A cytology smear (oncocytological smear, Papanicolaou test, Pap test) is a laboratory test, the object of which is the epithelial cells of the cervix. The Pap test examines the size, shape, and location of epithelial cells.

Cytological examination of the smear makes it possible to identify pathological changes in the epithelium, the presence of atypical cells and cellular abnormalities, as well as detect precancerous and cancer cells in the mucous membrane of the cervical canal. This ability to quickly and inexpensively diagnose oncological processes in the early stages has made the Pap test a mandatory procedure for all women.

The reliability of a cytological smear in pathological processes in the epithelial tissue of the cervix reaches 80%. Since the development of cancer is long-term and takes from 5 to 15 years, regular PAP tests make it possible to promptly detect deviations of the mucous membrane from the norm.

In case of identified pathologies, dysplasia, microcarcinoma, a more accurate invasive biopsy method and histology of the obtained tissues of the reproductive organs are used.

Indications for analysis

Depending on the woman’s age, it is necessary to conduct a routine cytological smear analysis with the following regularity:

• at 21-49 years old - once every 3 years;
• at 50-65 years old - once every 5 years.

In addition to a routine examination, a test to prevent cervical cancer is prescribed in the following cases:

• erosion;
• infertility;
• herpes infection in the vagina;
• diabetes;
• human papillomavirus (HPV);
• with vaginal discharge;
• menstrual irregularities;
• when planning pregnancy;
• before installing an IUD (IUD);
• 1-3 months after birth.

Contraindications

It is contraindicated to collect biological material for cytological studies in the following cases:

• during pregnancy, especially after the 20th week, a cytological smear is not performed, since intervention in the cervix can negatively affect the condition of the fetus;
• with menstrual bleeding;
• with cervicitis;
• in the presence of colpitis (vaginitis) - inflammation of the vaginal mucosa.

The results of a cytological analysis done during inflammatory processes of the genital organs may show a false-positive or false-negative oncocytology result.

Preparation for the procedure

To ensure the reliability of the results of a Pap test using the cytological method, it is necessary to adhere to certain rules of preparation for the procedure.

First of all, a violation of the vaginal microflora is excluded 48 hours before the smear. To do this, you should stop using intimate hygiene products, medications for vaginal use (suppositories, douching), and also avoid sexual contact. Immediately before the procedure, avoid visiting the toilet for 2-3 hours.

As a rule, cytological analysis is performed after treatment of bacterial infections. If a gynecological examination or colposcopy was performed the day before, a cytology smear is performed no earlier than 2 days later.

How to take a smear

When performing a smear for cytology, the immediate object of attention of the gynecologist is the cervical canal - the mucous part of the internal reproductive organs that connects the uterine cavity and vagina.

The length of the cervical canal is, on average, 3-4 centimeters, while the canal is conditionally divided into 3 zones:

• external os or ectocervix - extends into the vagina and is covered with squamous epithelial cells;
• internal pharynx or endocervix - located on the side of the uterus, covered with glandular epithelium;
• transitional, inner part of the channel.

There are two ways to carry out the procedure:

1. Standard smear for cytology. Using special instruments (Eyre spatula, Volkmann spoon), the gynecologist takes smears from the vagina, external os of the cervix and directly inside the cervical canal. For this, a special cervical brush is used, which does not injure the narrow canal and does not cause any discomfort during the procedure.

The biological material is placed on sterile glass, fixed with a special solution and dried, after which it is sent to the laboratory.

2. Method of liquid cytology (LBC, Liquid Based Cytology). A more modern and accurate way to study the mucous membrane of the cervical canal.

To obtain biological material, the gynecologist uses several types of brushes (endocervical, Wallach brush), after which the tips are removed from the used instruments. Next, the brushes are placed in a bottle (vial) with a special liquid for preserving biological material.

The bottle is labeled and sent to the laboratory. The liquid cytology method allows you to obtain more accurate results and the ability to conduct additional examinations of the epithelium if necessary.

Interpretation of a cytological examination of a cervical smear

First of all, deciphering the cytological analysis consists of assessing the biological material (normal or unsatisfactory quality). If poor quality of the smear is noted, the reason is indicated on the form. As a rule, this may be the presence of additional impurities (escudate, blood, sperm). In this case, you should take a repeat smear for cytology.

