Mucin in a smear for cytology. Cytological examination: when is it prescribed and why is it needed? What pathologies can be detected during a cytological examination?

The article describes one of the main methods for diagnosing cancer. The essence of a cytological study is explained, standards for indicators are given, and the interpretation of the analysis results is explained.

Probably in modern world There is no adult who, in one way or another, has not encountered such a concept as oncology. According to statistics from the Ministry of Health, every day this diagnosis takes the lives of about a thousand of our compatriots, while on the entire planet the weekly number of victims of cancer exceeds one hundred and forty thousand people. In connection with such deplorable statistics, scientific medicine considers the research of oncological diseases a priority in order to prevent and treat them. The most common way to identify cancer-related health problems is to examine cells suspected of being affected by the disease.

What is cytological analysis

As the biology teacher explained, cytology is a branch of biology aimed at studying the cells of the human body. Cytology analysis is a method for identifying all kinds of pathologies in the cellular structures of the internal organs of the body. Obtained using cytological analysis the results provide information about the health status of organs, the stage of progression and the nature of the possible disease. By analogy, histology analysis provides information about diseases of the body tissues.

Positive features of cytology analysis:

High percentage of reliability;
Does not require surgical intervention;
Simplicity of the procedure for collecting material - the analysis can be taken directly during a routine gynecological examination;
Relatively low cost of research;
High speed of data processing - the result, as a rule, can be obtained the next day.

The main problem of the cytological research method is the mandatory understanding of the areas affected by the disease. That is, even when symptoms appear, it can be difficult to determine the specific area of tissue from which a sample of cells needs to be examined for abnormalities.

When is a cytology test performed?

From the above it follows that cytological examination has great value in the diagnosis of cancer and precancerous diseases. At the same time, this method helps to determine the presence of inflammation of internal organs and promptly identify developing autoimmune diseases and viral infections.

In various medical fields (gynecological, oncological, surgical), cytology analysis is used for the following purposes:

Preventive. For example, to monitor the condition of the female genital organs, it is recommended to undergo a cytological examination at least once a year.
Diagnostic. A cytological examination makes it possible to confirm or refute a possible diagnosis, which corresponds to the results of a visual examination or another less detailed examination. Cytology analysis reveals structural abnormalities cells, causes of deviations and features of the course of diseases of internal organs.
To monitor the effectiveness of a therapeutic intervention. During treatment of a disease, it is important to monitor the condition of the body in order to timely adjust the direction of therapy or establish the fact of recovery. In oncology, it is very important to regularly undergo cytological examination, since with its help it is possible to identify trends towards relapse in a timely manner.

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What is PTI - analysis of norm and deviation

What is the object of cytological analysis?

The human body is a multifunctional cellular formation, therefore samples of all tissues and organs are used for cytological analysis. The only necessary condition is that for a successful test, the sample must be obtained from an area of tissue affected by the disease.

In connection with the source of material collection, the following classification of cytological analyzes is distinguished:

Exfoliative - tests, the object of study of which is secretions obtained from various internal organs.
Puncture - tests for which a surgical operation is performed - puncture. The puncture can be taken from the thyroid and mammary glands, lymph nodes, skin, and joints.
Operating - analyzes for which the biomaterial is tissue and organ areas removed from the body during surgery.

How is a cytological examination performed?

The sample for cytology analysis is taken from tissues and organs whose origin is described in the previous paragraph. The resulting biomaterial sample is placed on a glass slide and prepared for microscopic examination by removing moisture from the sample and adding a staining reagent. Such preparation can lead to partial death of the studied cells and, ultimately, to distorted analysis results.

Not so long ago, the method of liquid cytology began to be used in laboratory activities. This method involves directly immersing the resulting sample in a special preservative, which prolongs the lifespan of cells and protects them from external factors.

It is important to know!
The method of processing the sample for the study is the main factor in the reliability of the results. So, according to statistics, the method of drying a biomaterial sample on a glass slide gives the correct result in 35-90 percent of cases. While the liquid method of processing biomaterial increases the reliability of the analysis to 98%. Therefore, when choosing a diagnostic center, you should give preference to a more modern approach to cytological examination.

Physical indicators (cell structure, dimensions, geometric shape);
The orientation of cells in the structure of a substance relative to each other;
Number of cells in the field of view of the microscope;
The presence or absence of various physiological cell abnormalities.

Interpretation of cytology analysis results. Normal indicators

The result of the analysis is presented to the patient as a table of the content of elements identified in the cell by microbiological research. Interpretation of results is simplified through the use of international Bethesda systems, which assumes the same recording of the obtained indicators, compared with normal ones, for different laboratories.

Index	What does it mean
NILM	No malignant tumors were found. Norm
A.G.C.	Abnormal result. Pathologies found in gland cells
AGC, favor neoplastic	Abnormal result. Pathology in gland cells, similar to neoplasticity
AGUS-NOS	Abnormal result. Pathologies of unknown nature were found in gland cells
AIS	Abnormal result. Adenocarcinoma in the cervical canal
A.S.C.	Abnormal result. Flat epithelial cells found
ASC-US	Abnormal result. Flat epithelial cells of unknown nature were found
ASC-H	Abnormal result. Flat epithelial cells found, possible presence of HSIL
CIN 1- 3	Abnormal result. Neoplasia of various stages was detected in the cervical canal
CIS	Abnormal result. Carcinoma detected
SIL	Abnormal result. Flat intraepithelial cells found
HSIL	Abnormal result. Flat intraepithelial cells were found in high concentrations
LSIL	Abnormal result. Flat intraepithelial cells were found in low concentrations
NOS	The result is characterized as undetermined
VaIN	Abnormal result. Vaginal neoplasia detected
VIN	Abnormal result. Intraepithelial neoplasia was detected in the vagina

Early diagnosis of neoplasia and cervical cancer is the most important area of modern gynecology. In this case, the main screening method is cytological examination. The material for it is most often taken using a smear or targeted biopsy. This traditional method is technically simple, but gives up to 40% of false negative results. This means that there is a risk of untimely detection of cervical cancer even in women undergoing regular preventive examinations.

