epithelium, and in the cervical canal there is a cylindrical epithelium. If the cylindrical one extends beyond the canal, this is called ectopia, which is considered a physiological norm and cannot be treated.

Indications for prescribing a cytological examination of the cervix

The purpose of scraping the cervical canal is to identify atypical cells and diagnose pre-existing conditions. cancer. Main indications for prescribing the study:

Preparing for the study

The study does not require special preparation, but there are several recommendations that must be followed to avoid getting a false result. The study cannot be performed during menstruation. For inflammatory diseases of the genital organs. If during the examination a woman experiences pain, itching or burning in the vagina.

IMPORTANT! You cannot douche before the test, you must abstain from sexual intercourse for at least 48 hours and you must abstain from urination for 2 hours before the hemotest. If these rules are not followed, results may be inaccurate or altered.

Carrying out the procedure

First, the obstetrician-gynecologist examines the vagina and cervix in speculums and assesses the condition of the mucous membranes; a digital gynecological examination should not be done before the smear. If the epithelium covers a large amount of mucus, it must be removed. Then the cervix is ​​scraped (exocervix), using an Eyre spatula. After this, a scraping is taken from the cervical canal (), and the material is collected using a special cytobrush (Cervix Brash). It is inserted into the canal and 4-5 circular movements are performed. After collection, the resulting material is applied to glass, the smear is air-dried and fixed with alcohol or a special preparation (for Papanicolaou examination). The resulting preparations are then placed in a container and delivered to the laboratory. If liquid oncocytology is performed, then the brush is immersed in a liquid fixative, rinsed, and the tip of the brush is removed and left in the fixative.

The next stage of the study is laboratory. Laboratory assistants register the samples received. Then the smears are stained with special dyes (according to Leishman). Liquid cytology preparations are centrifuged or filtered.

The finished preparations are sent to the analytical stage, which is carried out using microscopy. The evaluation criteria are:

• Cell type;
• Cell sizes;
• Inclusions in cells;
• Maturity;
• Features and changes of kernels;
• Cytoplasm.

After evaluating the results, the laboratory issues a conclusion, which is sent to the attending physician.

Decoding the results

Classification of cytological changes according to Papanicolaou:

• Class 1 – negative result (norm – no atypical cells, cells have the same shape and size);
• Class 2 – morphological changes were detected that appeared under the influence of inflammation of the vagina or cervix;
• Class 3 – there is a suspicion of a malignant process, single cells with morphological abnormalities are found;
• class 4 – individual cells with malignant changes;
• Class 5 – signs of malignant tissue changes were detected.

What can a cytological examination show?

• A normal result – there are no altered cells; bacterial vaginosis is possible. Unchanged epithelial cells, moderate numbers of neutrophils, leukocytes and bacteria can be detected;
• Detection of unidentified atypical cells - such changes are caused by sexually transmitted infections, HPV, dysplasia, postmenopausal atrophy of the mucosal surface. It is necessary to be tested for the presence of HPV and undergo cytology again in a year;
• Low degree of change in the squamous epithelial cover – dysplasia or HPV infection is possible. The recommendations are the same;
• The presence of atypical cells indicates the degree or beginning of a malignant process. For further diagnosis, it is carried out (examination of the vaginal walls and the visible part of the cervix using a special optical device);
• High degree of squamous cell changes – high level dysplasia, possible uterus. It is necessary to carry out colposcopy, tissue biopsy, if the woman is over 25 years old, it is possible to perform diagnostic excision (removal of part of the mucous membrane with further histology of the tissue);
• The presence of atypical cells – epithelial dysplasia of 1-3 degrees, cervical or endometrial cancer. Recommendations – colposcopy, diagnostic curettage of the uterus and cervical canal, HPV analysis;
• Adenocarcinoma in situ (in place), squamous cell carcinoma - high degree of dysplasia or cancerous changes of the cervix. Colposcopy, diagnostic curettage of the uterus and cervical canal, and HPV analysis are prescribed;
• Benign glandular changes - endometrial hyperplasia. If a woman does not have non-menstrual bleeding or other pathological processes before her period, then such changes can be considered normal.

Microbiological examination of the cervix and cervical canal

When conducting a cytological examination, it is possible to simultaneously carry out microbiological diagnostics. Based on this, a final diagnosis cannot be made, but infectious diseases of the genital tract can be suspected.

• Trichomonas colpitis - when trichomonas are detected;
• Candidiasis (better known as thrush) - when fungi of the genus Candida are detected;
• Bacterial vaginosis – decrease in lactoflora (normal vaginal flora), detection of cocci, gonococci, rods or mixed flora;
• Chlamydia – chlamydia detected;
• under the influence of HPV.

To make a final diagnosis it is necessary to carry out additional research:

• Microbiological method - flora with subsequent determination of the type of pathogen and its sensitivity to antibacterial drugs;
• PCR – diagnostics (polymerase chain reaction) – modern method diagnostics based on determining the DNA of pathogens infectious diseases.

Additional methods for diagnosing malignant neoplasms of the female reproductive system

In addition to oncocytology, there are other studies to confirm tumor diseases of the female reproductive system. These include:

• – carried out using an ultrasound machine, it allows you to detect changes in the pelvic organs;
• Hysterosalpingography (HSG) is a method of examining the uterus and fallopian tubes, in which their cavities are filled with a contrast agent and X-ray or ultrasonography. Allows you to detect obstruction and structural changes in organs;
• Hysteroscopy is an endoscopic examination of the uterine cavity. The advantage of the method is that it can go from diagnostic to therapeutic (allows you to perform small surgical interventions, for example or biopsy);
• Immunohistochemical analysis is a laboratory method for determining the necessary cells using labeled antibodies;
• Determination of tumor markers in the blood - substances that are secreted by tumor cells and are not found normally.