There are 2 types of classifications used when assessing the results of a cytological examination of a smear: the Papanicolaou classification and the Bethesda system. Designations of both systems may be present on the smear form, as this increases the diagnostic capabilities of the PAP test.

Papanicolaou classification

The classification of analysis results, developed by Georgis Papanicolaou, consists of 5 classes, each of which has its own assessment of the number of identified atypical cells.

Class	Characteristic
1	The results of cytological studies are normal
2	Changes in cell morphology (damage to structural, membrane apparatus, enzyme system) due to inflammatory processes in the woman’s reproductive organs, then treatment and a repeat PAP test are carried out
3	A small number of abnormal cells with a disrupted structure of nuclei and cytoplasm are detected. Next, biopsy and histology are used
4	Signs of malignant changes were detected (cytoplasmic abnormalities, enlarged nuclei). Consultation and examination with a gynecological oncologist is required
5	A large number of cancer cells were detected, indicating cancer

Bethesda System Classification

The Bethesda System cytological classification is used in the CIS countries in parallel with the Papanicolaou classes, and the analysis form indicates the smear score for both classifications. The advantage of the new system is that there are more detailed descriptions of cellular changes in all areas of the cervical canal.

Name	Decoding
NILM	The smear is normal: there are no changes or malignant cells in the biological material
ASC-US	The squamous epithelium of the smear contains atypical cells
ASC-H	High probability of malignant processes that led to changes in cell structure. Extended colposcopy is used
L-SIL	Not numerous benign changes in flat epithelial cells with a low probability of developing cancer processes were identified. Requires colposcopy, HPV testing and a repeat Pap test after a year
H-SIL	A few changes in cells of malignant origin caused by dysplasia. For additional tests, a biopsy or excision followed by histology is used, and it is also necessary to perform a PAP test every 6 months for 2 years to further monitor the dynamics of the development of malignant processes
Squamous cell carcinoma	Squamous cell carcinoma
AGC-US	The smear revealed cellular pathologies of the glandular epithelium of unknown origin
AGCfavorneoplastic	A significant number of anomalies of the glandular epithelium were revealed, dysplasia was suspected. Requires colposcopy and HPV testing
AIS	Endocervical carcinoma, an early stage of a malignant tumor, was discovered. Colposcopy, diagnostic excision, and curettage procedures should be performed
Adenocarcinoma	Glandular epithelial cancer

The results of the cytological analysis also indicate the presence of microorganisms present in the smear. At the same time, microflora in cytology is not the object of detailed study, therefore, if there are violations, additional tests are required.

The results of a cervical smear Pap test may indicate the presence of the following microorganisms:

• reproductive organ herpes virus;
• trichomonas (Trichomonas vaginalis);
• chlamydia;
• bacteria that cause actinomycosis (Actinomyces spp.);
• coccal flora in bacterial vaginosis;
• thrush

Also, the oncocytology analysis form may indicate a result such as dysplasia (neoplasia) of the cervix - a change in the structure, size and multilayeredness of squamous epithelial cells. Another name for the pathology is cervical intraepithelial neoplasia (CIN).

There are three degrees of severity of neoplasia:

• CIN I (mild degree) - pathological changes are weakly expressed and are observed in the first third of the epithelium, while the superficial and intermediate layers are not changed;
• CIN II (moderate) - pathology with more pronounced cellular changes affecting the second third of the epithelial tissue;
• CIN III (pronounced form) - the entire thickness of the epithelial layer is affected and significant structural changes in cells are observed.

When cervical intraepithelial neoplasia is detected, it must be remembered that only CIN III is considered a precancerous condition, for which additional research and treatment are required.

As a rule, pathological changes in CIN I and CIN II do not require treatment if the woman does not have human papillomavirus, genitourinary infections or complaints, and the vaginal microflora is normal.

In half of the cases of mild and moderate neoplasia, the cervical epithelium returns to normal within two years. In this case, a cytology smear should be performed every 3-6 months to monitor the dynamics of neoplasia.

Examination of cervical scrapings, also known as a smear cytology (Pap test or Papanicolaou smear), is performed to detect precancerous and cancerous conditions of the cervix. The material for cytological examination is cells of the cervical canal (ectocervix and endocervix), which are examined for signs of atypia, dysplasia and malignancy. Smear cytology is a screening method for cervical cancer in most countries around the world.