The liquid cytology method is a more modern and informative screening option using the Papanicolaou test (). Despite its recent introduction into clinical practice, it is already recognized as the most effective way early diagnosis of cervical cancer. After all, the effectiveness of high-tech liquid cytology reaches 95%, while the sensitivity of the traditional technique averages 60%, and in some cases does not exceed 40%.

When and who needs such screenings?

There is an opinion that only women approaching the premenopausal period need to undergo regular gynecological oncological examinations. But that's not true. According to modern clinical guidelines, cervical cancer screening with cytological examination is recommended for all women over 21 years of age. In general, it is recommended to start it 3 years after the first sexual intercourse. So early entry into intimate life is the basis for the early start of preventive gynecological examinations.

In the first 2 years, screening is not carried out annually. Subsequently, if the results of repeated cytological examinations are negative, preventive examinations become more rare and are carried out once every 2-3 years. After 65 years, the frequency of screening studies is determined individually.

The reason for increasing the frequency of oncogynecological examinations is the appearance of background and precancerous diseases of the cervix in a woman. In this case, the patient is considered to be at high risk for developing cancer, and a cytological examination of gynecological smears is carried out on her annually. Additional screening activities are carried out during the preparation of a woman for conception.

Liquid cytology during pregnancy is performed according to strict indications. These include identifying changes in the patient’s cervix that are suspicious for precancer or malignant transformation. It should be remembered that such an analysis increases the likelihood of a threatened miscarriage and may require measures aimed at normalizing uterine tone.

How to prepare for research

Preparation for liquid cytology of the cervix begins 2-3 days before the test and includes:

sexual rest;
refusal to douche;
stopping the use of any means for vaginal administration (suppositories, tablets, sprays).

When is the best time to do screening?

Cytological examination is not carried out during menstruation, 5 days before it and 5 days after it. Preference is given to the first half of the menstrual cycle, although this recommendation is not strict.

If the patient has undergone a cytological examination, a cytological examination is permissible no earlier than 24 hours after it. And in the case of a cervical biopsy - only after 3 weeks.

How is liquid-based cytology performed?

Currently, several technological options for liquid-based cytology are used in clinical practice. The most famous and sought after of these is Becton Dickinson (BD) Sure Path™, which was approved by the FDA in the USA in 1999 and has been officially approved by NICE in the UK since 2004. Since that time, it has been actively introduced into everyday clinical practice in Europe, the Russian Federation and neighboring countries.

The main stages of this study are:

Collection of material. For this purpose, a specially designed combined cytobrush of a special design is used. It is carefully inserted into the cervical canal, after which it is performed rotational movements(2 counterclockwise and 3 clockwise). This ensures the maximum possible and at the same time low-traumatic acquisition of superficially located cells of the mucous membrane of the cervix - from its vaginal part, from the cervical canal and adjacent areas of the vagina. This manipulation does not require anesthesia, because the sensations experienced by the woman do not exceed the pain threshold.
Placing a cytobrush with the resulting material in a special test tube (bottle) with a special liquid, which gives the name to the technique. Such a medium not only has preservative and stabilizing properties, but also promotes the formation of a suspension with a uniform distribution of cells and other elements throughout the volume. The tubes are transported to a laboratory licensed to perform liquid-based cytology and equipped accordingly.
Automated preparation of cytospecimens. Includes vacuum filtration of a portion of the suspension from a test tube, centrifugation, application of the resulting cell sediment in a uniform layer on a glass slide, staining using the Papanicolaou method using wet fixation.
Microscopy of a cytospecimen. The PAP test based on liquid cytology is carried out according to the same principles as in the case of the traditional technique. But at the same time, the peculiarities of coloring, position and size of cells after wet fixation of the cytopreparation are taken into account. That is why the study can only be carried out by a certified laboratory technician who has undergone special training.

The results of the analysis are deciphered only by a gynecologist or oncologist. An answer from the laboratory can be received 5-10 days after collecting the material. But often this period extends to 2-3 weeks. The speed of receiving an answer depends on the transportation time, the workload of the laboratory and the method of informing the outpatient department about the data of the studies performed. If necessary, an express test is carried out; in this case, the doctor will know the result within the first 24 hours.

Scheme of liquid cytology of the cervix

What after the research?

The recovery period after liquid cytology is not fundamentally different from that when taking a regular smear for oncocytology or. It is recommended to maintain sexual rest for 1.5 weeks and stop using vaginal tampons and douching. In the first days after the test, light vaginal discharge is acceptable, so it is advisable for a woman to use sanitary pads.

An increase in body temperature, prolonged or heavy bleeding, pain in the lower abdomen is an alarming sign. The appearance of such symptoms requires immediate consultation with a doctor.

How does liquid cytology differ from conventional cytology?