Conclusion

Oncocytology of the cervix and cervical canal is an important diagnostic method in gynecological oncology, although it is not the only one. The test has many applications, including mass screening of healthy women. The method is simple, has no contraindications and can be performed in outpatient practice. All these advantages have allowed cytological research to take a leading position in medical practice. Thank you for your attention.

Video: cytological and histological examination

Video: epithelial cytology - introduction

A smear is a method of examination in which the doctor collects a small amount of material from the surface of the mucosa. Smear analysis is most often used in urology in men and in gynecology in women. A smear examination for flora allows you to check for the presence of pathogenic bacteria, cancer cells, in some cases - to evaluate hormonal background And general state fabrics. A smear from the vagina for flora is taken every three months, during preventive examinations by a gynecologist.

In the case when you are undergoing treatment, a swab for infection is taken after the end of the course of therapy to confirm its success. An analysis from the vagina or cervix is ​​a painless procedure that allows you to get an idea of ​​\u200b\u200bthe state of women's health.

Gynecological smear - 4 main types:

1. Smear on the flora.

2. Smear for sterility.

3. Cytology smear (PAP test for atypical cervical cells).

4. Smear for latent infections (PCR).

1. Smear on flora: norm and deviations from it

Why it is carried out: The study allows you to evaluate the microflora - the presence of pathogenic bacteria and their quantity.

Such an analysis, taken from a healthy woman, should show 95% of lactobacilli in the collected material. Lactobacilli produce lactic acid, thereby protecting the genitals from infections and maintaining the desired acidity. In pregnant women, the number of lactobacilli decreases, so the body’s natural defenses are weakened. In order to prevent the development of diseases that cause sexually transmitted infections, a smear during pregnancy should be taken by all expectant mothers, without exception.

Vaginal smears are examined to ensure the absence of infectious agents, such as:

• Trichomonas;
• gardnerella.

To identify infections that cannot be detected by flora analysis, a smear is taken for hidden infections. One of the most common methods for detecting hidden infections is the PCR method.

Normally, the microflora of a healthy woman may contain gardnerella and candida, but their quantity should be low. Gardnerella and candida begin to actively develop when immunity decreases. The body's defenses can be weakened for various reasons:

• pregnancy;
• fatigue;
• emotional fatigue;
• presence of a disease that you are “busy” with fighting the immune system.

When assessing it, four purity groups are distinguished.

• First. The reaction is acidic - pH 4.0–4.5. Most microorganisms are Doderlein bacilli (aka lactobacilli), in small quantities - leukocytes in the smear, epithelial cells. Such results indicate a healthy reproductive system.
• Second. The reaction is acidic - pH 4.5–5.0. In addition to lactobacilli, there are gram-negative bacteria - these are most often the causative agents of infections, which become discolored after laboratory staining.
• Third. The reaction is alkaline or slightly acidic - pH 5.0–7.0. Mainly bacterial microflora, epithelial cells are also in large numbers. Several lactobacilli were detected.
• Fourth. The reaction is alkaline - pH 7.0–7.5. There are no lactobacilli, the flora is represented by pathogenic organisms. There are a large number of leukocytes in the smear. This analysis indicates inflammation of the vaginal mucosa.

If the result is bad (group 3 or 4), your doctor may refer you for a repeat test or culture to confirm the results.

Decoding

Results may vary from laboratory to laboratory. Depending on which laboratory you took the smear from, the norm may vary. Since research methods may differ in each individual laboratory, the results will be different. It is advisable to take all tests in one laboratory so that you can observe changes over time and these changes are not associated with a change in the laboratory where you take tests. Decoding must be carried out by a doctor.

To indicate the number of bacteria when examining smears from the urethra, vagina, as well as when analyzing a cervical smear, CFU/ml is used. These units of measurement are read as quantities colony forming units per milliliter of liquid.

2. Smear test for sterility

Why it is performed: it allows you to determine the presence or absence of sexually transmitted infections, assess the woman’s hormonal background, as well as the composition of the vaginal contents; during pregnancy, the results of a smear allow you to assess the threat of miscarriage.

This test is called a smear for purity, or a vaginal smear for sterility.

The study is carried out according to the following indicators:

• Flat epithelium

Flat epithelium - cells of the mucous membrane of the cervix and vagina. An analysis of a woman who is healthy will definitely show it in small quantities. If there is no epithelium in the smear, this indicates hormonal disorders, while the level of androgens is increased and estrogen levels are decreased. An increased amount of epithelium indicates inflammation.

Cervical smear with increased level squamous epithelium indicates inflammation in the cervix, a smear from the urethra - in the bladder, a smear from the vagina, respectively, - inflammation of the vaginal walls.

The amount of squamous epithelium is also affected by the phase of the cycle. Depending on what day the flora analysis was done, the norm varies.

If you have taken a smear for flora, it should be deciphered by your attending physician.

• Lactobacilli(synonyms: gram-positive rods, lactobacilli or Doderlein rods)

With healthy genitals, lactobacilli (bacillus) predominate in the smear. The results of smears in which the number of lactobacilli is 95% of the total number of bacteria are considered good. Sometimes during the study the number of lactobacilli is lower than normal. At the same time, the acidity in the vagina decreases and it is easier for pathogenic microbes to enter the body.

