How many days does cytology take? Cytology smear explanation, what it shows and how long it takes. Opportunistic flora is not always the norm

Cytology is a diagnostic method that allows you to study the structure of cells and detect the presence of atypical elements indicating the development of the disease. In gynecology, cytology analysis is a fairly common procedure.

The popularity of the method is easy to explain:

• firstly, a diagnostic smear for cytology does not require large expenses;
• secondly, a guarantee of reliable results in the shortest possible time;
• thirdly, it helps prevent the development of precancerous and cancerous conditions.

Cytology, smear for cytology or oncocytology - these are all popular synonyms of the medical term - Papanicolaou test.

Analysis for cell research in gynecology

The cervical canal or cervix is ​​the anatomical site for collecting cellular material for research in gynecology. This anatomical site functions with two types of epithelium:

1. stratified epithelium (covers the area of ​​the vaginal part);
2. columnar epithelium (lining the cervical canal at the junction of the cervix and uterus).

According to physiological norms, cellular elements are regularly renewed. Taking a smear for cytology in these parts of the cervical canal helps to detect atypical cancer cells at first initial stage development.

A cytology analysis helps identify initial changes in the cervical canal of the uterus that contribute to the development of cancer over a short period of time. Given this reason, a cytology test is a mandatory preventive method in gynecology.

Mass smear testing among women belonging to different age groups and segments of the population demonstrates positive dynamics in reducing the incidence of cervical cancer.

If your appointment sheet indicates a smear for cytology, do not panic! This does not mean that you have cancer or are at increased risk of developing it. By no means, constant preventive examination and performing a smear for cytology delays the possibility of developing terrible diseases.

Women under 65 years of age should regularly visit a gynecologist and comply with all prescribed requirements. After 65 years, the frequency of submitting material for cytology is determined individually by the attending physician.

A Papanicolaou test is mandatory in the following cases:

• All girls/women over 18 years of age. In this case, the analysis is carried out without medical requirements, at will;
• Presence of sexual activity;
• Women over 30 years of age are required to undergo a medical test once a year;
• Pregnant women. Cytology is carried out according to the rules 3 times during the period of gestation;
• Interruptions in the menstrual cycle, the presence of human papillomavirus and malignant tumors in close family members are the reasons for a cytology smear every six months.

Factors leading to gynecological diseases and a negative cytology test result:

• Nicotine intake;
• Insufficiency of vitamins A, C;
• Immunodeficiency conditions, including HIV;
• Infection with chlamydial and herpes infections;
• Long-term inflammatory lesions of the female genital organs;
• Isolation of human papillomavirus in the blood;
• Systematic use of hormonal contraceptives;
• Onset of sexual activity before 16 years of age;
• Regular change of sexual partners;
• Several births in the anamnesis.

Stages of preparation for the analysis

It is difficult to predict what the doctor will prescribe at your next visit to his office. But if you are going to undergo a regular preventive examination with a gynecologist and undergo a number of necessary tests, follow these simple recommendations:

• Forget about nighttime pleasures for a few days;
• Move everything to the back drawer chemicals For intimate hygiene, stop douching;
• Do not use medications, such as vaginal suppositories, sprays, etc. before taking a smear.

A smear for cytological examination is taken during a routine gynecological examination with speculum. The duration of all procedures, including examination, is 15 minutes.

Initially, the doctor assesses the condition of the vaginal walls and the visible part of the uterus after inserting a gynecological “mirror”. After this, the gynecologist proceeds directly to collecting the epithelium of the cervical canal. To do this, you will need a probe, a special swab or brush. Although the procedure is short and unpleasant, try to relax, otherwise the discomfort will increase due to muscle tension.

The resulting scraping is immediately sent to the laboratory for further study. Accurate results from the laboratory will arrive after 1 – 2 weeks.

The results will indicate either "positive" or "negative". It is absolutely clear that if the transcript contains the clause “negative”, this means absolute health of the cervix, the absence of atypical cells.

The item “positive” is not a clinical diagnosis! Yes, such a result indicates the presence of atypical cells, but this does not mean that they will soon become cancerous or are already cancerous. An analysis with a positive result occurs in infectious diseases acquired sexually, and even in inflammatory processes.