Key differences between these screening methods include:

In a conventional cytological examination, tissue samples are taken in a targeted manner, and the areas for examination are selected by the doctor based on visual changes in the mucous membrane. In the case of the liquid technique, material from any woman is obtained from the entire circumference of the cervix. This significantly reduces the likelihood that any modified section will be missed.
When performing conventional cytology, the biomaterial is dried on glass at room temperature before sending. And in liquid cytology, it is placed in a special test tube (bottle) with a special stabilizing medium, which extends the permissible period of transportation and storage of the resulting sample. The biomaterial placed in a test tube is suitable for research for several months and does not require special conditions.
With the traditional method, no filtration is performed. Therefore, if there are inflammatory elements, a large amount of mucus and other impurities in the smear, the result of a cytological study is not reliable enough and usually requires a repeat PAP test after treatment. The liquid method does not have this disadvantage.
With the traditional method, not the entire volume of the resulting tissue ends up on glass and is subjected to subsequent examination. Up to 35-40% of cells remain on the doctor’s instruments and gloves. This creates the possibility that existing malignant tissue will remain undiagnosed. With the liquid method, such loss of biomaterial does not occur. This is ensured by placing the cytobrush in a stabilizing and suspending medium, followed by automated centrifugation of the sample and the formation of a special cytopreparation with a standardized, even layer of cells on a glass slide.
When taking a traditional smear for oncocytology, cells on a glass slide are usually located in several layers, overlapping each other and thereby impairing visualization. Liquid cytology bd shurepath does not have this drawback; the resulting cytopreparation is monolayer.
Possibility of re-analysis of the same biomaterial or other studies using liquid cytology. After all, the suspension in a test tube does not lose its properties for several months, and its volume is sufficient to obtain several cytopreparations. With the traditional method, the tissues being examined are not protected in any way, and there is a high risk of damage during storage.

In general, liquid-based cytology using automatic screening is a significantly more informative technique compared to traditional collection of smears from the cervix for oncocytology. And its main advantage is the low percentage of false-negative results of gynecological cancer screening, which is ensured by the progressive technological features of the test with strict adherence to the rules for collecting biomaterial.

Diagnostic capabilities

Liquid cytological screening is aimed at identifying a variety of cellular atypia, which indicates that a woman has a precancerous condition or cervical cancer. Single-layer and homogeneity of the cytopreparation is ensured high degree visualization, allowing the laboratory technician to reliably determine the nature of the changes. This minimizes the likelihood of diagnostic errors and false negative results.

The presence of the suspension and its sufficient volume allow additional studies to be carried out according to indications:

analysis for tumor markers;
any PCR studies;
HPV testing;
immunocytochemical studies with determination of proliferation markers.

But liquid cytology does not allow diagnosing inflammatory conditions, because the obligatory filtration step removes detritus, leukocytes and other impurities from the suspension. Therefore, if colpitis is suspected, it is advisable to simultaneously take a traditional smear for oncocytology. This is significant drawback techniques.

However, liquid-based Pap cytology is recommended by the WHO, FDA and global cancer communities as the gold standard for early diagnosis of cervical cancer. But currently in the Russian Federation, when conducting screening, the traditional smear for oncocytology is most often used. This is mainly due to the insufficient technical equipment of the outpatient department and the lack of proper qualifications among doctors. Liquid cytological examination is still carried out mainly by large private laboratories: Hemotest, Invitro and others.

Every woman who begins sexual activity should regularly visit a gynecologist and have a smear for cytology. The procedure for collecting a smear is performed by a doctor during a routine examination on a gynecological chair. Thanks to cytology studies, it is possible to study the condition of the mucous membrane of the vagina and cervix, to detect inflammatory, precancerous and oncological diseases of the woman’s genital area.

The difficulty of diagnosing gynecological pathologies often leads to a loss of time that could be spent on effective treatment. Sometimes oncology develops asymptomatically, and the root cause of the disease can only be identified with the help of a special study. Analysis of a smear for cytology allows you to identify an oncological condition on early stage and start treatment in a timely manner.

What does a smear reveal for flora and cytology? Its main purpose is to detect pathological changes in tissues, which can later transform into a cancerous tumor. If a cytology smear from the cervix is taken regularly, then negative indicators can be identified at an early stage - for example, an inflammatory disease, which can be cured in a short time with appropriate therapy and prevent further complications.

What does a cytology smear show? The results of the study can be both positive and negative.

Positive can be "bad", "abnormal", "atypical" or mean "dysplasia". It is clear that a bad cytology smear is not the norm, that is, there are inflammatory changes in the mucosa, atypical pathological cells are detected in the smear, which should not be there.

A negative smear is considered normal. This means that the cervix is healthy, the cellular structure of the epithelium is not changed, and the microflora does not contain pathogenic microbes. When to take a smear for cytology, the gynecologist decides. Experts advise conducting research at least twice a year.

Indications and contraindications

When to do a smear for cytology:

when diagnosed;
at ;
in the case of, for example, an atrophic type of cytology smear will indicate hormonal changes in the body against the background of menopause;
if used ;
with genital herpes;
for obesity;
if human papillomavirus is detected in the body;
if a woman is promiscuous;
in preparation for the production.

This research is not always possible.

A smear for cytology is not taken:

during menstruation, because red blood cells may be erroneously detected in a cytology smear;
with acute inflammatory process in the genital area;
with heavy vaginal discharge and severe itching.

Pregnancy cannot be a contraindication to the procedure. There is no point in taking this test for women who are not sexually active (virgins). The same applies to women who have undergone surgery to remove the uterus - a hysterectomy.

How to take a smear

How a smear is taken for cytology is of interest even to those women who have undergone this procedure more than once. A doctor or midwife takes a smear during an examination in a gynecological chair.

Before performing the procedure, the doctor inserts a speculum into the vagina. After a visual examination of the cervix, the specialist takes a sterile brush and makes a light scraping of the epithelium from the surface of the cervix and cervical canal, as well as from the urethra. The resulting biological material is applied to a slide mirror and sent to the laboratory for further study.

How long does it take to perform a smear for cytology? Usually the results of the study become known after 1 day.

