Gynecology Book

http://www.fpnotebook.com/

Pap Smear

Aka: Pap Smear, Cervical Smear, Papanicolaou Smear
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  1. See Also
    1. Pap Smear Intervals
    2. Cervical Cancer Screening
  2. Efficacy: Pap Smear
    1. Specificity of Pap Smear: 70%
    2. Sensitivity of Pap Smear: 80%
      1. Thin Prep Pap Smear
        1. Liquid based Pap Smear improves sensitivity
        2. Can be used for HPV DNA testing
        3. Will allow Gonorrhea and Chlamydia testing
        4. Reduces sampling error (e.g. drying artifact)
        5. Use spatula and cytobrush (instead of broom)
          1. Improves endocervical sampling
      2. Repeating Pap Smear improves sensitivity
        1. Repeated in short interval, sensitivity: 96%
        2. Third repeated in short interval: 99.2%
        3. Short interval is approximately 1 year
  3. Precautions
    1. Despite negative Pap Smears, HPV positive status confers higher risk at older ages
      1. Kjaer (2006) Cancer Res 66(21): 10630-6
  4. Prognosis: Reassuring findings
    1. Negative HPV test with a negative Pap Smear after age 30
      1. High longterm Negative Predictive Value
      2. Bigras (2005) Br J Cancer 93(5): 575-81
  5. Technique
    1. Preparation: Water-based Speculum lubrication
      1. Does not contaminate conventional Pap Smear slide
        1. Amies (2002) Obstet Gynecol 100:889-92
        2. Harer (2002) Obstet Gynecol 100:887-8
      2. Does not affect thin prep Pap Smear
        1. Note that thin-prep manufacturer recommends water
        2. Hathaway (2006) Obstet Gynecol 107:66-70
    2. Tips to prevent unsatisfactory Pap Smears
      1. Avoid Pap Smear during time of Menses
      2. Avoid tampons and intercourse within 48 hours
      3. Blot Cervix prior to Pap Smear
      4. Focus on endocervical canal in postmenopausal women
    3. Step 1: Clean Cervix (clean only if large discharge)
      1. Gently wipe excess Cervical Mucus from os
      2. Use large cotton tipped swab
      3. Do not rinse Cervix with Saline
      4. Avoid performing Pap Smear during menstruation
    4. Step 2: Sample the Cervix
      1. Order is critical for less blood
        1. First: Chlamydia cultures (if needed)
        2. Option 1: Conventional Pap Smear
          1. Second: Exocervix with Ayres spatula (or similar)
          2. Last: Endocervix with Brush (rotate 180 degrees)
        3. Option 2: Thin prep
          1. Liquid pap (with broom or spatula/brush as above)
          2. Reflex to HPV testing (do not HPV test under age 20 due to low predictive value)
      2. Conventional Pap Smear pointers
        1. Get exo- and endocervix before applying to slide
          1. Prevents one from drying while collecting other
          2. Thin prep eliminates drying risk
        2. Samples may be placed on top of one another
        3. Spread spatula material in one smooth stroke
        4. Roll the brush along slide by twirling handle
      3. Pregnancy
        1. Place brush only 50% into canal and sample sides
    5. Step 3: Fix Pap Smear Sample (except thin prep)
      1. Fix sample immediately to prevent air drying
      2. Air drying is common reason for ASCUS Pap Smear
  6. Findings
    1. Normal
      1. Bethesda: Normal
      2. World Health Organization (WHO): Normal
    2. Inadequate Pap Smear
    3. Benign Pap Smear Changes
      1. Vaginal Infection
      2. Reactive changes (Inflammation)
    4. ASCUS Pap Smear
      1. Atypical Squamous Cells of Undetermined Significance
    5. AGUS Pap Smear
      1. Atypical Glandular Cells of Undetermined Significance
    6. Cervical Intraepithelial Neoplasia (Dysplasia)
      1. Mild Dysplasia
        1. Bethesda: Low Grade SIL
        2. WHO: CIN I
        3. Risk of progression
          1. Regresses spontaneously in 60% of cases
          2. Persists in 30% of cases
          3. Progresses to CIN III in 10% of cases
          4. Progresses to invasive cancer 1% of cases
      2. Moderate Dysplasia
        1. WHO: CIN II
        2. Risk of progression
          1. Regresses spontaneously in 40% of cases
          2. Persists in 40% of cases
          3. Progresses to CIN III in 15% of cases
          4. Progresses to invasive cancer 5% of cases
      3. Severe dysplasia
        1. Bethesda: High Grade SIL
        2. WHO: CIN III
        3. Risk of progression
          1. Regresses spontaneously in 33% of cases
          2. Persists in 55% of cases
          3. Progresses to invasive cancer >12% of cases
    7. Carcinoma In-Situ (Pre-invasive Cervical Cancer)
    8. Cervical Cancer
    9. References
      1. Ostor (1993) Int J Gynecol Pathol 12(2): 186-92
  7. Management: Normal Pap Smear and Physical Exam
    1. See Pap Smear Intervals
    2. HPV DNA test positive (tested at age 30 regardless of Pap Smear results)
      1. Repeat Pap Smear and HPV DNA test in 1 year
    3. High Risk for Cervical Cancer
      1. Repeat Pap Smear yearly
    4. Low Risk for Cervical Cancer with few prior Pap Smears
      1. Repeat Pap Smear Yearly
    5. Low Risk and 3 consecutive normal Pap Smears
      1. Repeat Pap Smear every 2-3 years
      2. Yearly Pap Smear if even remote history of dysplasia
  8. Management: Benign or Mild Pap Smear Changes
    1. See Inadequate Pap Smear
    2. See Benign Pap Smear Changes
  9. Management: Abnormal Pap Smear
    1. See ASCUS Pap Smear (Pap Smear Atypia)
      1. ASC-H should be managed as abnormal with Colposcopy
    2. See AGUS Pap Smear
    3. See Low Grade Squamous Intraepithelial Lesion ( LSIL)
    4. See High Grade Squamous Intraepithelial Lesion (HSIL)
    5. Colposcopy Indications
      1. See Colposcopy Protocol
      2. ASCUS Pap Smear on 2 or more Pap Smears
      3. ASCUS Pap Smear with HPV positive for high risk type
      4. CIN: ASC-H, LGSIL or LSIL, HGSIL or HSIL
    6. See Cervical Cancer
  10. Resources
    1. American Society for Colposcopy and Cervical Pathology
      1. http://www.asccp.org
  11. References
    1. Boon (1989) Acta Cytol 33(6):843-8
    2. Brotzman (1996) Am Fam Physician 53(4):1154-62
    3. Fowler (1993) Postgrad Med 93(2):57-70
    4. Kurman (1994) JAMA 271(23):1866-9
    5. Koss (1989) JAMA 261(5):737-43
    6. Miller (1992) Am Fam Physician 45(1):143-50
    7. Orr (1992) Gynecol Oncol 44:260-2
    8. Shepherd (1995) Am Fam Physician 51(2):434-40
    9. Stack (1997) Postgrad Med 101(4):207-4

