PAP SMEAR METHODS OF

COLLECTION
25th February, 2021
Kamau Nicholas
H31/42271/2017
Procedure for obtaining specimens from the
cervix, endocervix and vagina
• Conventional pap smear slides
• Liquid based cytology
• HPV testing
• Reflex HPV DNA if PAP ASCUS
• Chlamydia & GC PCR
Conventional PAP smear slide preparation

• Patient preparation
– The patient should not be menstruating (a mid-
cycle smear is preferred). The patient should not
use vaginal medication, vaginal contraceptives,
personal lubricants or douches during the 48
hours before the exam. In addition, there should
be no clinical evidence of inflammation and
patient should not be pregnant.
• Advantages of conventional PAP smear method: History of long use,
widely accepted, permanent record of test, training and mechanisms for
quality control established, high specificity.
• Limitations of conventional PAP smear: results not immediately available,
systems needed to ensure timely communication of results and follow-up
of women, requires laboratory quality assurance, moderate sensitivity
• Liquid based cytology strengths include: fewer inadequate or
unsatisfactory samples requiring patient call-back or rescreening, once
cytotechnicians are proficient, LBC samples take less time for review, same
sample can be used for molecular testing e.g. HPV PCR. Limitations
include: results are not immediately available, more expensive than
conventional PAP smear interms of equipment and requires highly trained
personnnel.
 Visual inspection methods
• Visual inspection with acetic acid (VIA)
• When vinegar is applied to abnormal cervical tissue, it temporarily turns
white (acetowhite)
• Visual inspection with Lugol’s iodine (VILI)
• If iodine is applied to the cervix, precancerous and cancerous lesions
appear well-defined, thick, and mustard or saffron-yellow in colour, while
squamous epithelium stains brown or black, and columnar epithelium
retains its normal pink colour.
• These are promising alternatives to cytology where resources are limited.
However, until data from these studies are available, VIA and VILI are
recommended by WHO only for use in pilot settings, because the impact on
cervical cancer incidence and mortality is still unproven.
• Screening programs allow for early detection
and Tx in order to achieve a max. impact on
cervical ca prevention
• Increasing availability of HPV vaccination for
girls does not eliminate the need for regular
screening when women get older.
 Who should be screened and when?

1. Any woman who has ever had sex is eligible for

cervical screening
2. Target population is women aged 25-49 yrs
3. Women aged 50-65 yrs are still at risk of cervica
ca thus receive screening every 5 yrs on
individual resources.
4. Screening interval is 5yrs among women who
test HIV –ve and 2 yrs for those who are HIV +ve
 Kenyan screening programme
1. HPV testing is recommended as primary screening
method for women above 30 yrs
2. Where HPV test is N/A, loss of follow-up is at risk,
then VIA or VILI is recommended
3. PAP smears is recommended as primary screening
method in the following:
(a) Women not eligible for VIA or VILI bc SCJ is not visible i.e
postmenopausal and HPV test is not accessible
(b) As a primary test in women under 30 yrs
(c) As a co-test w/ HPV in HIV+ women where resource are available
 References
• UpToDate:Screening for cervical cancer in
resource-limited settings
• National cancer screeing guidelines 2018,p 38-
50.