To obtain reliable results, it is advisable to prepare for the smear procedure in advance:

abstain from intimate relations for 24-48 hours before visiting a gynecologist;
exclude the use of vaginal products - lubricants, sprays, suppositories, etc.;
Do not urinate for at least 2 hours before taking a smear.

Decoding the results

Deciphering the smear for cytology allows us to draw conclusions about the degree of cleanliness of the vagina and the presence of pathologies in the woman.

In total there are 4 degrees of purity:

First degree. Rarely seen. The smear reveals exclusively rod flora, a small amount of squamous epithelium and single leukocytes.
Second degree. A common study finding found among healthy women. In the flora in the cytology smear there are squamous epithelial cells, single cocci and other non-pathogenic microorganisms.
Third degree. This degree of purity means the initial stage of the inflammatory process. Detected inflammation in a cytology smear requires the start of other diagnostic studies to find the root cause of the problem. The smear contains polymorphic rod flora, neutrophilic leukocytes, granulocytes and glandular epithelium; in addition, the results of cytology of a smear from the cervical canal can reveal yeast fungi with a tendency to multiply and be active.
Fourth degree. The inflammatory process is pronounced. Coccal and bacillary-coccal flora predominate. This research result requires an urgent search for the causative agent of infection and appropriate treatment.

Doctors often talk about the fifth degree of purity, the result of which is a harbinger of an oncological process in the woman’s genital area, since in this case a large number of atypical cells are detected in the smear.

Pap smear during pregnancy

A smear for cytology during pregnancy is taken at least 3 times - this can be done either in the gynecologist’s office or in a private laboratory - for example, in Invitro using liquid cytology. The study is important for monitoring the vaginal microflora of the expectant mother. If there is the slightest suspicion that a woman’s genital tract is infected, a cytological examination is performed additionally.

The result of a smear on flora above type 2 purity during pregnancy means an inflammatory process in the woman’s genital tract. In this case, the expectant mother may complain of itching and burning in the external genital area, as well as a change in the smell and color of vaginal discharge. Treatment is required and should be administered as soon as possible and before delivery to minimize infection of the membranes and fetus.

A smear is an examination method in which the doctor collects a small amount of material from the surface of the mucosa. Smear analysis is most often used in urology in men and in gynecology in women. Examination of a smear for flora allows you to check for the presence of pathogenic bacteria, cancer cells, and in some cases, assess hormonal levels and the general condition of the tissue. A vaginal smear for flora is taken once every three months, during routine examinations with a gynecologist.

If you are undergoing treatment, a swab test for infection will be taken after the end of treatment to confirm its success. A vaginal or cervical test is a painless procedure that provides insight into a woman's health.

Gynecological smear - 4 main types:

1. Smear on the flora.

2. Smear for sterility.

3. Cytology smear (PAP test for atypical cervical cells).

4. Smear for latent infections (PCR).

1. Smear on flora: norm and deviations from it

Why it is carried out: The study allows you to evaluate the microflora - the presence of pathogenic bacteria and their quantity.

Such an analysis, taken from a healthy woman, should show 95% of lactobacilli in the collected material. Lactobacilli produce lactic acid, thereby protecting the genitals from infections and maintaining the desired acidity. In pregnant women, the number of lactobacilli decreases, so the body's natural defenses are weakened. In order to prevent the development of diseases that cause sexually transmitted infections, a smear during pregnancy should be taken by all expectant mothers, without exception.

Vaginal smears are examined to ensure the absence of infectious agents, such as:

Trichomonas;
gardnerella.

To identify infections that cannot be detected by flora analysis, a smear is taken for hidden infections. One of the most common methods for detecting hidden infections is the PCR method.

Normally, the microflora of a healthy woman may contain gardnerella and candida, but their quantity should be low. Gardnerella and candida begin to actively develop when immunity decreases. The body's defenses can be weakened for various reasons:

pregnancy;
fatigue;
emotional fatigue;
the presence of a disease that the immune system is “busy” fighting.

When assessing it, four purity groups are distinguished.

First. The reaction is acidic - pH 4.0–4.5. Most microorganisms are Doderlein bacilli (aka lactobacilli), in small quantities - leukocytes in the smear, epithelial cells. Such results indicate a healthy reproductive system.
Second. The reaction is acidic - pH 4.5–5.0. In addition to lactobacilli, there are gram-negative bacteria - these are most often the causative agents of infections, which become discolored after laboratory staining.
Third. The reaction is alkaline or slightly acidic - pH 5.0–7.0. Mainly bacterial microflora, epithelial cells are also in large numbers. Several lactobacilli were detected.
Fourth. The reaction is alkaline - pH 7.0–7.5. There are no lactobacilli, the flora is represented by pathogenic organisms. There are a large number of leukocytes in the smear. This analysis indicates inflammation of the vaginal mucosa.

If the result is bad (Group 3 or 4), your doctor may refer you for a repeat test or culture to confirm the results.

Decoding

Results may vary from laboratory to laboratory. Depending on which laboratory you took the smear from, the norm may vary. Since research methods may differ in each individual laboratory, the results will be different. It is advisable to take all tests in one laboratory so that you can observe changes over time and these changes are not associated with a change in the laboratory where you take tests. Decoding must be carried out by a doctor.

To indicate the number of bacteria when examining smears from the urethra, vagina, as well as when analyzing a cervical smear, CFU/ml is used. These units of measurement are read as quantities colony forming units per milliliter of liquid.

2. Smear test for sterility

Why it is performed: it allows you to determine the presence or absence of sexually transmitted infections, assess the woman’s hormonal background, as well as the composition of the vaginal contents; during pregnancy, the results of a smear allow you to assess the threat of miscarriage.

This test is called a smear for purity, or a vaginal smear for sterility.

