pap smear and interpretation

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