• Leukocytes

When examining smears, the number of leukocytes is determined - this is one of the important indicators.

Leukocytes are the "defenders" of the body. Leukocytes in a smear are present in large numbers when pathogenic bacteria are actively multiplying in the body. That is, the more leukocytes are elevated in the analysis, the more pronounced the inflammatory process.

If a cervical smear contains up to 30 leukocytes, from the urethra - up to 5, and from the vagina - up to 10, this is normal. Such values ​​are typical for all women who live sexually.

Leukocytes in a smear, the norm of which is significantly increased, only indicate the presence of inflammatory process. The cause of the infection must be determined by a doctor. To do this, it is necessary to conduct additional studies, such as bacterial culture, immunological analysis and polymerase chain reaction (PCR).

• Red blood cells

The number of red blood cells increases during menstruation, trauma to the vaginal mucosa or inflammation. The analysis may normally contain several red blood cells.

• Slime

Mucus is secreted by the glands of the cervix and vagina - a smear from the vagina and cervix should contain a small amount of it.

3. Smear for latent infections and polymerase chain reaction

Why it is carried out: allows you to detect infections that cannot be detected by analyzing a smear for flora

In 1983, American biochemist Kary Mullis developed the polymerase chain reaction method, for which he was awarded the Nobel Prize. Thanks to the scientist, it became possible to “recognize” bacteria and viruses by sight, even in their minimal quantities. Polymerase chain reaction is often called PCR diagnostics. PCR analysis and PCR smear are also synonymous. A smear, scraping or urine sample taken for analysis can reveal hidden diseases.

Polymerase chain reaction is a biological research method in which a section of DNA is multiplied in the laboratory.

Why is PCR analysis needed? When researching, it is necessary to identify what type of infection causes the disease. But sometimes there are so few bacteria that it is impossible to recognize them. In such cases, PCR diagnostics of infections comes to the rescue.

For analysis, a section of bacterial DNA is taken and cloned many times. When the DNA “grows”, it is possible to determine what type of bacteria or fungi the laboratory technician is dealing with.

PCR diagnostics of infections gives an accurate result. It allows you to identify not only the genus, but also the type of bacteria: for example, not only to say that the fungus is of the genus Candida, but also to clarify that it belongs to Candida albicans. If the exact type of infection is not determined, treatment may not be effective.

Often, PCR diagnostics are used in the study of smears for sexually transmitted infections. Most sexually transmitted diseases, such as gardnerellosis, chlamydia, mycoplasmosis, gonorrhea, ureaplasmosis, may not show signs in the early stages of development. Symptoms appear in later stages. Thanks to PCR analysis, sexually transmitted infections can be detected at the initial stage of development and, accordingly, quickly cured.

When carrying out such an analysis, it is also possible to identify such viral infections, like hepatitis or papilloma. Other methods can detect not the virus itself, but only the presence of its metabolic products or antibodies to it.

The polymerase chain reaction method allows you to detect infections in any environment: in blood, urine, saliva, and on mucous membranes. In addition, thanks to PCR analysis, viruses are isolated in soil and water.

Advantages of the polymerase chain reaction:

• the accuracy of determining the infection;
• the ability to isolate the virus (and not the decay products or antibodies to it);
• a small amount of test material is sufficient (even in the presence of one pathogen cell);
• the ability to detect infection in any environment (urine, blood, saliva);
• the speed of the analysis;
• the only method for isolating some infections.

4. Pap test, or cytological smear

Why it is carried out: allows the diagnosis of cervical cancer.

The Pap test has different names: a smear for cytology, as well as a test, analysis or smear according to Papanicolaou, a smear for atypical cells. The analysis is named after the Greek scientist who first applied this method. To perform a Pap test, a swab is taken from the cervical canal (cervix) during an in-chair gynecological examination.

A cytological smear in a woman over 30 years of age is a mandatory annual test. Cervical smear results help diagnose cervical cancer, the second most common cancer among women.

How is a smear taken for cytology?

Several factors may affect the results of the study. To get a reliable result, refrain from going to the toilet 2-3 hours before taking a smear. Otherwise, you will wash away the epithelium and bacteria that are important for examining a vaginal smear.

For accurate results, 48 ​​hours before the test:

• don't have sex;
• do not douche (so as not to wash the contents of the vagina);
• do not use vaginal contraceptives (spermicidal creams, ointments, foams);
• do not take baths;
• do not use tampons or vaginal suppositories.

Taking a smear from the cervix

The interpretation of the smear and, accordingly, the success of treatment depend on whether the woman followed the requirements listed above. A Pap smear can be taken on any day of the cycle when there is no menstrual flow.

A smear is taken by a gynecologist during an examination on a chair.

Eyre spatula - a plastic stick for taking a cervical smear

In this case, the doctor uses a gynecological speculum and Eyre's spatula - a special plastic stick. Taking swabs takes no more than two minutes. The procedure is painless.

Smears are taken in three places - possible foci of infections: a smear is taken from the cervical canal (cervix), from the vagina and the urethral opening.

Taking smears from the cervical canal

The study is carried out by studying under a microscope or bacteriological culture. In most cases, women do not experience any discomfort after a smear. Only occasionally can there be spotting from the vagina and pain in the lower abdomen. They should go away in a few hours.