The study is carried out according to the following indicators:

Flat epithelium

Flat epithelium - cells of the mucous membrane of the cervix and vagina. An analysis of a woman who is healthy will definitely show it in small quantities. If there is no epithelium in the smear, this indicates hormonal disorders, while the level of androgens is increased and estrogen levels are decreased. An increased amount of epithelium indicates inflammation.

A cervical smear with an increased level of squamous epithelium indicates inflammation in the cervix, a smear from the urethra - in the bladder, a smear from the vagina, respectively - to inflammation of the vaginal walls.

The amount of squamous epithelium is also affected by the phase of the cycle. Depending on what day the flora analysis was done, the norm varies.

If you have taken a smear for flora, it should be deciphered by your attending physician.

Lactobacilli(synonyms: gram-positive rods, lactobacilli or Doderlein rods)

With healthy genitals, lactobacilli (bacillus) predominate in the smear. The results of smears in which the number of lactobacilli is 95% of the total number of bacteria are considered good. Sometimes during the study the number of lactobacilli is lower than normal. At the same time, the acidity in the vagina decreases and it is easier for pathogenic microbes to enter the body.

Leukocytes

When examining smears, the number of leukocytes is determined - this is one of the important indicators.

Leukocytes are the “defenders” of the body. Leukocytes in a smear are present in large numbers when pathogenic bacteria are actively multiplying in the body. That is, the more leukocytes are elevated in the analysis, the more pronounced the inflammatory process.

If a cervical smear contains up to 30 leukocytes, from the urethra - up to 5, and from the vagina - up to 10, this is normal. Such meanings are typical for all women who are sexually active.

Leukocytes in a smear, the norm of which is significantly increased, only indicate the presence of an inflammatory process. The cause of the infection must be determined by a doctor. To do this, it is necessary to conduct additional studies, such as bacterial culture, immunological analysis and polymerase chain reaction (PCR).

Red blood cells

The number of red blood cells increases during menstruation, trauma to the vaginal mucosa or inflammation. The analysis may normally contain several red blood cells.

Slime

Mucus is secreted by the glands of the cervix and vagina - a smear from the vagina and cervix should contain a small amount of it.

3. Smear for latent infections and polymerase chain reaction

Why it is carried out: allows you to detect infections that cannot be detected by analyzing a smear for flora

In 1983, American biochemist Kary Mullis developed the polymerase chain reaction method, for which he was awarded the Nobel Prize. Thanks to the scientist, it became possible to “recognize” bacteria and viruses by sight, even when they minimum quantity. Polymerase chain reaction is often called PCR diagnostics. PCR analysis and PCR smear are also synonymous. A smear, scraping or urine sample taken for analysis can reveal hidden diseases.

Polymerase chain reaction is a biological research method in which a section of DNA is multiplied in the laboratory.

Why is PCR analysis needed? When researching, it is necessary to identify what type of infection causes the disease. But sometimes there are so few bacteria that it is impossible to recognize them. In such cases, PCR diagnostics of infections comes to the rescue.

For analysis, a section of bacterial DNA is taken and cloned many times. When the DNA “grows”, it is possible to determine what type of bacteria or fungi the laboratory technician is dealing with.

PCR diagnostics of infections gives an accurate result. It allows you to identify not only the genus, but also the type of bacteria: for example, not only to say that the fungus is of the genus Candida, but also to clarify that it belongs to Candida albicans. If the exact type of infection is not determined, treatment may not be effective.

PCR diagnostics are often used to test smears for sexually transmitted infections. Most sexually transmitted diseases, such as gardnerellosis, chlamydia, mycoplasmosis, gonorrhea, ureaplasmosis, may not show signs in the early stages of development. Symptoms appear in later stages. Thanks to PCR analysis, sexually transmitted infections can be detected by initial stage development and, accordingly, quickly cure them.

When carrying out such an analysis, viral infections such as hepatitis or papilloma can also be detected. Other methods can detect not the virus itself, but only the presence of its metabolic products or antibodies to it.

The polymerase chain reaction method allows you to detect infections in any environment: in blood, urine, saliva, and on mucous membranes. In addition, thanks to PCR analysis, viruses are isolated in soil and water.

Advantages of polymerase chain reaction:

accuracy of infection detection;
the ability to isolate the virus (and not decay products or antibodies to it);
a small amount of test material is sufficient (even in the presence of one pathogen cell);
the ability to detect infection in any environment (urine, blood, saliva);
speed of analysis;
the only method for isolating certain infections.

4. PAP test, or cytological smear

Why it is carried out: allows you to diagnose cervical cancer.

The Pap test has different names: a smear for cytology, as well as a test, analysis or smear according to Papanicolaou, a smear for atypical cells. The test is named after the Greek scientist who first used this method. To perform a Pap test, a swab is taken from the cervical canal (cervix) during an in-chair gynecological examination.

A cytological smear in a woman over 30 years of age is a mandatory annual test. Cervical smear results help diagnose cervical cancer, the second most common cancer among women.

How is a smear taken for cytology?

Several factors may influence the results of the study. To get a reliable result, refrain from going to the toilet 2-3 hours before taking a smear. Otherwise, you will wash away the epithelium and bacteria that are important for examining a vaginal smear.

To ensure accurate results, 48 hours before the test:

don't have sex;
do not douche (so as not to wash the vaginal contents);
do not use vaginal contraceptives (spermicidal creams, ointments, foams);
do not take baths;
Do not use tampons or vaginal suppositories.

Taking a smear from the cervix

The interpretation of the smear and, accordingly, the success of treatment depend on whether the woman followed the requirements listed above. A Pap smear can be taken on any day of the cycle when there is no menstrual flow.

A smear is taken by a gynecologist during an examination on a chair.