The decoding additionally includes the stages of the identified process:

• Stage 1 – the cytological picture is not changed;
• Stage 2 – there are minor deviations from the norm due to inflammation;
• Stage 3 – single cells with abnormalities of cellular elements (presumably malignant);
• Stage 4 – single cells of an exclusively malignant nature;
• Stage 5 – malignant cells in large numbers (exact diagnosis – cancer).

In case of a positive result, regardless of the stage, additional tests will be prescribed, for example, a repeat cytology test if the results are questionable, or colposcopy.

General condition after taking material for cytology

Do not worry if brownish-green discharge appears within 5 days after taking a smear. This is a normal reaction of the body and does not require treatment. On such not very joyful days, gynecologists advise using personal hygiene products.

To avoid pain and discomfort, take a week's break from sexual activity.

IN urgently Consult a doctor if, after taking material for analysis, your body temperature rises, sharp pain in the lower abdomen and heavy bloody discharge appear.

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

Cytological analysis of cervical cells (“cervical cytology”), helps to detect in time a fairly common cancer — 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. Highest value has 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 .

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.

The unfavorable environmental situation, early maturation and sexual intercourse among modern youth, smoking, exposure to all sorts of gadgets and other problems of 21st century society lead to disappointing medical statistics: cases of cancer are increasingly being recorded. The disease also affects the female reproductive organ - the uterus. How to protect your health, are there methods for diagnosing such a serious disease in the early stages? The answer lies, as they say, on the surface. Almost every girl who visits a gynecologist undergoes an analysis, which is aimed at studying the structure of cells, finding atypical ones or those that do not correspond to generally accepted standards. This test is called “atypical cell test”, “pap test” or “cytology test”. What it is and what it is needed for, we will explain in detail in the article.

Cytology as a science

What does the word “cytology” mean? This is a separate science that studies the structure, functioning, and characteristics of living cells. This branch of medicine is also called cell biology.

Clinical cytology is a branch of laboratory research, the essence of which is the microscopic descriptive analysis of cytological material. Using cytology analysis, cancer, precancerous conditions and benign neoplasms, as well as inflammatory processes are determined.

Cytology is a science that also studies the ability of cells to respond to external stimuli. This means that this medical field, in addition to identifying diseases, is also involved in the experimental development of drugs.

Cytology in gynecology

Clinical cytology - what is it in gynecology? In this industry medical science The cytological analysis method is widely used, as it is highly informative and reliable. With its help you can determine a large number of a variety of pathological conditions in the vagina, cervix and the uterus itself. In addition, the analysis does not require large expenses: all that is needed is a concentrate that stains the material under study and the microscope itself.

The advantages of this diagnostic study are also safety, painlessness, ease of sampling, and low risk of adverse reactions. A smear for cytology is performed even on pregnant women. And the result will be ready within a day after taking the material.

Typically, the material is collected in a complex manner: from the urethra, vagina and cervix. Therefore, this analysis may be called “atypical cell smear” or “cervical cytology”. What it is? This is the same analysis for atypical cells, which has the same method of conducting and interpreting the results.

Indications

So, a smear for cytology. What is it and when is it prescribed? There are no specific indications for testing for atypical cells. This study is recommended for all representatives of the fair sex from the moment they have their first sexual intercourse. During reproductive age, doctors advise women to check their health with a cytology smear at least once a year. Cytology is a simple and reliable way to detect cancer cells.

Cytology analysis is routinely carried out before gynecological surgery, various gynecological manipulations (for example, when inserting a contraceptive - a spiral), when planning pregnancy, directly during pregnancy, if there is a suspicion of infectious diseases reproductive organs, infertility treatment, disorders menstrual cycle.

Cytology is a science that studies the functioning of a cell, which means it can be used to detect damaged, atypical structures and their reactions. Therefore, the analysis is also prescribed by the doctor when confirming the diagnosis of “human papillomavirus”, “genital herpes”, “obesity” and “ diabetes» for dynamic monitoring of the patient’s condition, as well as for analyzing the effectiveness of treatment methods.