Currently, clinical gynecology around the world pays great attention to identifying precancerous conditions. For this purpose, a Pap smear is taken. In the initial stages of cervical cancer, the reliability of the Pap test reaches 80%.

Indications and contraindications

An annual cytological examination of cervical scrapings is indicated for all women over the age of 20 years (or from the beginning of sexual activity). If the smear result is negative twice, you can repeat the test less often - once every 2-3 years, up to 65 years. More frequent (2 times a year) cytology examinations are indicated for women with HPV who often change sexual partners, suffer from menstrual irregularities, obesity, infertility, genital herpes, and take hormonal contraceptives. A cytological examination of cervical scrapings is performed on women before inserting an intrauterine device.

Taking scrapings for a Pap smear is not performed during menstruation or in the presence of inflammatory diseases of the vagina and cervix, as this may lead to a false result. One day before taking a smear, you should not have sexual intercourse, use tampons or vaginal suppositories.

Material collection

A smear for cytological examination is taken during an examination in a gynecological chair using vaginal speculum. The material is collected from 3 areas: the vaginal vault, the vaginal part of the cervix (ectocervix) around the external os and the cervical canal. If changes are visually detected on the cervix (erosions, leukoplakia, etc.), a smear for cytological examination is taken from these areas.

Taking material from the mucous membrane is carried out by superficial scraping. The cervix should not be wiped before taking a scraping. If there is an accumulation of discharge in the area of ​​the posterior vaginal vault, they are carefully removed with a tampon. The scraping is taken with a cyto-brush (cervix brush) or an Eyre spatula. After samples of the material are collected, they are applied to glass slides and sent to the cytology laboratory. A two-manual gynecological examination is performed after taking material for cytological examination.

Interpretation of results

During a cytological examination of cervical scrapings, the size, shape, number and nature of the arrangement of cells are assessed. To do this, a method of staining a smear using the Papanicolaou method is used, it is dried and examined under a microscope. The Pap test result is considered negative (normal) if all cells have an unchanged structure. To interpret the results of a cytological examination of a smear, a classification according to the degrees (stages) of anomaly assessment is used.

• The first stage corresponds to the normal cytological picture observed in healthy women.
• The second stage is characterized by some morphological changes in cells caused by the presence of inflammation of the internal genital organs. This stage is also considered normal, but requires careful further examination to identify the pathogen.
• At the third stage, individual cells with an abnormal nuclear structure are identified. In this case, it is recommended that a smear be taken and examined again, as well as a histological examination of the material.
• The fourth stage is characterized by altered cells (with changes in the cytoplasm, chromosomes and nuclei), which gives reason to suspect a malignant process and also requires careful further examination.
• The cytological picture of the fifth stage shows a large number of atypical malignant cells.

Cytological examination of cervical scrapings reveals only changes in the cervical canal, but does not characterize the condition of the uterus, fallopian tubes or ovaries. False negative Pap test results account for 20-30% of the total number of studies. Upon receipt of tests that suggest cervical dysplasia or cancer, additional colposcopy and tissue biopsy are performed.

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

Cytological analysis of cervical cells (“cervical cytology”), helps to detect a fairly common cancer disease in time - cervical cancer.

But the “usefulness” of this analysis does not end there; based on its results, one can judge the beginning changes in the structure of cells and their functioning, the presence of inflammation and infection.

When performing a cytological analysis, tissue cells, their number, shape, relative position and other characteristics are examined. Of greatest importance is the ability to detect precancerous changes cervical cells.

Since such changes do not manifest themselves in any way in a woman’s general well-being, it is difficult to detect them in other ways. Material for research is taken by scraping a very small amount of tissue from the surface of the cervix with a spatula, spatula, spoon or probe.

The sampling takes place from three different parts of the cervix (vault, outer surface, canal). Before this, the uterus is cleaned of secretions with a cotton swab. The process is quick and painless during the examination of the woman on the gynecological chair. Usually, simultaneously with scraping tissue from the surface of the uterus, material is also obtained from the cervical canal in the same way, but using a special brush.

The resulting material is applied in a thin layer to a glass slide. (make a smear), and this glass is sent to the laboratory for testing. The examination itself takes place under a microscope. In many clinics, cells are simultaneously examined by staining using the Papanicolaou method (PAP test), by drying and other methods.

