PAP-test

Execution and Classification of the results

Modality of execution

Put in evidence the uterine cervix with a vaginal speculum, the exocervicals cells (exocervix: part of the uterus visible through the vagina) are picked u passing on the cervix one small wooden spatula ( Ayre's spatula). The captured material comes therefore stratified on a glass slide. Later another sample is obtained by the cytobrush inserted into the cervical channel (endocervix). The two samples (exocervicals and endocervicals cells) are fixed by fixative (usually fixative spray).The glass slide with the material sampled, with an informative card with the data of the patient (personal identifying, datum, clinicians, history of the patient) and is sended all to the Cytological Laboratory where the microscopical examination will be made.

Classification of the results

Till the years'80 the reports of the Pap-test came described by the classification of Papanikolaou.

This classification is based on 5 classes:

• Class I: sample clearly benign (normal);

• Class II: sample with minimal cellular anomalies (inflammatory), considered benign;

• Class III: sample with obvious cellular anomalies (atyical), but not clearly neoplastic;

• Classe IV: sample very subspect for neoplasia;

• Classe V: sample clearly neoplastic. 

Actually is used the classification called Bethesda system:

• negative for intraepithelial lesion or malignancy 

• Negative with Reactive cellular changes;

SQUAMOUS CELL ABNORMALITIES

• Atypical squamous cells:

  • of undetermined significance (ASC-US)

  • cannot exclude HSIL (ASC-H)

• LSIL: Low grade squamous intraepithelial lesion:  HPV/mild dysplasia/CIN 1

• HSIL: High grade squamous intraepithelial lesion: moderate and severe dysplasia, CIS/CIN 2 and CIN 3

  - with features suspicious for invasion (if invasion is suspected)

• Squamous cells carcinoma

GLANDULAR CELL ABNORMALITIES

• Atypical

  • endocervical cells (NOS or specify in comments)

  • endometrial cells (NOS or specify in comments)

  • glandular cells (NOS or specify in comments)

•  Atypical

  • endocervical cells, favor neoplastic

  • glandular cells, favor neoplastic

• Endocervical adenocarcinoma in situ

• Adenocarcinoma

  • endocervical

  • endometrial

  • extrauterine

  • not otherwise specified (NOS)

   

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