Cytology analysis: how does it happen?

Cytology analysis - what is it, how is it carried out? The material is collected on a gynecological chair. The doctor will use a special medical brush to collect mucus from the vagina, the entrance to the cervical canal, and also from the cervical canal. During sampling, gynecological speculums are also used to visually detect inflamed areas of the mucous membrane. If there are any, the doctor will take an analysis from such damaged area. The procedure causes discomfort, but the patient should not experience any pain if the procedure is performed correctly.

Cytological material (mucus) is applied to a diagnostic glass, fixed and dried, and then delivered to the laboratory for examination.

Test portability

We talked about what a cytology smear is and what it is. What are the contraindications and adverse reactions? There are cases when the mucous membrane is too inflamed, so the slightest touch of a medical instrument causes minor bleeding due to damage to the capillaries. This condition does not require treatment and goes away on its own within 24 hours.

If after a few hours the patient has a fever, nagging pain in the abdomen, continuous heavy bleeding, and chills, then it is necessary to call an ambulance. None of the above symptoms are normal when conducting a test such as cervical cytology. What is this, why do such reactions occur? The causes of complications may be unprofessional sampling of material, as well as neglected inflammatory process mucous membrane.

Preliminary preparation

Contrary to popular belief that no preparation is needed before taking a smear for atypical cells, it is necessary to take the recommended measures the day before in order to exclude false test results. Therefore, next we will consider the question: “Cytology of the uterus - what is it and how to prepare for analysis?”

1. It is necessary 2 weeks before the proposed examination to exclude the use of intravaginal suppositories, local creams, ointments, including contraceptives, and not to use the douching method.
2. A week earlier you need to give up intimacy.
3. The study cannot be carried out during menstrual flow. The most reliable results of analysis for atypical cells are observed when the material is collected on the 5th day after the end of menstruation.
4. Several hours before the cytology test, it is recommended to refrain from urinating.

Decoding the result

Many people are interested in the question of what clinical cytology is, what it is in gynecology, and how to decipher the obtained indicators. Only a doctor should analyze the test results. The detected indicators do not constitute a diagnosis and require additional research and clarification.

The results are divided into 5 degrees of purity:

1. The first means that cytological analysis did not reveal any pathological changes in the cells. This means that the patient is healthy.
2. The second indicates the presence of an inflammatory process. To clarify the diagnosis, the doctor will prescribe additional tests.
3. In the third degree, cells in which the structure of the nucleus is disrupted are found in the smear. In this case, it is recommended to undergo microbiological and histological examination to make a diagnosis.
4. If the results indicate the fourth degree, then there is a risk of cancer. The patient is prescribed a full urgent examination using a biopsy and examination using a colposcope.
5. At stage 5, laboratory technicians found a large number of cancer cells in the smear. In this case, the woman is immediately referred to an oncologist.

In the second and third degrees, after additional examinations, it is necessary to conduct a repeat cytology test.

Cytology smear analysis: what is it, how to decipher it?

In addition to purity indicators, the cytology test result form also contains other parameters:

• Latin letters indicate the area of ​​sampling of the test material: U - urethra, C - cervical canal, V - vagina;
• the presence of leukocytes in the field of view (normally - up to 15 units);
• it is possible to detect infectious agents: fungi, trichomonas or gonococci;
• a large amount of epithelium indicates a possible oncopathology (normally up to 10 units);
• the presence of mucus in small quantities is normal.

Cytology test results are not a diagnosis. Only a doctor, having assessed the entire situation of a particular medical case, can determine the pathology. Thus, grades 2-4 may indicate not only cancer, but also less dangerous and easily treatable health problems, such as candidiasis, vaginitis, cervicitis, cervical erosion, genital herpes, papillomavirus.

Cost of analysis

Cytology is a widely used and available method diagnosing cancer in the early stages. Almost every laboratory or clinic can take this test, so the cost of the test has a wide range depending on the level of the medical institution and its equipment, personnel qualifications, and the like. According to the insurance policy, the analysis is carried out free of charge in public clinics. In private laboratories, such a service costs from 500 to 1200 rubles. Additionally, you will have to pay for the collection of material itself - that’s another 200-500 rubles.