An integrated approach allows you to obtain more accurate results. Assessing the condition of individual cells and the overall assessment of the material makes it possible to diagnose a disease or say that the woman is healthy. Based on the results of the analysis, a cytological conclusion is drawn up. Usually the doctor receives it 1-2 weeks after collecting the material.

There is an assessment of the results of a cytological study of cervical cells according to the already mentioned Papanicolaou technique.

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

To date the interpretation of the results of a cytological study of cervical cells is more popular from the cervical canal according to the Bethesda method.

This method reveals the presence of various changes in the cell nucleus (dyskaryosis).

Depending on the number of cells with dyskaryosis and their location, one or another diagnosis can be made.

Cervical cytology in this interpretation allows us to determine the following conditions:

• No pathological changes
• Various atypical cell conditions, including cervical dysplasia (cervical intraepithelial neoplasia)
• Carcinoma (cancer) of the cervix.

These states are designated by Latin letters. The table below will help you decipher them and understand what is hidden behind the combinations of Latin letters in the analysis results.

The most common tests are those with the designation CIN 1, 2 or 3 .

This designation means dysplasia of the first, second or third degree of severity.

First degree dysplasia suggests the presence of dyskaryosis in single, mature cells located scattered or in small clusters among normal cells.

Second degree dysplasia– there are more pathological cells, pathologies are more diverse and are found not only in the surface layer, but also in approximately half the thickness of the epithelial layer.

Third degree– pronounced changes, about 2/3 of the epithelial layer is affected.

Presence in diagnosis CIN speaks of the need to be tested for the presence of the human papillomavirus (HPV), since it is this virus that in most cases provokes the development of cervical dysplasia.

The importance of cytological analysis

Considering the results that cytological analysis gives, its importance is difficult to overestimate. This is one of the simplest, cheapest and most reliable methods for determining the presence of precancerous conditions of the cervix.

Cervical cancer accounts for almost half of all cancers in women.

In the initial stages it occurs without symptoms, and until the mid-20th century it was almost impossible to diagnose precancerous conditions. But with the advent of the PAP test in the 40s of the 20th century, this became possible, which saved a huge number of women’s lives.

Timely detection of initial changes in cells makes it possible to treat dysplasia and other precancerous conditions relatively simply and effectively.

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

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

Regardless of the results of previous tests, women at risk ( HIV carriers taking steroids, chemotherapy, etc.)– the test must be taken every year or more often, as recommended by a doctor.

If a pathology is detected in the analysis, repeat it after three months, six months, or as recommended by a doctor.

We also note that cervical cytology in 5-10% of cases are false negative. Experts attribute this to improper collection of material and improper preparation for analysis.

For the result to be reliable, a woman needs at least two days:

• Abstain from sexual intercourse
• Do not sanitize (douche) the vagina
• Do not use vaginal suppositories, tablets, creams or other medications.
• Before directly collecting the material, do not urinate for 2-3 hours.

Cytology analysis cannot be taken:

Compliance with these simple rules will allow a woman to be calm about her health, and if any pathologies are detected, they can be treated effectively and relatively simply.

All women 21 years of age and older, or no later than within the first three years of sexual activity, should undergo a cervical Pap smear followed by cytology and an annual gynecological examination, in accordance with the recommendations of the Institute of Obstetrics and Gynecology.

Annual screening should be performed until age 30. If the last three tests have been negative up to this point, screening may be performed once every 2-3 years (at the discretion of the treating physician). When performing a cervical Pap smear, it is necessary to collect material from the cervical canal and ectocervix.

The number of false-negative Pap test results for highly differentiated intraepithelial changes reaches an average of 20%, but for glandular changes and invasive cancer their number is even higher.

To reduce the number of false negative results, new technologies for cytological examination of cervical smears have been developed, for example, the use of liquid slides for the preparation of material. In this case, the stick with the material is placed in a fixing solution on a glass slide, and not on dry glass. Blood, mucus and inflammatory cells are removed, and a monolayer of epithelial cells is automatically prepared by the machine. Special processors select the most atypical cells of the smear. This helps to increase the sensitivity of the test, reducing the time required for the cytologist to perform the analysis, and thus increasing the efficiency of the test.

The effectiveness of using this test alone or in combination with cytological examination of the cervix in women over 30 years of age is currently being discussed. The HPV DNA test is more sensitive but less specific than a cytological test.