There is no need to abstain from sex after a smear. Starting from the age of 18, even if the girl does not live sexually, experts recommend undergoing annual preventive examinations and taking a smear for oncocytology. And those who are sexually active, regardless of age, are advised to visit a gynecologist at the beginning of an intimate relationship. To detect cervical cancer in the early stages of development, after 30 years of age, be examined by a gynecologist at least twice a year.

Cervical dysplasia

If there are “wrong” cells as a result of cytology analysis of a cervical smear, the doctor uses a special term: dysplasia.

Dysplasia is a condition of the cervix in which some of the cells have a damaged structure. This means that cells can develop into cancer cells. Therefore, such a pathology can be a precancerous condition.

What influences the development of cervical dysplasia?

The risk of developing pathology increases with:

• smoking;
• a large number of births;
• long-term use of intrauterine and hormonal contraceptives;
• lack of vitamins;
• the presence of sexually transmitted infections (especially papillomavirus);
• early sexual activity (up to 16 years);
• childbirth (up to 16 years);
• a large number of sexual partners (three or more);
• genetic predisposition.

Cervical dysplasia is caused by human papillomavirus (HPV) types: 6, 11, 16, 18, 31, 33 and 35.

Signs may include:

• frequent inflammatory processes;
• spotting bloody issues;
• bleeding after intercourse or when using tampons.

Some women with dysplasia experience pain in the lower abdomen.

Dysplasia: degrees of development

Depending on how much dysplasia has developed, the degree of its development indicates the depth of tissue damage. There are three degrees: first, second and third.

Degrees of cervical dysplasia

• TO first degree Dysplasia refers to slight changes in the structure of the cells of the cervix. In this case, abnormal cells affect only the superficial layer of squamous epithelium.
• At second degree cervical dysplasia, “wrong” cells affect the superficial and middle layer cervix.
• Cervical dysplasia third degree means that abnormal cells have grown into all three layers of the epithelium.

Cervical dysplasia: treatment

Cervical dysplasia. HPV - human papillomavirus

If you have cervical dysplasia, treatment involves reducing the number of abnormal cells. To do this, the doctor removes a small affected area of ​​the cervix. If you have been diagnosed with cervical dysplasia, treatment may not completely remove the human papillomavirus from your body. However, it can prevent the development of a malignant tumor.

Treatment of the disease - removal of the affected area - the uterus can be carried out different ways: using laser, freezing and other methods. This depends on the woman’s age, the degree of development and the condition of other genital organs. If the patient has sexually transmitted infections, they are eliminated first. Only after a smear analysis shows that there are no sexually transmitted infections is treatment carried out.

When cervical dysplasia is detected in the early stages, treatment is carried out, which not only preserves women's health, but also life. To do this, every woman should undergo preventive examinations at least once a year.

Who needs to be examined by a gynecologist?

A smear examination of the vagina, urethra and cervix should be performed on women who:

• began to be sexually active;
• got pregnant;
• planning pregnancy;
• have multiple sexual partners;
• feel discomfort in the genitals (pain during sex, frequent urination or burning in the genitals, and others);
• over 18 years old;
• undergo a preventive examination.

Regular examinations in the gynecologist's office, during which you can take a smear test, allow you to notice the onset of the disease in time, make the correct diagnosis and even save your life. For example, uterine dysplasia, the treatment of which was started on time, will not degenerate into an incurable malignant tumor.

Smear: norm and deviations, or Who is at risk

Regardless of age, there are factors that increase your risk of cervical cancer. Their combination and prolonged “effect” on the body reduce the body’s defenses in the fight against the disease, even in the early stages of development.

It is especially important to take a cervical smear for oncocytology for women who:

• have multiple sexual partners;
• started sexual activity before the age of 18;
• have had cancer of the reproductive system in the past;
• smoke;
• are carriers of viral infections;
• have weakened immunity.

Viral infections such as: virus herpes simplex, HIV and human papillomavirus.

• inflammation of the vaginal mucosa;
• dysbacteriosis of vaginal microflora;
• intestinal dysbiosis;
• sexually transmitted diseases;
• inflammation of the uterine mucosa;
• tumor processes in the pelvic organs;
• inflammation of the uterine appendages;
• fungal infection of the vagina;
• urethritis;
• inflammation of the cervix.

There are situations when elevated white blood cells do not indicate the presence of a pathological inflammatory process in the reproductive system. In particular, an increase in the content of white blood cells in a smear may be a consequence of inflammation in the male genitourinary system. For example, after unprotected sexual intercourse with a man who suffers from prostatitis, leukocytes in the smear will be in increased numbers. This must be taken into account by the doctor when carrying out diagnostic measures.

Elevated leukocytes in a smear in men

To find out the cause of infertility, men also take a smear from the urethra. An increase in the number of white blood cells indicates the presence of an inflammatory process in the genitourinary system in men. These pathological conditions can lead to reproductive dysfunction and infertility. Moreover, if left untreated inflammatory diseases pelvic organs in men, the pathological process can spread to nearby organs or even lead to the development of systemic inflammation.

Therefore, elevated white blood cells in representatives of the stronger sex are a serious marker of an infectious process that must be diagnosed and treated in a timely manner. To do this, the doctor prescribes appropriate treatment, which in most cases has a positive effect. Pathological changes in a smear in the form of an increase in leukocytes can be a sign of diseases such as cystitis, prostatitis, orchiepididymitis, and so on. In these pathological conditions, a man experiences pain or a burning sensation when urinating, as well as cloudy urine. In addition, elevated white blood cells can be detected after sexual intercourse with a woman who suffers from inflammatory diseases.