Where to get a smear for cytology?

In any modern laboratory, a smear is performed for cytology; a doctor’s referral is not necessary at all. By contacting a antenatal clinic or a private clinic, for example, “Invitro”, “Hemotest”, you can undergo such a diagnostic test.

Cytology is a science that has saved many lives over the course of several decades of its existence. Don't forget to get tested annually for abnormal cells. Such a simple, safe and affordable test can detect a deadly disease in the early stages of development. Timely request for medical care significantly increases the likelihood of complete medical victory over the disease.

For some reason, everyone thinks that oncocytology concerns exclusively the female genital area (cervix, cervical canal). This is probably because the condition of the cervix is ​​the subject of daily study by any cytologist, while a smear for oncocytology can be applied to the glass after scraping or fine-needle aspiration biopsy (FNA) from other places. In addition, you can make smears of the mucous membrane of the larynx, nasopharynx, skin (melanoma), and soft tissues. In principle, if an oncological process is suspected, material for research can be obtained from any place, albeit using different methods. For example, using fine needle aspiration biopsy. Most often this is done if there are doubts about the health of the mammary or thyroid gland, where cytological diagnosis plays a role main role, because histological verification is provided only during surgical intervention(urgent histology) and after organ removal.

Oncocytology

Oncocytology involves microscopic analysis (study of the cellular composition and state of cell organelles) of material suspicious of an oncological process and taken from any accessible place.

In this regard, patients should not be surprised by smears for oncocytology, prepared not only from scrapings of the female genital organs, but also fine-needle aspiration biopsy (FNA):

• Enlarged regional lymph nodes (cancer of the larynx, nasal cavities and paranasal sinuses, salivary glands, penile cancer, eye tumors, etc.);
• Tumors of the pancreas, liver, gallbladder and extrahepatic bile ducts;
• Seals and nodes of the mammary and thyroid glands.

Detection and diagnosis of malignant neoplasms of soft tissues, skin, lips, mucous membranes of the mouth and nose, cancer of the direct or colon, bone tumors often begin with the examination of smears-imprints. And then FNA of the changed lymph nodes and/or histological diagnosis (histology) is added. For example, if a tumor of the rectum or colon is suspected, cytology is the first stage of diagnosis, but cannot replace histology.

It should be noted that some organs are not subjected to histological analysis until surgery, after all, you cannot cut off a piece of tissue in the mammary or thyroid gland and send it for research. In such cases, the main hope is in cytology, and here it is important not to make a mistake and not create the risk of removing an organ that could be saved by other methods.

A smear for oncocytology during a preventive gynecological examination or for the purpose of identifying oncological pathology (squamous cell carcinoma of the vulva, cervix and vagina) is taken by a gynecologist or midwife, applied to a glass slide and transferred to the cytology laboratory for staining (according to Romanovsky-Giemsa, Pappenheim, Papanicolaou) and research. It will take no more than an hour to prepare the drug (the smear must first be dried and then painted). Viewing will also take no more time if the drugs are of high quality. In short, for cytology you need glasses, paint prepared in advance, immersion oil, a good microscope, eyes and the knowledge of a doctor.

The analysis is performed by a cytologist, but in other cases, smears during screening after medical examinations are entrusted to an experienced laboratory assistant who is well acquainted with variants of the norm (norm – cytogram without features). However, the slightest doubt is the basis for transferring the smear to a doctor, who will take final decision(will refer you to a specialist, offer histological examination, if possible). TO gynecological smears We will return to oncocytology a little lower, but for now I would like to introduce the reader to what oncocytology is in general and how it differs from histology.

Cytology and histology – one science or different?

What is the difference between cytology and histology? I would like to raise this question due to the fact that many people in non-medical professions do not see the differences between these two areas and consider cytological diagnosis to be a section included in histological analysis.

A cytogram shows the structure and condition of a cell and its organelles. Clinical cytology (and its important branch - oncocytology) is one of the sections of clinical laboratory diagnostics aimed at finding pathological processes, including tumor cells that change the state of cells. To evaluate a cytological preparation, there is a special scheme that the doctor adheres to:

• Stroke background;
• Assessment of the condition of cells and cytoplasm;
• Calculation of nuclear plasma index (NPI);
• State of the nucleus (shape, size, state of the nuclear membrane and chromatin, presence and characteristics of nucleoli);
• The presence of mitoses and the height of mitotic activity.