Eyre spatula - a plastic stick for taking a cervical smear

In this case, the doctor uses a speculum and an Eyre spatula - a special plastic stick. Taking swabs takes no more than two minutes. The procedure is painless.

Smears are taken in three places - possible foci of infection: a smear is taken from the cervical canal (cervix), from the vagina and urethral opening.

Taking smears from the cervical canal

The study is carried out by studying under a microscope or bacteriological culture. In most cases, women do not experience any discomfort after a smear. Only occasionally may spotting from the vagina and painful sensations in the lower abdomen be observed. They should go away in a few hours.

There is no need to abstain from sex after a smear. Starting from the age of 18, even if a girl is not sexually active, experts recommend undergoing annual preventive examinations and taking a smear for oncocytology. And those who are sexually active, regardless of age, are advised to visit a gynecologist at the beginning of an intimate relationship. To detect cervical cancer in the early stages of development, after 30 years of age, be examined by a gynecologist at least twice a year.

Cervical dysplasia

If there are “wrong” cells as a result of cytology analysis of a cervical smear, the doctor uses a special term: dysplasia.

Dysplasia is a condition of the cervix in which some of the cells have a damaged structure. This means that the cells can develop into cancer. Therefore, such a pathology may be a precancerous condition.

What influences the development of cervical dysplasia?

The risk of developing pathology increases with:

smoking;
a large number of births;
long-term use of intrauterine and hormonal contraceptives;
lack of vitamins;
the presence of sexually transmitted infections (especially papillomavirus);
early sexual activity (up to 16 years);
childbirth (up to 16 years);
a large number of sexual partners (three or more);
genetic predisposition.

Cervical dysplasia is caused by human papillomavirus (HPV) types: 6, 11, 16, 18, 31, 33 and 35.

Signs may include:

frequent inflammatory processes;
spotting bloody discharge;
bleeding after sexual intercourse or when using tampons.

Some women with dysplasia experience pain in the lower abdomen.

Dysplasia: degrees of development

Depending on how much dysplasia has developed, the degree of its development indicates the depth of tissue damage. There are three degrees: first, second and third.

Degrees of cervical dysplasia

TO first degree Dysplasia refers to slight changes in the structure of the cells of the cervix. In this case, abnormal cells affect only the superficial layer of squamous epithelium.
At second degree Cervical dysplasia “irregular” cells affect the superficial and middle layers of the cervix.
Cervical dysplasia third degree means that abnormal cells have grown into all three layers of the epithelium.

Cervical dysplasia: treatment

Cervical dysplasia. HPV - human papilloma virus

If you have cervical dysplasia, treatment involves reducing the number of abnormal cells. To do this, the doctor removes a small affected area of the cervix. If you have been diagnosed with cervical dysplasia, treatment may not completely remove the human papillomavirus from your body. However, it can prevent the development of a malignant tumor.

Treatment of the disease - removal of the affected area - the uterus - can be carried out in different ways: using a laser, freezing and other methods. This depends on the woman’s age, the degree of development and the condition of other genital organs. If the patient has sexually transmitted infections, they are eliminated first. Only after a smear analysis shows that there are no sexually transmitted infections is treatment carried out.

When cervical dysplasia is detected in the early stages, treatment is carried out, which not only preserves women's health, but also life. To do this, every woman should undergo preventive examinations at least once a year.

Who needs to be examined by a gynecologist?

A smear examination of the vagina, urethra and cervix should be performed on women who:

began to be sexually active;
got pregnant;
planning pregnancy;
have multiple sexual partners;
feel discomfort in the genitals (pain during sex, frequent urination or burning in the genitals and others);
over 18 years old;
undergo a preventive examination.

Regular examinations in the gynecologist's office, during which you can take a smear test, allow you to notice the onset of the disease in time, make the correct diagnosis and even save your life. For example, uterine dysplasia, the treatment of which was started on time, will not degenerate into an incurable malignant tumor.

Smear: norm and deviations, or Who is at risk

Regardless of age, there are factors that increase your risk of cervical cancer. Their combination and prolonged “effect” on the body reduce the body’s defenses in the fight against the disease, even in the early stages of development.

It is especially important to take a cervical smear for oncocytology for women who:

have multiple sexual partners;
started sexual activity before the age of 18;
have had cancer of the reproductive system in the past;
smoke;
are carriers of viral infections;
have weakened immunity.

Viral infections such as: herpes simplex virus, HIV and human papillomavirus.

inflammation of the vaginal mucosa;
dysbacteriosis of vaginal microflora;
intestinal dysbiosis;
sexually transmitted diseases;
inflammation of the uterine mucosa;
tumor processes in the pelvic organs;
inflammation of the uterine appendages;
fungal infection of the vagina;
urethritis;
inflammation of the cervix.

There are situations when elevated white blood cells do not indicate the presence of a pathological inflammatory process in the reproductive system. In particular, an increase in the content of white blood cells in a smear may be a consequence of inflammation in the male genitourinary system. For example, after unprotected sexual intercourse with a man who suffers from prostatitis, leukocytes in the smear will be in increased numbers. This must be taken into account by the doctor when carrying out diagnostic measures.

Elevated leukocytes in a smear in men

To find out the cause of infertility, men also take a smear from the urethra. An increase in the number of white blood cells indicates the presence of an inflammatory process in the genitourinary system in men. These pathological conditions can lead to reproductive dysfunction and infertility. In addition, if inflammatory diseases of the pelvic organs in men are not treated, the pathological process can spread to nearby organs or even lead to the development of systemic inflammation.