Thus, a smear should be taken in both women and men. This study will identify inflammatory diseases in the early stages, which are manifested by an increase in the number of leukocytes. This will allow you to prescribe on time correct treatment and increase its efficiency.

Smear during pregnancy

All women, regardless of whether they are in an “interesting situation” or not, are given the same smear for flora. The only difference is the frequency: pregnant women, accordingly, more often.

Even future mom She hasn’t been sick with anything lately; she could have contracted the infection and be its carrier for a long time. And since the immune system is weakened during pregnancy, bacteria can begin to actively multiply at this time.

Smear tests before and after pregnancy can differ significantly. Even if no symptoms of the disease were observed before pregnancy, then with the onset of pregnancy, sexually transmitted diseases most often appear:

• gonorrhea;
• syphilis;
• ureaplasmosis;
• genital herpes;
• mycoplasmosis and others.

If a pregnant woman is a carrier of one of the sexually transmitted infections, then, most likely, leukocytes will be found in the smear, the norm of which is exceeded. If a pregnant woman has elevated leukocytes in a smear, the doctor should prescribe treatment. To establish an accurate diagnosis, a blood smear is also taken. This analysis is carried out on the same principle as the gynecological one. A blood smear can detect diseases such as malaria, typhus and others.

It is not uncommon for pregnant women to develop thrush, so the test may also show an increased amount of Candida fungus.

What should not be included in a smear test?

For normal functioning of the genital organs and good health, the body must have a balance of good and bad bacteria. A smear for the degree of purity may contain a small amount or not contain the following microorganisms and cellular structures:

• Atypical cells. May indicate a precancerous condition. They have an incorrect structure.
• Key cells. The key cells in the smear are epithelial cells “glued together” by gardnerella or other pathogens. Key cells in a smear can be observed in increased numbers with reduced immunity. In cases where a smear is examined for flora, this category includes squamous epithelial cells that are glued to infectious agents.
• Gardnerellas. These are small sticks in a smear. When examining vaginal smears, gardnerella may be present in small quantities. If a clean smear reveals an increased number of these bacteria, bacterial vaginosis. An increased number of them is also observed when vaginal dysbiosis.
• Candida. This fungus, like Gardnerella, is present in small quantities on the vaginal mucosa in healthy women. If the amount of candida fungus exceeds the number of lactobacilli, vaginal candidiasis develops (popular name - thrush). A gynecological smear confirms the disease in a latent form in the presence of spores, and in an active form in the presence of fungal threads. As a rule, the number of candida increases with reduced immunity, including during pregnancy.

Up to 40 different types of bacteria live in the vagina of a healthy woman. While the total number of lactobacilli predominates, all bacteria, including Candida and Gardnerella, “peacefully” coexist.

• Cocci (gonococcus, staphylococcus and other cocci in a smear)

Cocci in a smear look like spherical bacteria. A smear for purity may contain several types of cocci, but only extracellularly. Otherwise, cocci indicate a venereal disease.

• Gonococcus. A gram-negative bacterium that multiplies at high air humidity. In addition to gonorrhea, cocci in a smear of this type of bacteria cause inflammation of the urethra, cervix, fallopian tubes, and rectum.
• Staphylococcus. The most common one is Staphylococcus aureus is a Gram-positive bacterium. 20% of the world's population are carriers of this type of cocci. Bacteria belonging to this genus of cocci in a smear cause mild skin infections (acne, etc.) and are fatal. dangerous diseases(pneumonia, osteomyelitis, endocarditis and others).
• Streptococcus. Gram-positive bacterium that lives in small numbers in gastrointestinal tract(GIT) and respiratory tract, as well as in the nasal cavity and mouth. If a pregnant woman has high levels of streptococci in her smear, they can cause miscarriage, early labor, and stillbirth. In addition, they cause diseases such as scarlet fever, bronchitis, tonsillitis, pharyngitis and others. In single quantities, streptococci in a smear may be normal.
• Enterococcus. A gram-positive bacterium that is part of the gastrointestinal microflora. Withstands heating up to 60 °C for half an hour. Such cocci in large quantities indicate inflammation of the genitourinary system, pelvic organs and other diseases.

• Trichomonas. A smear for infection does not always reveal Trichomonas, since this bacterium can have altered forms. To confirm its presence, bacteriological culture is done.

Your result is bad, does your vaginal smear contain pathogenic bacteria? Most infections are now successfully treated. The main thing is not to self-medicate and follow the doctor’s recommendations.

Cytological examination of a smear from the vagina and cervix makes it possible to identify dangerous diseases. By detecting pathologies at the earliest stages, much greater success in treatment can be achieved. Doctors use a rather complex system for classifying the data obtained, which reflects the degree of deviation from the norm. Patients are often interested in how to decipher the results of cytology and understand whether they should be alarmed and how dangerous the condition that the analysis shows is. All women are recommended to undergo such examination regularly.

Content:

What is cytology, objectives of the study

Cytological examination of the cervix is ​​a method of studying cells taken from various parts of its internal surface. The study is carried out under a microscope and allows the presence of cells to be detected by the appearance of cells. various diseases this organ. Cytology is also commonly called the PAP test (named after the scientist Papanicolaou, the inventor of this technique). To obtain cells, a smear is taken from the vaginal part of the cervix and cervical canal.

The main purpose of a cytological examination of the cervix is ​​to detect cells of atypical structure and assess the degree of changes in the mucous membranes. The results obtained make it possible to diagnose precancerous diseases with sufficient accuracy or determine the degree of risk of developing uterine cancer. In addition, this technique is used to detect inflammatory lesions of the genitals by human papillomaviruses (HPV) and herpes.