There are two types of cytology:

1. Simple cytological examination, including taking a smear, applying it to a glass slide, drying and staining according to Romanovsky, Pappenheim or Papanicolaou (depending on the dyes and methods used by the laboratory) and viewing the smear under a microscope, first at low (x400) and then at high magnification (x1000) with immersion;
2. Liquid oncocytology, opening up new perspectives, allowing the doctor to most accurately determine the state of the cell, its nucleus and cytoplasm. Liquid oncocytology is, first of all, the use of modern high-tech equipment (Cytospin) for the isolation and uniform distribution of cells on glass, preserving their structure, which provides the doctor with easy identification of cellular material after staining microslides in special automatic devices. Liquid oncocytology undoubtedly provides fairly high reliability and accuracy of results, but significantly increases the cost of cytological analysis.

Oncocytological diagnosis is carried out by a cytologist and, of course, in order to see all this, he uses immersion and high magnification of the microscope, otherwise the changes occurring in the nucleus are simply impossible to notice. While describing the smear and establishing its type (simple, inflammatory, reactive), the doctor simultaneously interprets the smear. Due to the fact that cytology is more descriptive in nature than establishing an accurate diagnosis, the doctor can afford to write the diagnosis under a question mark (in histology this is not accepted; the pathologist gives an unambiguous answer).

As for histology, this science studies tissues which, when preparing specimens (biopsy, autopsy), are cut into thin layers using special equipment - a microtome.

Preparation of a histological specimen (fixation, wiring, filling, cutting, staining) is a rather labor-intensive process, requiring not only a highly qualified laboratory technician, but also a long time. The histology (series of specimens) is “reviewed” by pathologists and a final diagnosis is made. Currently, traditional histology is increasingly being replaced by a new, more progressive direction - immunohistochemistry, which expands the possibilities of histopathological microscopic examination of affected tissues.

Gynecological oncocytology (cervix)

A smear is taken during a gynecological examination using a cytobrush, and then the material is placed on glass (for liquid oncocytology, a removable cytobrush is used, which, together with the material, is immersed in a bottle with a special medium). Oncocytology of the cervix, as a rule, is not limited to one smear (vaginal portion of the cervix), since there is a need to study the epithelium of the cervical (cervical) canal. This happens because the most problematic area in relation to the oncological process is the junction zone (transformation zone)– the place of transition of the multilayered squamous epithelium of the vaginal part of the cervix (ectocervix) into the single-layer prismatic (cylindrical) epithelium of the cervical canal (endocervix). Of course, it is unacceptable to “slap” both smears on one glass during diagnosis (this is only possible during a medical examination), because they can get mixed up and the smear will turn out to be inadequate.

In a smear from the cervix of a young healthy woman, one can see cells of the superficial and intermediate layer (in various proportions) of non-keratinizing four-layer squamous epithelium growing from the basal cell, which is normally located deep and does not enter the smear, as well as cells of the prismatic epithelium of the cervical canal.

Differentiation and maturation of epithelial layers occurs under the influence of sex hormones (phase I of the cycle - estrogens, phase II - progesterone), therefore smears in healthy women different phases menstrual cycles are different. They also differ during pregnancy, pre- and postmenopause, and after radiation and chemotherapy exposure. For example, the presence of more than 10% of superficial cells in a smear of an elderly woman makes one wary, because their appearance, in addition to inflammation, leukoplakia, vaginal dermatosis, may indicate the development of a tumor of the genital organs, breast, and adrenal glands. That is why the referral for a smear for oncocytology always indicates:

• Woman's age;
• Cycle phase or gestational age;
• The presence of an intrauterine device;
• Gynecological operations (removal of the uterus, ovaries);
• Radiation and chemotherapy treatment (reaction of the epithelium to these types of therapeutic effects).

If necessary (if the hormonal type of smear does not correspond to age and clinical data), the doctor conducts a hormonal assessment using vaginal preparations.

