The document discusses the Pap smear test, which screens for cervical cancer. It describes the test procedure, which involves collecting cell samples from the cervix using an Ayres spatula or endocervical brush. The samples are analyzed under a microscope to detect any abnormal or infected cells. Abnormal results are categorized according to the Bethesda system and can range from atypical squamous cells to high-grade lesions and carcinoma. The goal of the Pap smear is to detect cervical changes at early, precancerous stages to prevent cancer from developing.

1. PAP SMEAR
PRESENTED BY -
TOPIC

2. INTRODUCTION
METHODS OF PAP SMEAR
PROCEDURE
INTRRPRETETION
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Table of
Contents
PURPOSE OF PAP SMEAR

3. INTRODUCTION
• First described by Papanicolaou and Traut , this is screening test and is often referred as the
Pap Smear test.
• It is a cytology based test which detects current cellular changes in cervix and can detect
certain infections as well.
• It forms a part of the routine gynaecological examination.
• All sexually active women older than 21 years should undergo an annual check-up with 3
yearly Pap test.
• In Indian scenario, Pap smears are taken whenever patients present with gynecological
complaints in the outpatient departments of public and private hospitals.

4. 4
PURPOSE OF PAP SMEAR TEST
• Screening test in Ca Cervix.
• To detect estrogen activity related to menopause or
endocrine abnormalities
• Detect certain Infections
1. Bacterial Vaginosis
2. Trichomonas
3. Candida
4. Actinomycetes
5. Herpes Simplex Virus

5. 5
METHODS OF PAP SMEAR
1. CONVENTIONAL METHOD
Slide is prepared using Ayer’s Spatula (wooden/plastic)
/ Endocervical Brush
2. LIQUID BASED CYTOLOGY
Specimen is obtained by cervical brush and is put
in fixative directly.

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Procedure of Conventional Pap Smear
• Inform and explain the procedure to patient
• Ask her to void her bladder
• Ask her to lie in lithotomy position and do proper exposure
• Insert Cusco’s speculum of appropriate size and visualize the
whole of Cervix
• First sample- Fix ayres spatula at the level of external os, rotate
by 360 degree 2-3 times
Ensure that patient has not used any vaginal medications, had douching,
intercourse, and vaginal examination 48 hours before the procedure

7. 7
Procedure of Conventional Pap Smear
• Second sample- endocervical brush at the level of endocervix
and rotate 180 degree, 2-3 times.
• Make a common smear on prelabelled slide and immerse it in
95% alcohol
• Document & send the slides for cytological examination

8. THE 2014 BETHESDA SYSTEM FOR REPORTING
CERVICAL CYTOLOGY
5 components of a Pap smear report
• Specimen type ( Conventional / Liquid Based)
• Adequacy (Satisfactory/ Unsatisfactory)
• General category (Negative for intraepithelial lesion or malignacy /
Epithelial cell abnormality)
• Interpretation
• Adjunctive testing

9. Adequacy
• Pap Smear is adequate when No. of squamous cells are 8000 -
12000 / 10 HFP + Endocervical Cells are 10- 12.
• Obscuring factors like Air artefacts, Blood, Inflammation if
present >75% then the sample would be inadequate

10. Negative for intraepithelial lesion or malignacy
• No cellular evidence of neoplasia
• Non-neoplastic findings
• Non-neoplastic cellular variations like squamous metaplasia
• Reactive cellular changes associated with Inflammation including
repair, Radiation, Intrauterine contraceptive device (IUD).
• Organisms like Bacterial Vaginosis, Trichomonas, Candida,
Actinomycetes, Herpes Simplex Virus

11. EPITHELIAL CELL ABNORMALITIES
• Squamous cell
• Atypical squamous cells (ASC)
• LSIL (encompassing HPV/ mild dysplasia/CIN 1)
• HSIL (encompassing moderate and severe dysplasia/ CIS /CIN 2 and CIN 3)
• With features suspicious for invasion (if suspected)
• Squamous cell carcinoma in situ.
• Glandular cell
• Atypical Glandular Cells (AGS)
• Adenocarcinoma in situ (AIS)
• Adenocarcinoma

13. Thank you
for listening!

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Interpretations

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Interpretations