Therefore, elevated white blood cells in representatives of the stronger sex are a serious marker of an infectious process that must be diagnosed and treated in a timely manner. To do this, the doctor prescribes appropriate treatment, which in most cases has a positive effect. Pathological changes in a smear in the form of an increase in leukocytes can be a sign of diseases such as cystitis, prostatitis, orchiepididymitis, and so on. In these pathological conditions, a man experiences pain or a burning sensation when urinating, as well as cloudy urine. In addition, elevated white blood cells can be detected after sexual intercourse with a woman who suffers from inflammatory diseases.

Thus, a smear should be taken in both women and men. This study will identify inflammatory diseases in the early stages, which are manifested by an increase in the number of leukocytes. This will allow you to prescribe the correct treatment in a timely manner and increase its effectiveness.

Smear during pregnancy

All women, regardless of whether they are in an “interesting situation” or not, are given the same smear for flora. The only difference is the frequency: pregnant women, accordingly, more often.

Even if the expectant mother is Lately was not sick with anything, she could have contracted the infection and be its carrier for a long time. And since the immune system is weakened during pregnancy, bacteria can begin to actively multiply at this time.

Smear tests before and after pregnancy can differ significantly. Even if no symptoms of the disease were observed before pregnancy, then with the onset of pregnancy, sexually transmitted diseases most often appear:

gonorrhea;
syphilis;
ureaplasmosis;
genital herpes;
mycoplasmosis and others.

If a pregnant woman is a carrier of one of the sexually transmitted infections, then, most likely, leukocytes will be found in the smear, the norm of which is exceeded. If a pregnant woman has elevated leukocytes in a smear, the doctor should prescribe treatment. To establish an accurate diagnosis, a blood smear is also taken. This analysis is carried out on the same principle as the gynecological one. A blood smear can detect diseases such as malaria, typhus and others.

It is not uncommon for pregnant women to develop thrush, so the test may also show an increased amount of Candida fungus.

What should not be included in a smear test?

For normal functioning of the genital organs and good health, the body must have a balance of good and bad bacteria. A smear for the degree of purity may contain a small amount or not contain the following microorganisms and cellular structures:

Atypical cells. May indicate a precancerous condition. They have an incorrect structure.
Key cells. The key cells in the smear are epithelial cells “glued together” by gardnerella or other pathogens. Key cells in a smear can be observed in increased numbers with reduced immunity. In cases where a smear is examined for flora, this category includes squamous epithelial cells that are glued to infectious agents.
Gardnerellas. These are small sticks in a smear. When examining vaginal smears, gardnerella may be present in small quantities. If a clean smear reveals an increased number of these bacteria, bacterial vaginosis. An increased number of them is also observed when vaginal dysbiosis.
Candida. This fungus, like gardnerella, is present in small quantities on the vaginal mucosa in healthy women. If the amount of candida fungus exceeds the number of lactobacilli, vaginal candidiasis develops (popular name - thrush). A gynecological smear confirms the disease in a latent form in the presence of spores, and in an active form in the presence of fungal threads. As a rule, the number of candida increases with reduced immunity, including during pregnancy.

Up to 40 different types of bacteria live in the vagina of a healthy woman. While the total number of lactobacilli predominates, all bacteria, including Candida and Gardnerella, “peacefully” coexist.

Cocci (gonococcus, staphylococcus and other cocci in the smear)

Cocci in a smear look like spherical bacteria. A smear for purity may contain several types of cocci, but only extracellularly. Otherwise, cocci indicate a sexually transmitted disease.

Gonococcus. A gram-negative bacterium that multiplies at high air humidity. In addition to gonorrhea, cocci in a smear of this type of bacteria cause inflammation of the urethra, cervix, fallopian tubes, and rectum.
Staphylococcus. The most common is Staphylococcus aureus, a gram-positive bacterium. 20% of the world's population are carriers of this type of coccus. Bacteria belonging to this genus of cocci in a smear cause mild skin infections (acne, etc.) and deadly diseases (pneumonia, osteomyelitis, endocarditis, etc.).
Streptococcus. A gram-positive bacterium that lives in small numbers in the gastrointestinal (GI) and respiratory tracts, as well as in the nasal and oral cavities. If a pregnant woman has high levels of streptococci in her smear, they can cause miscarriage, early labor, and stillbirth. In addition, they cause diseases such as scarlet fever, bronchitis, tonsillitis, pharyngitis and others. In single quantities, streptococci in a smear may be normal.
Enterococcus. A gram-positive bacterium that is part of the gastrointestinal microflora. Withstands heating up to 60 °C for half an hour. Such cocci in large quantities indicate inflammation of the genitourinary system, pelvic organs and other diseases.

Trichomonas. A smear for infection does not always reveal Trichomonas, since this bacterium can have altered forms. To confirm its presence, bacteriological culture is done.

Your result is bad, does your vaginal smear contain pathogenic bacteria? Most infections are now successfully treated. The main thing is not to self-medicate and follow the doctor’s recommendations.

Today, the main way to examine internal female organs is a cytology smear, which shows the development of infections and dangerous pathologies. It differs from other types of laboratory tests by a special set of dyes and fixatives that increase the reliability of the final results.

What is a cytology smear?

Cytological Papanicolaou, PAP test) is a laboratory microscopic examination of the upper ball of the cervix, intended for the timely diagnosis of cancer. This method is the most painless, simple and fast among all known examination methods.

Purpose of the analysis

In order to prevent and prevent the development dangerous diseases Cytology of a smear from the cervical canal is done for every woman. This analysis allows us to identify abnormalities in the cellular structure of the cervix that cause the development of cancer. To avoid possible pathologies, all women should regularly visit a gynecologist. If changes occur, they are recorded at an early stage, when the disease is treatable and full recovery is still possible.

In addition to cellular pathologies, a cytology smear allows you to evaluate the mucous membrane and determine the presence of harmful microorganisms in the vagina. The Pap test provides accurate data on these parameters, so in such cases it is necessary to use additional methods of analysis.

