3. GIT cytology
• Lesions from the oral cavity can be sampled by
scrapping(abrasive cytology) the surface with wooden or
metallic spatula
• Samples from oesophagus, stomach, small and large
intestine can be obtained either by brushing or lavage
during endoscopy
7. Urine cytology
• 3 consecutive samples necessary to rule out any
pathology especially malignancy
• Early morning freshly voided sample required
• To be sent to the cytology lab immediately for processing
• Centrifugation of 10-20 ml of sample at 3000rpm for 5-10
min and smears made from the sediment
• Fix the smeared slide and stain
8. Urine cytology
• Paucicellular normally
• Only very few cells should be seen- squamous and
transitional epithelial cells
• Difficult to interpret reactive vs atypical cells
• Malignancy based on irregularity of nuclear margins and
hyperchromatism ( Transitional epithelial cells)
11. Buccal smear
• Smears prepared from the oral cavity after cleaning the
area
• For determination of sex chromatin
• One barr body/nucleus in 20-80% of the cells in a normal
female
• In males count is in <2% nuclei
• In XXX female 2 barr bodies are seen whereas in XO no
barr body is visualized
14. This project on pap smears started during dinner at Il Mulino, a well known
Italian restaurant in Manhattan’s West Village
15. Female genital tract
• Prepared by different methods depending upon the
purpose for which they are intended
Cervix ( ayres spatula/brush)- Pap smear
Vagina ( lateral vaginal wall)- hormonal status
Endocervix
Combined ecto and endocervix
endometrial
• Study of the cells on smears for screening of
premalignant , malignant and other non malignant
lesions
• Cost effective and easy screening method
16. Age Screening
< 21 No Screening
21-29 Cytology alone every 3 years
30-65 Preferred: Cytology + HPV every 5 years* OR
Acceptable: Cytology alone every 3 years*
> 65 No screening, following adequate neg prior screens
After total hysterectomy No screening, if no history of CIN2+ in the past 20
years of cervical cancer ever
Triple A Guideline: ACS, ASCCP,
American Society for Clinical Pathology
CA Cancer J CLIN March 2012
*If cytology result is negative or ASCUS + HPV negative
17. Ayers Spatula
• Concave end to fit the
cervix
• Convex end for vaginal
wall and vaginal pool
scrapings
18. Squamo-Columnar Junction• Junction of pink cervical skin
and red endocervical canal
• Inherently unstable
• Key portion of the cervix to
sample
• Most likely site of dysplasia
19. Sample Cervix
- Use concave end
- Rotate 360 degrees
- Don’t use too much
force (bleeding, pain)
- Don’t use too little
force (inadequate
sample)
20. Make Pap Smear• As thin as possible
• Properly labeled
• Put wet slide in fixative 95%
alcohol / cytofix
21. Spray with Fixative
• Within 10-15 seconds
• Allow to fully dry before
packaging
• Cytologic Fixative
(hairspray works
acceptably also)
• Stain and visualize
under microscope
22. Pap smear: reporting
• Sample adequacy
- Maximum 10-15,000 squamous epithelial cells in
conventional smears
- Endocervical / transformation zone
component(metaplastic cells) may/may not be present
- Reporting by Bethesda method
- Sample adequacy,
- Benign cellular changes,
- Epithelial cell abnormalities,
- Other malignant neoplasms
23. IMPROVEMENTS TO THE PAP TEST
• New collection devices (brooms and brushes rather than
spatulas)
• Liquid-based Pap Tests rather than smears
• Ancillary tests such as HPV detection
• Computerized screening devices.(PAPNET)