For preventive purposes cytological examination Women are recommended to undergo it once a year from the beginning of sexual activity until old age. This will allow at the earliest, most mild stage, detect dangerous pathologists when their symptoms are still absent. Before the advent of cytological techniques, this was impossible to do, so cancer was detected only on late stages when it was too late for treatment.

If necessary, cytology is performed several times a year.

Indications for cytological examination

Cytology of the cervix is ​​a technique that is used as a kind of emergency and screening diagnostics (that is, a mandatory examination of the condition of the genital organs). Indications for its implementation are:

• pregnancy planning, including preparation for IVF;
• pregnancy and childbirth under the age of 18;
• annual occurrence of pregnancies and childbirths for several years;
• repeated changes of sexual partners;
• preparation for installation of an intrauterine device;
• the onset of menopause and monitoring the health status of women in the postmenopausal period;
• familial predisposition to oncological diseases cervix;
• control examination after detecting any changes in the condition of the cervix;
• detection of HIV infection in a woman.

Indications for an unscheduled cytological examination of the cervix are infertility, menstrual irregularities, the appearance of watery or bloody discharge, detection of condylomas in the vagina (signs of HPV infection) or herpes rash, the presence of erosion and damage to the surface of the cervix. Cytology is necessarily performed after long-term hormonal therapy.

Preparing for analysis

A feature of cytological research is that its accuracy largely depends on compliance with the rules for collecting biological material. It is also important for the patient to follow the recommendations for preliminary preparation. In approximately 5-10% of cases, the results are false due to the influence of extraneous factors.

The analysis cannot be taken during menstruation, as well as in the presence of pathological discharge, accompanied by itching in the vagina, characteristic of acute inflammatory and infectious diseases of the cervix. Such discharge usually has a foamy consistency, sharp bad smell, painted yellow-green. Carrying out cytology during this period will lead to the spread of infection to the uterus and its appendages.

Cytology is not performed when examining pregnant women or virgins. Sexually active minor patients are examined with the consent of their parents or guardians.

After childbirth, a cytological examination of the cervix can be performed no earlier than 3 months later. You must avoid sexual intercourse for 2 days before the procedure. You should avoid using vaginal suppositories or tablets, douching, and treatment with vaginal ointments.

It is necessary to refrain from using hormonal and anti-inflammatory drugs. The examination is carried out 5-7 days from the beginning of the cycle (after the end of menstruation) or about a week before the onset of the next menstruation.

Analysis technique

For the study, cells are taken from the cervical canal (cylindrical epithelium), from the surface of the cervix extending into the vagina (squamous epithelium), as well as cells from the transformation zone (the area at the junction of the cylindrical and squamous epithelium). A smear is taken from the throat of the cervix using special spatulas, spatulas, and spoons. A medical brush is used to collect material from the transformation zone. A sample is taken from the cervical canal by suctioning out the mucus with a probe.

At the same time, a smear is taken for the microflora of the cervical canal (for bacteriological inoculation of the mucous membrane), using a double-sided spoon. Sowing allows you to verify the presence or absence of pathogens of various infections in chronic diseases.

The patient does not experience pain. The entire procedure, including examination on the mirrors, takes approximately 10 minutes. The selected material is transferred to a glass slide, treated with a fixative, dried and sent to the laboratory. Here the sample is specially stained and examined under a microscope.

Previously, the laboratory assistant evaluates the quality of the smear. The layer of material should not be too thin or thick so that the number of selected cells is sufficient to obtain a reliable result. The swab should not be contaminated with blood or other foreign matter.

If the quality of the smear is unsatisfactory, repeat sampling may be necessary. The patient must understand the reason for repeating the analysis, so as not to make frightening guesses and assumptions.

When deciphering the result, the size and shape of the cells, their number and relative position are assessed. You can get an answer in about a week.

After taking smears, a woman may have scanty pink discharge. The doctor prescribes the use of anti-inflammatory suppositories for several days. You should abstain from sexual intercourse for 1-2 days.

Liquid cytology

One of the varieties of such a study is liquid cytology of the epithelium of the cervix. What it is and why it is carried out, you also need to know so as not to be scared in advance.

The selection of material from different parts of the neck is carried out in the same way as in a traditional study. But the material is not placed on a glass slide, but is transferred to a bottle with a special liquid (preservative), which is delivered to the laboratory. Here, before placing the cells under study on a microscope glass, they are first separated from foreign elements (leukocytes, erythrocytes, etc.). This allows for a better look at the material being examined.

The advantage of the technique is the ability to store the sample for several months for repeated testing, as well as additional analyzes using other methods. However, this technique has significant drawbacks. Due to the fact that the material is pre-treated, the shape of the cells sometimes changes, which reduces the reliability of the result. In addition, research using this method is more expensive than traditional cytology.

Typically, the liquid technique is used when examining women living in remote areas, where mobile medical teams arrive. A similar technology is also used when it is necessary to store material and conduct a control check of the results.

Decoding the results

Cytological examination of the cervix can detect cell mutations. Cells with nuclei of increased size, having a modified shape and color are considered atypical. As a result of cell fusion, multinucleated cells with an altered internal structure are formed.

Based on the results obtained, the degree of cervical dysplasia (cell changes in various layers of the mucous membrane) is determined. Unlike histological examination cells taken during a biopsy, when performing cytology it is impossible to answer absolutely exactly what type of pathology was detected - precancerous dysplasia or cancer.