Issues of cervical carcinogenesis

Human papillomavirus

Issues of cervical carcinogenesis are often associated with the penetration into the body of a chronic resistant infection such as high-risk human papillomavirus (HPV). Human papillomavirus (HPV) can be detected only by indirect signs (koilocytes, multinucleated cells, parakeratosis) and even then, after the virus is activated, it leaves the nucleus of the basal cell of the transition zone into its cytoplasm and “moves” to the more superficial epithelial layers . The conclusion “mucosal epithelium with signs of papillomavirus infection” is worthy special attention, because HPV, for the time being, “sitting quietly”, can lead to the development of a precancerous and then a malignant process.

Thus, the identification and study of this DNA virus is very important in oncocytology, since it relates to the factors of malignant transformation of stratified squamous epithelial cells into cervical precancer - dysplasia (CIN), non-invasive cancer in situ and, finally, into invasive tumor diseases.

Unfortunately, in a smear for oncocytology in women without dysplasia, but with high-risk HPV, the detection of a dangerous virus does not reach 10%. However, with dysplasia this figure increases to 72%.

It should be noted that signs of HPV infection in a smear are most noticeable in mild and moderate dysplasia, but practically do not appear in severe CIN, so other research methods are required to identify the virus.

Dysplasia

A cytological diagnosis of dysplasia (CIN I, II, III) or cancer in situ is already considered bad oncocytology (the term is not entirely correct, more correctly “bad cytogram”).

Dysplasia is a morphological concept. Its essence boils down to disruption of the normal layering in multilayered squamous epithelium and access to different levels a layer of cells of the basal and parabasal type (cells of the lower layers that do not normally appear in a smear of a young healthy woman) with characteristic changes in the nucleus and high mitotic activity.

Depending on the depth of the lesion, there are weak (CIN I), moderate (CIN II), severe (CIN III) degrees of dysplasia. It is almost impossible to distinguish the preinvasive form of cancer (carcinoma in situ) from severe dysplasia in an oncocytology smear. Cancer that has not left the basal layer (cr in situ) can be difficult to differentiate from CIN III during histological analysis, but the pathologist always sees invasion, if it exists and the fragment of the neck in which it occurs is included in the preparation. When identifying the degree of dysplasia, the cytologist takes the following criteria as a basis:

• Weak degree (CIN I) is assigned if 1/3 of basal type cells are detected in smears of a young healthy woman in the absence of signs of inflammation. Of course, mild dysplasia will not develop into a malignant tumor overnight, but in 10% of patients it will reach a severe stage in less than 10 years and in 1% it will transform into invasive cancer. If there are still signs of inflammation, then when deciphering the smear, the doctor notes: “Inflammatory type of smear, dyskaryosis (changes in the nucleus)”;
• Moderate the degree of dysplasia (2/3 of the field is occupied by cells of the basal layer) should be distinguished from the cytological picture in menopause (to exclude overdiagnosis of CIN II), but on the other hand, the identification of such cells with dyskaryosis in reproductive age gives every reason to make a diagnosis: CIN II or write: “The changes found correspond to moderate dysplasia.” Such dysplasia develops into invasive cancer in 5% of cases;
• Oncocytology of the cervix captures well expressed (heavy) degree of dysplasia. In this case, the doctor writes in the affirmative (CIN III) and urgently sends the woman for further examination and treatment (the risk of developing cancer under such circumstances is 12%).

cervical dysplasia

Oncocytology of the cervix shows not only the inflammatory process and dysplastic changes in the stratified squamous epithelium. With the help of cytological analysis, it is possible to identify other neoplastic processes and malignant tumors of this area (squamous cell carcinoma, glandular hyperplasia with atypia of type I, II, III dysplasia, cervical adenocarcinoma of varying degrees of differentiation, leiomyosarcoma, etc.), and according to statistics, the cytological interpretation is identical smear and histology findings are noted in 96% of cases.

Inflammation

Although the cytologist’s task is not to examine the smear for flora, the doctor nevertheless pays attention to it, since flora often explains the cause of inflammation and reactive changes in the epithelium. The inflammatory process in the cervix can be caused by any microflora, therefore a distinction is made between nonspecific and specific inflammation.