Indications for Pap test

A smear is prescribed to all women over 18 years of age during a routine examination by a gynecologist once a year. Also, indications for the analysis include: menstruation disorders, the presence of papilloma virus and genital herpes, free sexual intercourse, infertility, the use of hormonal contraceptives, the installation of an intrauterine device, planning pregnancy. Infectious diseases are also often a reason to take a smear for cytology. What the result shows can only be determined by a specialist.

Risk group

Regardless of age, there are certain factors whose exposure increases the risk of developing cancer. With prolonged exposure to the female body, they weaken the immune system. This risk group includes women who have many sexual partners, smoke, have weak immunity, are carriers of viruses, began sexual activity at an early age, and have had cancer of the reproductive system in the past.

How to make a smear

To obtain reliable results, a woman must stop taking antibiotics a week before the test. The day before the test, you need to stop douching and put vaginal suppositories and have sexual intercourse.

A smear is taken on the chair during an examination by a gynecologist. The doctor takes 3 smears: from the walls of the vagina, from and from the mouth of the paraurethral passages. This procedure is completely painless. A speculum and spatula are used to take a smear. So that objects are not cold and do not create discomfort, they can be heated with hot water before use.

At the next stage, the doctor applies the test material to a special glass, on which a laboratory analysis of the smear for cytology will be carried out under a microscope.

Interpretation of research results

The last and most important stage of the study is deciphering the smear for cytology. According to the analysis, the doctor can obtain information about the condition of the epithelium, the presence of inflammation and the composition of the microflora. In modern medical practice, the Papanicolaou technique is widely used to decipher the results of a smear, according to which there are 5 stages of the development of pathologies.

Stage 1 - there are no abnormalities, cytology is normal. This stage indicates the woman’s health.

Stage 2 - during a routine examination or based on complaints, a woman takes a smear for cytology, which shows a slight change in the structure of the cells. It is caused by inflammation of the internal genital organs. This stage is also considered normal, but more thorough research is still required to determine the causes of the disease.

Stage 3 - a small number of cells with abnormalities in the structure of the nuclei were detected. In this case, it is necessary to take a second smear and conduct a histological examination of the tissue.

Stage 4 - during the analysis, cells with malignant changes can be identified. For example, increased nuclear mass, changes in the cytoplasm and chromosomes. The result obtained is not a final diagnosis, but serves as a reason for further examination.

Stage 5 - present in large quantities in smears.

Deciphering a smear for cytology may take some time. Usually it takes a few days, but there are times when you need to wait a week for results.

The reliability of the results of the Papanicolaou method is very high, especially when a smear is examined for cervical cytology. But this analysis does not provide any information about the condition of the uterus itself, ovaries and fallopian tubes. There are times when a PAP test gives false data. Therefore, to accurately interpret the results, it is necessary to undergo a comprehensive examination.

Positive results: types of pathologies

If the research data obtained corresponds to the norms, then no abnormalities were identified and the woman is healthy. In case of positive results, pathology develops.

Finding abnormal cells does not always indicate the presence of cancer. Dangerous infectious diseases are often detected during a Pap test.

1. Human papillomavirus infection - the formation of genital warts in the vagina and on the cervix. This virus is very dangerous for women's health.

2. Chlamydia is the most common. Basically, this disease occurs without pronounced symptoms. In addition, it is difficult to diagnose in the laboratory. This makes treatment difficult, and its absence can lead to serious complications.

3. Trichomoniasis is a popular sexually transmitted disease. The main symptoms of the disease: itching, yellow-green discharge, discomfort when urinating and during sexual intercourse. Timely diagnosis of pathology allows you to completely cure the disease.

4. Gonorrhea is an infectious disease of the genitourinary system. The chronic form of the disease is often the cause of infertility in women.

5. A yeast infection is an overgrowth of fungus that lives in the vagina. For some reason, its reproduction gets out of control and inflammation occurs. It is accompanied by irritation and itching, white discharge with a characteristic odor.

If the smear test is positive due to the presence of infection, the identified diseases should be treated. Very often it is difficult to determine cancer precisely because of viruses. Therefore, after a course of therapy, it is necessary to repeat the analysis to obtain more accurate data.

Depending on the pathology, sometimes it is necessary to take a second smear for cytology, which shows the dynamics of changes in the structure of cells over a certain period.

Taking a smear during pregnancy

At the slightest suspicion of the presence of infections and fungi harmful to the fetus, cytology is often used. The inflammatory type of smear makes it possible to diagnose pathological processes if a woman complains of burning and itching of the external genitalia, changes in the color and smell of discharge. To analyze the state of the vaginal microflora in pregnant women, cytology smears are done at least three times. If necessary, your doctor may order additional Pap tests.

A Pap test for pregnant women is performed using conventional technology.

Possible complications after taking a smear

Taking a smear for cytology should be done by a specialist doctor who knows the technique of this process. There may be some complications after performing a Pap test. Most often they manifest themselves as severe pain after manipulation and bleeding for a day or a little longer. Such symptoms are considered completely normal and do not require treatment. If after the study you experience severe abdominal pain, fever and chills, you should consult a doctor.

Cytology when taken incorrectly also sometimes has dangerous consequences. With rough intervention, stenosis caused by adhesions may develop. For this reason, it is not customary to carry out prophylactic smear taking in deep places of the cervical canal.

For a week after the Pap test, you should avoid intimate relations, douching, and the use of tampons.

A cytological smear is considered the best method for detecting cervical cancer in the early stages of development. But even the best laboratories sometimes cannot detect cellular changes. Therefore, for a greater likelihood of detecting pathology, you need to take a smear annually.