The result of the analysis can be positive or negative:

1. Positive result. Atypical cells were detected in the smear.
2. Negative result. The cell structure is normal and there are no signs of viral damage.

When assessing the results and the degree of danger of the detected changes, the condition of the cells is assessed. In this case, they are used different kinds classifications (Papanicolaou method, Bethesda method and others).

Papanicolaou technique

According to the Papanicolaou method, 5 classes are distinguished pathological changes in the condition of the cervix:

1. Cytology is within normal limits. This means that there are no atypical elements in the cell structure and there are no diseases.
2. Minor changes were found in some cells, and there were signs of slight inflammation in the genitals. This result is considered a relative norm.
3. There are a small number of atypical cells grouped together, which may be a sign of a precancerous condition. But to clarify the results, histology is required.
4. Malignant cells were found in the material, their number is small, which indicates initial stage malignant disease.
5. There are quite a lot of atypical cells. This indicates the development of cancer. To establish its type, location, and stage, in-depth diagnostics is required.

Other results

The conclusion obtained after a cytological examination may indicate that a patient of reproductive age has a “cytogram without features” (the same as “without intraepithelial lesions” - NILM). This means that the condition of both cylindrical and flat epithelium is normal.

In women of menopausal age, cytology results may indicate that there is an “atrophic type of smear.” This suggests that partial atrophy of the squamous epithelium has occurred, which is caused by an age-related decrease in the level of estrogen in the body. This condition is also considered normal.

The detection of atypical cells during a cytological examination of the cervix does not mean that the woman has cancer. Such results can only indicate the presence of a risk of cancer. They can be erroneous (for example, due to poor sample selection or contamination when transferred to glass). Atypical changes are caused by the presence of an inflammatory process and exposure to HPV. In case of doubt, a repeat analysis is done, possibly in another laboratory. In addition, there are various examination methods that give more accurate results (blood test for oncology, colposcopy, pelvic ultrasound, CT, MRI and others).

Video: Why and how a PAP test is performed

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 inject any medicines in 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 of the vagina and cervix must 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 regularly examined by a gynecologist, this procedure will not become 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.

WHO SAID THAT INFERTILITY IS HARD TO CURE?

• Have you been wanting to have a baby for a long time?
• I've tried many ways but nothing helps...
• Diagnosed with thin endometrium...
• In addition, the recommended medicines for some reason are not effective in your case ...
• And now you are ready to take advantage of any opportunity that will give you the long-awaited baby!

Early diagnosis of neoplasia and cervical cancer is the most important area of ​​modern gynecology. In this case, the main screening method is cytological examination. The material for it is most often taken using a smear or targeted biopsy. This traditional method is technically simple, but gives up to 40% false negative results. This means that there is a risk of untimely detection of cervical cancer even in women undergoing regular preventive examinations.

The liquid cytology method is a more modern and informative screening option using the Papanicolaou test (). Despite its recent introduction into clinical practice, it is already recognized as the most effective way early diagnosis of cervical cancer. After all, the effectiveness of high-tech liquid cytology reaches 95%, while the sensitivity of the traditional technique averages 60%, and in some cases does not exceed 40%.

When and who needs such screenings?

There is an opinion that only women approaching the premenopausal period need to undergo regular gynecological oncological examinations. But that's not true. According to modern clinical guidelines, cervical cancer screening with cytological examination is recommended for all women over 21 years of age. In general, it is recommended to start it 3 years after the first sexual intercourse. So early entry into intimate life– the basis for the early start of preventive gynecological examinations.

In the first 2 years, screening is not carried out annually. Subsequently, at negative results repeated cytological examinations, preventive examinations are becoming more rare and are carried out once every 2-3 years. After 65 years, the frequency of screening studies is determined individually.

The reason for increasing the frequency of oncogynecological examinations is the appearance of background and precancerous diseases of the cervix in a woman. In this case, the patient is considered to be at high risk for developing cancer, and a cytological examination of gynecological smears is carried out on her annually. Additional screening activities are carried out during the preparation of a woman for conception.

Liquid cytology during pregnancy is performed according to strict indications. These include identifying changes in the patient’s cervix that are suspicious for precancer or malignant transformation. It should be remembered that such an analysis increases the likelihood of a threatened miscarriage and may require measures aimed at normalizing uterine tone.

How to prepare for research

Preparation for liquid cytology of the cervix begins 2-3 days before the test and includes:

• sexual rest;
• refusal to douche;
• stopping the use of any means for vaginal administration (suppositories, tablets, sprays).

When is the best time to do screening?

Cytological examination is not carried out during menstruation, 5 days before it and 5 days after it. Preference is given to the first half of the menstrual cycle, although this recommendation is not strict.

If the patient has undergone a cytological examination, a cytological examination is permissible no earlier than 24 hours after it. And in the case of a cervical biopsy - only after 3 weeks.

How is liquid-based cytology performed?

Currently, several technological options for liquid-based cytology are used in clinical practice. The most famous and sought after of these is Becton Dickinson (BD) Sure Path™, which was approved by the FDA in the USA in 1999 and has been officially approved by NICE in the UK since 2004. Since that time, it has been actively introduced into everyday clinical practice in Europe, the Russian Federation and neighboring countries.