Regular screening is necessary even among vaccinated women, since the vaccine does not protect against all types of HPV.

Classification of positive results of cytological examination of cervical smears according to Papanicolaou

In 1988, a meeting was held at the National Institute of Oncology, at which issues of existing terminology and methods for describing cytological studies were discussed. As a result, the Bethesda system was developed, which takes into account:

• — the quality of the material taken for research;
• — options for establishing a diagnosis (there are changes or not);
• - descriptive diagnosis.

This system, revised and expanded in 2001, is presented below.

Abbreviated Bethesda classification of pathological cytological changes of the cervix

According to the quality of the drug:

• — the drug is suitable for assessing changes (there is no tissue of the transformation zone);
• — the drug is not suitable for the study (indicate the reason);
• — the drug was not submitted for research (indicate the reason);
• - the drug has been studied, but the results are unreliable for assessing the degree of changes in the mucous membrane of the cervix.

General classification:

• — with the absence of intraepithelial lesions or malignancy;
• — with a violation of the structure of epithelial cells;
• - other.

Interpretation of the results of a cytological examination of a cervical smear

Tumors with no intraepithelial lesion or malignancy:

• - caused by microorganisms (for example, Trichomonas vaginalis);
• - reactive changes in the mucous membrane caused by inflammation, radiation, and the use of intrauterine contraceptives;
• - atrophic changes.

Tumors with disruption of the structure of epithelial cells.

Squamous cell tumors:

• - the presence of atypical squamous cells of undetermined origin (ASCUS) does not exclude the existence of high stages of squamous intraepithelial formation (ASC-H);
• — initial stages of squamous intraepithelial formations (LSIL), including HPV damage, moderate dysplasia, SIN I;
• - late stages of squamous intraepithelial formation (HSIL), including moderate or severe dysplasia, carcinoma in situ, SHIN II and SHIN III;
• - squamous cell carcinoma.

Glandular cells:

• - atypical glandular cells of the endocervix, endometrium or other localization;
• - atypical neoplastic glandular cells (especially endocervix or unspecified origin);
• - endocervical cancer in situ (AIS);
• - adenocarcinoma;
• - others (for example, endometrial cells in the cervix in women over 40 years of age).

Evaluation of positive Pap smears

All patients with visible changes in the cervical mucosa, regardless of the results of a cytological examination of cervical smears according to Papanicolaou, should undergo a biopsy

If a small number of atypical cells in the smear (ASCUS) is detected, the test is repeated after 6 months. It is also possible to perform a virological test aimed at detecting herpes viruses (HPV). In 6-10% of patients with a questionable result of a cytological examination of cervical smears according to Papanicolaou, a high degree of SIN is found on colposcopy. In 90% of women, particularly pathogenic types of herpes viruses are detected using genetic research.

A colposcopic sign of cervical neoplasia is a clearly defined white line on the surface of the epithelium after treatment with acetic acid. This effect is due to the fact that under the influence of acetic acid, cell dehydration occurs and cells with a higher nuclear density appear lighter. In addition to white epithelial cells, an atypical vascular pattern may or may not be present.

Vascular changes in SPIN include two phenomena: point changes and mosaicism. Point changes are caused by the formation of single spirally twisted capillaries inside the papillae of the subepithelial layer, which then extend to the surface of the epithelium and appear as points. Mosaicism occurs as a result of the formation of a network of capillaries located parallel to the surface of the epithelium. Both phenomena can be found in the same area of ​​the cervix. The wider the capillaries, the more atypical the pattern and the greater the distance between the capillaries during the study, the higher the degree of tissue atypia. The whiter the epithelium during colposcopy, the higher the degree of dysplasia.

With microinvasive, point vascular changes and mosaicism are expressed to a significant extent. With invasive cancer, these changes are even more pronounced. The tortuosity of the course of the vessels, changes in the shape, width and location of the terminal vessels are combined with much more serious changes in the architectonics associated with the formation of twisted, dilated and blindly ending comma-shaped vessels.

The article was prepared and edited by: surgeon

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 method for the 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 is the basis for the early start of preventive gynecological examinations.

In the first 2 years, screening is not carried out annually. Subsequently, if the results of repeated cytological studies are negative, preventive examinations become 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 the obligatory filtration step 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.