Vaginal Smears (C1744620)

Definition (NCI) A procedure in which cells are scraped from the cervix for examination under a microscope. It is used to detect cancer and changes that may lead to cancer. A Pap smear can also show conditions, such as infection or inflammation, that are not cancer.
Definition (CSP) collection of pooled secretions of the posterior vaginal fornix for cytologic examination.
Definition (MSH) Collection of pooled secretions of the posterior vaginal fornix for cytologic examination.
Concepts Laboratory Procedure (T059)
MSH D014626
English Papanicolaou Smear, Papanicolaou Test, Smear, Papanicolaou, Smear, Vaginal, Smears, Vaginal, Test, Papanicolaou, Vaginal Smear, Vaginal smears, Papanicolaou smear, PAP TEST, PAP SMEAR, pap smear, Smear vagina, vaginal smear (lab test), vaginal smear, cervical/vaginal smear, Pap test, Pap Smear, cervical smear, vaginal smears, Vaginal Smears, Pap Test
Swedish Vaginalcytologiskt prov
Japanese ﾁﾂｽﾐｱ, 腟垢スミア, 膣スミア, 腟スミア, 腟塗抹, パパニコロースメア, パパニコロースミア, 子宮頸管乾燥スミア, 子宮頚部スメア, パパニコラウスミア, 子宮頸管乾燥スメア, 子宮頚部スミア, 子宮頸部スメア, 子宮頸部スミア, 腟脂膏, 腟塗抹標本, パパニコラウスメア, Papanicolaouスメア, 腟スメア
Czech vaginální výtěry, Stěr z pochvy
Finnish Emättimen sivelynäytteet
French Frottis cervico-vaginaux, Frottis cervicovaginaux, Frottis cervico-vaginal, Frottis cervicovaginal, Frottis vaginaux, Test Pap, Test de Papanicolaou, Frottis vaginal
Russian VLAGALISHCHNYE MAZKI, PAPANIKOLAU TEST, PAPANIKOLAU MAZOK, TSERVIKAL'NYE MAZKI, ВЛАГАЛИЩНЫЕ МАЗКИ, ПАПАНИКОЛАУ МАЗОК, ПАПАНИКОЛАУ ТЕСТ, ЦЕРВИКАЛЬНЫЕ МАЗКИ
Italian Test di Papanicolau, Citologia cervicovaginale, Pap test, Pap-test, Striscio vaginale
Croatian VAGINALNI RAZMAZ
Polish Rozmazy pochwowe
Hungarian Vaginalis kenet
Portuguese Esfrgegaço vaginal, Esfregaço de Papanicolaou, Esfregaço Vaginal, Teste de Papanicolaou, Exame Colpocitológico, Exame Papanicolau, Papanicolau, Teste de Papanicolau
Spanish Citologia vaginal, Prueba de Papanicolau, Frotis Papanicolaou, Frotis Vaginal, Examen de Papanicolau, Papanicolau, Prueba de Papanicolaou
Dutch uitstrijkje vagina, Cervixuitstrijkje, Uitstrijkje, Uitstrijkje, cervix-
German Vaginaabstrich, Papanicolaou-Abstrich, Vaginalabstriche
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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