The main stages of this study are:

1. Collection of material. For this purpose, a specially designed combined cytobrush of a special design is used. It is carefully inserted into the cervical canal, after which rotational movements are made (2 counterclockwise and 3 in its direction). This ensures the maximum possible and at the same time low-traumatic acquisition of superficially located cells of the mucous membrane of the cervix - from its vaginal part, from the cervical canal and adjacent areas of the vagina. This manipulation does not require anesthesia, because the sensations experienced by the woman do not exceed the pain threshold.
2. Placing a cytobrush with the resulting material in a special test tube (bottle) with a special liquid, which gives the name to the technique. Such a medium not only has preservative and stabilizing properties, but also promotes the formation of a suspension with a uniform distribution of cells and other elements throughout the volume. The tubes are transported to a laboratory licensed to perform liquid-based cytology and equipped accordingly.
3. Automated preparation of cytospecimens. Includes vacuum filtration of a portion of the suspension from a test tube, centrifugation, application of the resulting cell sediment in a uniform layer on a glass slide, staining using the Papanicolaou method using wet fixation.
4. Microscopy of a cytospecimen. The PAP test based on liquid cytology is carried out according to the same principles as in the case of the traditional technique. But at the same time, the peculiarities of coloring, position and size of cells after wet fixation of the cytopreparation are taken into account. That is why the study can only be carried out by a certified laboratory technician who has undergone special training.

The results of the analysis are deciphered only by a gynecologist or oncologist. An answer from the laboratory can be received 5-10 days after collecting the material. But often this period extends to 2-3 weeks. The speed of receiving an answer depends on the transportation time, the workload of the laboratory and the method of informing the outpatient department about the data of the studies performed. If necessary, an express test is carried out; in this case, the doctor will know the result within the first 24 hours.

Scheme of liquid cytology of the cervix

What after the research?

The recovery period after liquid cytology is not fundamentally different from that when taking a regular smear for oncocytology or. It is recommended to maintain sexual rest for 1.5 weeks and stop using vaginal tampons and douching. In the first days after the test, light vaginal discharge is acceptable, so it is advisable for a woman to use sanitary pads.

An increase in body temperature, prolonged or heavy bleeding, pain in the lower abdomen is an alarming sign. The appearance of such symptoms requires immediate consultation with a doctor.

What is the difference between liquid cytology and conventional cytology?

Key differences between these screening methods include:

• In a conventional cytological examination, tissue samples are taken in a targeted manner, and the areas for examination are selected by the doctor based on visual changes in the mucous membrane. In the case of the liquid technique, material from any woman is obtained from the entire circumference of the cervix. This significantly reduces the likelihood that any modified section will be missed.
• When performing conventional cytology, the biomaterial is dried on glass at room temperature before sending. And in liquid cytology, it is placed in a special test tube (bottle) with a special stabilizing medium, which extends the permissible period of transportation and storage of the resulting sample. The biomaterial placed in a test tube is suitable for research for several months and does not require special conditions.
• With the traditional method, no filtration is performed. Therefore, if there are inflammatory elements, a large amount of mucus and other impurities in the smear, the result of a cytological study is not reliable enough and usually requires a repeat Pap test after treatment. The liquid method does not have this disadvantage.
• With the traditional method, not the entire volume of the resulting tissue ends up on glass and is subjected to subsequent examination. Up to 35-40% of cells remain on the doctor’s instruments and gloves. This creates the possibility that existing malignant tissue will remain undiagnosed. With the liquid method, such loss of biomaterial does not occur. This is ensured by placing the cytobrush in a stabilizing and suspending medium, followed by automated centrifugation of the sample and the formation of a special cytopreparation with a standardized, even layer of cells on a glass slide.
• When taking a traditional smear for oncocytology, cells on a glass slide are usually located in several layers, overlapping each other and thereby impairing visualization. Liquid cytology bd shurepath does not have this drawback; the resulting cytopreparation is monolayer.
• Possibility of re-analysis of the same biomaterial or other studies using liquid cytology. After all, the suspension in a test tube does not lose its properties for several months, and its volume is sufficient to obtain several cytopreparations. With the traditional method, the tissues being examined are not protected in any way, and there is a high risk of damage during storage.

In general, liquid-based cytology using automatic screening is a significantly more informative technique compared to traditional collection of smears from the cervix for oncocytology. And its main advantage is the low percentage of false-negative results of gynecological cancer screening, which is ensured by the progressive technological features of the test with strict adherence to the rules for collecting biomaterial.

Diagnostic capabilities

Liquid cytological screening is aimed at identifying a variety of cellular atypia, which indicates that a woman has a precancerous condition or cervical cancer. The single-layer and uniformity of the cytospecimen ensures a high degree of visualization, allowing the laboratory technician to reliably determine the nature of the changes. This minimizes the likelihood of diagnostic errors and false negative results.

The presence of the suspension and its sufficient volume allow additional studies to be carried out according to indications:

• analysis for tumor markers;
• any PCR studies;
• HPV testing;
• immunocytochemical studies with determination of proliferation markers.

But liquid cytology does not allow diagnosing inflammatory conditions, because mandatory stage filtration removes detritus, leukocytes and other impurities from the suspension. Therefore, if colpitis is suspected, it is advisable to simultaneously take a traditional smear for oncocytology. This is a significant drawback of the technique.

However, liquid-based Pap cytology is recommended by the WHO, FDA and global cancer communities as the gold standard for early diagnosis of cervical cancer. But currently in the Russian Federation, when conducting screening, the traditional smear for oncocytology is most often used. This is mainly due to the insufficient technical equipment of the outpatient department and the lack of proper qualifications among doctors. Liquid cytological examination is still carried out mainly by large private laboratories: Hemotest, Invitro and others.