Nonspecific inflammation occurs:

• Acute(up to 10 days) – the smear is characterized by the presence of a large number of neutrophilic leukocytes;
• Subacute and chronic when in the smear, in addition to leukocytes, lymphocytes, histiocytes, macrophages, including multinucleated ones, appear. It should be noted that a simple accumulation of leukocytes cannot be perceived as inflammation.

The cytological picture of specific inflammation is determined by the influence of specific pathogens that enter the body and begin their development in the genital organs of the new host. It can be:

Thus, inflammation can be caused by the presence of various pathogens of a bacterial and viral nature, of which there are about 40 species (only a few of them are given as an example above).

table: norms of smear results for women, V - material from the vagina, C - cervical canal (cervix), U - urethra

As for opportunistic bacterial flora and leukocytes, the whole point here is their number in each phase of the cycle. For example, if a cytologist clearly sees an inflammatory type of smear, and the cycle is coming to an end or has just begun, then the presence of a large number of leukocytes cannot in any way be considered as a sign of inflammation, because the smear was taken from a non-sterile area and such reactivity only indicates that menstruation will begin soon ( or just finished). The same picture is observed during the period of ovulation, when the mucus plug comes off (there are many leukocytes, but they are small, dark, immersed in mucus). However, with a truly atrophic smear, which is typical for older women, the presence of a large number of surface cells and even a small flora already indicates an inflammatory process.

Video: smear for oncocytology and how to take it correctly

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Cytology of the cervix allows you to determine pathological changes in the female body. The results of the study make it possible to diagnose a precancerous or oncological process in an organ. And also establish the nature of the disease, inflammation, benign formation in the body.

Cytology of the cervix is ​​performed when examining the patient in a gynecological chair to exclude a cancerous process in the body. The doctor uses mirrors to examine the vagina, cervical canal and uterine mucosa. If the gynecologist suspects cervical cancer, he takes a smear for atypical cells. A collection of mucus is applied to glass, then it is dried and sent for laboratory testing.

During examination, experienced specialists take two types of smears:

• from the cervical canal for cancer;
• from the vagina to identify inflammation, diseases of bactericidal or viral origin.

This procedure will allow you to diagnose a pathological deviation on early stage. After receiving the results, the doctor will be able to immediately prescribe effective therapy.

After taking a smear, many women may experience bleeding a few days. This is not a deviation and does not require treatment. But if after the procedure there is heavy bleeding with abdominal pain, you need to urgently consult a gynecologist.

Ideally, every woman should undergo a gynecological examination once a year, during which a smear is taken for cytological examination.

But there are indications when the examination is carried out unscheduled:

• disruptions of the menstrual cycle;
• inflammation in the cervical canal or cervix, chronic forms diseases;
• reproductive system disorders;
• before conceiving a child;
• before surgery, installation of an intrauterine device;
• overweight, diabetes;
• use of hormonal drugs;
• the presence of genital warts, herpes, human papillomavirus;
• promiscuous sexual relations;
• intermenstrual discharge, bleeding;
• HIV infection.

A cytology smear is an informative diagnostic method. The results of the analysis make it possible to identify an anomaly in the first stages of development.

In order for the study to show reliable results, it is important to adhere to the recommendations of experts.

The procedure does not require special preparation, but before the manipulation you need to refuse:

• from sexual contact;
• douching;
• vaginal suppositories, ointments and creams;
• use hormonal contraception, anti-inflammatory drugs;

The analysis is not carried out during menstruation if there is an inflammatory process in the body. Before the procedure, you must refrain from urinating for several hours.

The manipulation is painless and takes about ten minutes along with a gynecological examination.

The test shows a positive or negative result, which can confirm or exclude malignancy, inflammation, viral, bacterial infection.

Negative result – the woman has no pathological abnormalities, the state of the microflora and cell structure are normal.

A positive test means that there is an abnormality in the cervix. The interpretation of the analysis depends on the shape, size, and type of atypical cells.

