PAPANICOLAOU(PAP) TEST

Presented by:
Nikil Sharma (1856)
 PAPANICOLAOU TEST

❖ First described by Papanicolaou and Traut, this screening

test is also called as ‘Pap test’.
 History: George Nicholas Papanicolaou (1883–1962),
worked in New York hospital on exfoliative cytology
for the diagnosis of cancer of the female genital tract.
In collaboration with Dr. Herbert Trout, he published
their landmark work in 1941.
❖ It is a screening test and positive test (abnormal test)
requires further investigations like colposcopy, cervical
biopsy and fractional curettage.
 RECOMMENDATION

❖ All sexually active women should be screened starting

from the age of 21 years or after 3 years of vaginal sex with
no upper age limits

❖ Screening should be a yearly till the age of 30

❖ A yearly negative pap smear for 3 years is assuring and

thereafter 5 yearly test is adequate.
 INDICATION

❖ As a screening test for cervical carcinoma and for

endometrial cancer.
(Can detect 60-70% of pre-cancerous lesions and cancer
of cervix and less than 70% of endometrial cancer).

 For cytohormonal study

❖ Can also detect other local inflammatory conditions.
 Instruments required
• Examination table with foot supports
• Examination light

• Metal or plastic speculum

• Examination gloves

• Ayre’s spatula and cytobrush

• Liquid-based cytology container or glass slide and

fixative
 P re p a ra t io
n
❖ Should be done when the lady is not menstruating
❖ Lubricant may prevent detection of organisms.

❖ Avoid intercourse, douching, use of sanitary pads ,

contraceptive cream for 24 -48 hrs prior to procedure
❖ Pre-existing cervicitis should be treated.
 Positioning
❖ The patient should be supine, in dorsal lithotomy position to correctly perform a pap smear

❖ The coccyx of the patient must be at the edge of the examination table to provide
adequate visualization of the cervix once the speculum is inserted.
 PROCEDURE

❖Bladder is emptied.

❖Patient is placed in the dorsal position, with the

labia parted.
❖Cusco’s self retaining speculum is gently
introduced without the use of lubricant or jelly.
❖ Cervix is exposed; the squamo-columnar junction is now scraped
with Ayre’s spatula by rotating the spatula 360 degree (5 turns).
Whole of the squamocolumnar junction has to be scrapped to
obtain good material.
■ For cervical cells—
projected end of the
spatula goes within the
external os. The spatula
is rotated 360° to
collect cells from the
entire ectocervix.

■ For endocervical cells

—the cytobrush goes
within the cervical canal
and is rotated to
collect cells.

■ For cytohormonal
study, the rounded end
of the spatula is used.
❖ As soon as the spatula or Cytobrush is removed from the
cervix, they are placed in cytology vial, and the vial is
labeled and sent for histology.

❖ The specimens are smeared in glass slide and fixed with

95% ethyl alcohol and ether

❖ After fixing it for 30 min, the slide is air dried and stained
with Pap stain.
 Accuracy

❖ A single Pap smear has a diagnostic sensitivity of about

60%. False negative results may be up to 25%.

❖ False negative rate of Pap smear after three consecutive

negative tests is less than 1%.

❖ There are several reasons for false-negative smear. This

may be due to technical error where smear is too scanty,
too thick, too bloody, poorly stained or due to
misinterpretation by the cytologist.
 Liquid based cytology
❖ Liquid-Based Cytology (LBC):
❖ Cervical smear is taken using a plastic spatula.
❖ The spatula is rinsed in a liquid media.
❖ Cells are separated by centrifugation.
❖ Thin layer smears are made. LBC has the
following advantages:
(a) Improved cell collection and preparation quality
(b)Even distribution of abnormal cells that makes easy
detection. Whereas with conventional Pap smear cells are
clustured and obscured. LBC avoids the risk of false-positive,
false-negative or unsatisfactory smears.
 PAPANICOLAOU
CLASSIFICATION

❖ Grade I : normal cells

❖ Grade II : Presence of borderline atypical cells – probably
due to infection. No evidence of malignancy
❖ Grade III : Cell suspicious of malignancy
❖ Grade IV : Presence of few malignant cells
❖ Grade V : Presence of large number of
malignant cells
 Bethesda Classification

❖Specimen type
❖Conventional Pap test
❖Thin layer liquid based cytology

❖Specimen Adequacy
❖Satisfactory
❖ Unsatisfactory
❖Squamous cell abnormalities
1. Atypical squamous cells(ASC)
 Atypical squamous cells of undetermined significance (ASC-
U.S)
 ASC- cannot exclude high grade lesion (Ascus-H)

2. Low grade squamous intraepithelial lesion (LSIL)

3. High grade squamous intraepithelial lesion (HSIL)

4. Squamous cell carcinoma

❖ Glandular cell abnormalities

❖ Atypical glandular cells (AGC):Endocervical,

endometrial or not specified
❖ Atypical glandular cells, favor neoplastic endocervical or
not specified
❖ Adenocarcinoma(Endocervical) in situ(AIS)
❖ Adenocarcinoma

❖ Other cancers (e.g. lymphoma, metastasis, sarcoma)

 Complications

❖ Complications are extraordinarily rare and include minor

bleeding and infection.

❖ The patient must be educated on the likelihood of vaginal

spotting immediately after a pap smear is performed, as
this is considered normal.
THANK YOU!