PAP SMEAR

Introduction

Since the Pap examination was introduced after 

World War II, death rates from uterine cervical 
cancer have decreased by 70 in the US.
PAP smear is the most effective cancer screening 
test so far
Cytopathology
Cytopathology is diagnosis of disease in cells.
Exfoliative Non-Exfoliative - cytology.
Exfoliative Cell samples are collected from 
normally shedding tissues like epithelium. 
spatula or brush to enhances collection.
Non-Exfoliative Cells samples collected by 
needles with suction pressure. (FNAC)
Cytology specimen is fixed, stained and studied 
under microscope.
What is a Pap Smear?
Screening test for cervical cancer. It is a type 
of exfoliative cytology test.
Simple, safe, non-invasive method
Developed by George Papanicolaou
Exfoliated cells from cervix are collected 
usually enhanced by using a variety of spatulas 
or brushes.
The specimen is processed and studied for 
morphology.
WHEN TO DO PAP TEST?
cervical cancer screening be initiated no earlier than
age 21 in immunocompetent, asymptomatic women
Regular Pap examinations (yearly) should continue 
even after menopause and after a hysterectomy.
How frequent should be done
After every three years.
What is the best time for PAP
The best time for a Pap examination is during the 
two weeks following the end of menstrual flow. 
(Proliferative phase)
If menopause, Pap examination can be scheduled 
anytime.
Pathogenesis (non-neoplastic)
HPV Infection
Chronic cervicitis
Hyperplasia Number
Metaplasia Change to squamous
DNA damage BRCA12, E6,7
Dysplasia no-maturation, disorder (CIN 1-3, 
CIS)
Further DNA damage leads to invasion
Carcinoma
PAP Smear reporting
Negative or benign Pap smears
inconclusive Pap smears
low grade changes requiring an early repeat Pap 
smear -
high grade lesions biopsy
Pap Smear Results
Class I Normal
Class II Atypical, inflammation or uterine cells 
seen
Class III Dysplasia (CIN I, II III, CIS) mild, moderate
or severe
Class IV Carcinoma-in-situ
Class V Invasive cancer
Normal Pap Smear
Pap Smear Dysplastic Cells
Cervical dysplasia
Squamous cell carcinoma
Thank you