Experienced gynecologists use qualifications based on 5 criteria:

1. The result shows that the woman is completely healthy.
2. With the second type of changes, a slight abnormal change in cells, an inflammatory process, is diagnosed. In this case, additional examination is required to identify the cause of the disease.
3. The third type of result indicates an abnormal structure of the nucleus and cytoplasm. At this stage, an oncological process can be suspected. An accurate diagnosis is established after a biopsy.
4. In the fourth type, the study shows a precancerous condition, an oncological change in a small number of cells. With this result, it is necessary to perform a colposcopy, histology, and a repeat smear for cytology. Timely diagnosis of cancer pathology makes it possible to effectively treat the disease.
5. With the fifth type of changes, a large number of pathogenic cells are observed, indicating a malignant formation. Such tests require a comprehensive examination to assess the patient’s condition. Holistic clinical picture will allow you to prescribe the correct therapy.

The cytological test does not determine the cause of the abnormality; the analysis only shows the degree of abnormal cell abnormality. A cytogram allows you to suspect pathology at an early stage; this inexpensive procedure is recommended for all women.

In a healthy woman, the study results are as follows:

• a single-layer columnar epithelium of cervical cells is observed;
• multilayer vaginal cells without changes;
• minor deviations indicate primary inflammation within normal limits;
• changes in cells do not always indicate a cancer process; only the HSIL indicator indicates the initial stage of a cancer tumor.

In the transcript of the test, there are indicators that indicate a benign tumor. This indicates a deviation from the norm, but does not confirm oncology.

Experts name a number of diseases or factors that affect the test results and cause deviations from the norm: pregnancy, birth control pills, IUD, vaginal herpes, thrush, human papillomavirus.

Serious deviations from the norm do not always indicate the last stages of cancer pathology. Only an experienced specialist can make an accurate diagnosis after a complete examination of the patient.

Even if the result is bad, you should not panic. Under the supervision of doctors, you can cope with the problem.

For effective treatment It is important to take additional measures:

• repeat cytological examination;
• biopsy, colposcopy;
• scraping;
• blood test;

To treat dysplasia, cauterization is often performed; in case of a viral disease, drug therapy is recommended for both partners. Cervical cytology is performed to assess the woman's condition to confirm the effectiveness of treatment.

During pregnancy, a woman's hormonal balance and the microflora of the vaginal environment change. A weakened immune system does not protect the body from inflammation, fungal disease. Cytology allows you to assess the state of the microflora, the nature of the inflammatory process, and the structure of cells.

During the entire period of bearing a child, a woman is recommended to undergo a test every three months:

• the first swab is taken upon registration;
• the second time the procedure is carried out at the thirtieth week;
• to assess the body’s readiness for labor, cytology is performed at the thirty-seventh week.

You should not refuse a cytological examination; timely detection of abnormal deviations in the vaginal microflora will eliminate the problem. The presence of pathogenic microorganisms can lead to miscarriage; microbes negatively affect the development of the child.

Vaginal candidiasis in the last stages of pregnancy can provoke infection of the baby during childbirth.

Vaginal cleanliness is determined by four degrees:

1. The first is that the acidity of the vagina is normal, there is no inflammation.
2. In grades II and III, minor changes and decreased acidity are observed.
3. In the fourth degree, a significant number of pathogenic bacteria, an alkaline environment and pronounced signs of inflammation are diagnosed.

Before planning a pregnancy, every woman is recommended to undergo a cytological examination of the cervix in order to promptly eliminate the pathology. After treatment, you need to take the test again; after satisfactory results, you can plan to conceive a baby.

If pathogenic microbes and elevated white blood cells are detected, the woman in labor is diagnosed with inflammation of the birth canal. In such cases, it is necessary to place the pregnant woman in a medical department under the constant supervision of doctors.

In the last weeks, the test allows you to assess the body’s readiness for labor. Elevated indicators determine the time of birth.

A cytological smear of the cervix is ​​a safe and reliable method for identifying infectious, bactericidal, viral diseases. It also allows you to diagnose the inflammatory process and early-stage cervical cancer.

This method will help you not waste time and prescribe effective therapy in a timely manner. Timely treatment of cancer can save lives and achieve positive results.