Abnormal Pap test results.!

Published: 02/05/2018 Updated: 03/10/2021

The liquid cytology method with Papanicolaou staining (Pap test/PAP test) is recommended by the World Health Organization as the “gold standard” for diagnosing cervical cancer. Its effectiveness is 95%, while the sensitivity of traditional methods does not exceed 40% in some cases.

A Pap test helps identify the disease even when there are no clinical symptoms yet. Cervical cancer has a long development period - on average 10-15 years, which means that a serious illness can be avoided!

Since the Pap test was introduced into medical practice (in 1950), the mortality rate in women from cervical cancer has decreased by 10 times.

1.What are abnormal Pap test results and their causes?

When your doctor says your cervical smear or Pap test results are abnormal, it means that the test found cells in your cervix that don't look like they should be.

A Pap test is usually done during a routine pelvic exam. Essentially, it is a smear of the cervix that helps detect cervical dysplasia or cancer. But abnormal test results do not mean you have cervical cancer. In fact, this disease is rarely diagnosed.

Causes of Abnormal Pap Smear Results

In most cases, abnormal changes in cervical cells are caused by certain human papillomaviruses

, or HPV.
This virus is transmitted sexually. As a rule, some changes in cells go away on their own. But some types of HPV are associated with the development of cervical cancer
. This is why identifying them and having regular cervical smears is very important.

Sometimes cells change due to other types of infections, including bacterial or fungal infections. These infections can be cured.

In women who have already entered menopause, a Pap test can show changes in cells that are a result of the natural aging process.

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How to prepare for the procedure

Two days before the event, a woman should follow a few simple rules.

Avoid sexual contact.
Avoid douching and vaginal douches.
Do not use vaginal lubricants, creams or suppositories.

It is highly undesirable to empty your bladder for 2-3 hours immediately before visiting the doctor. You should not take a smear test during menstruation or during treatment for genital infections. Otherwise, the woman can lead her usual lifestyle. There are no restrictions on diet and physical activity.

Traditional cytology

The first screening method to emerge is called the PAP test. The doctor takes material with a special brush from the surface of the cervix and from the canal, then applies the material to the glass. The sample is dried, stained and examined under a microscope at high magnification. The main advantage is the low cost of the method, which makes it very convenient for mass examinations in conditions of limited funding. The cells on the glass retain their natural shape, which makes the cytologist’s work easier. But there is mucus and vaginal leucorrhoea on the glass, making examination difficult. All stages of the study are carried out manually.

Liquid cytology

A new technology that is rapidly replacing traditional testing. The material is taken simultaneously from the cervix and canal with a special brush-broom and placed in a bottle with liquid. Processing and preparation of biomaterial is carried out using powerful processors and centrifuges. The devices prepare samples with minimal participation of a laboratory assistant, which eliminates involuntary errors due to the human factor. In addition, modules in this category are capable of simultaneously processing several samples. Cell analysis is also performed by a computer; the doctor can only confirm the abnormal conclusions. In this case, the cells are ultimately also applied to the glass, but they are washed from impurities and distributed evenly across the fields of view, which facilitates the work of the cytologist.

The main advantage is automation of the process, reducing the burden on staff. The disadvantage is the high cost of equipment and consumables.

Peculiarities

The container holds all the collected material, which increases the information content of the analysis and minimizes the likelihood of data loss.
When processed in a centrifuge, mucus, blood elements and other impurities are removed from the sample, which affect the reliability of the final indicators.
The use of a special liquid greatly increases the shelf life of the resulting tissue and prevents the immediate drying of cellular elements.
The solution retains all molecular biological, as well as morphological properties and characteristics of cells that are subjected to microscopic monitoring.
The use of modern equipment simplifies and speeds up the process of preparing biomaterials
Possibility of simultaneous HPV testing
Can be used in self-sampling tests.

This begs the question - which test to choose? It should be understood that both tests are acceptable for diagnosis and have similar sensitivity. But the advantages and disadvantages of the methods do not overlap, which is why it is most advisable to alternate tests during regular observation.

The PAP test for preventing invasive cervical cancer works very simply: despite the large number of analysis errors, when performed regularly once a year, it is almost always possible to identify precancerous conditions, because cancer takes years to form, on average 5-10 years. Detection of pathology at any stage before invasive cancer is a success of screening and allows the patient to be cured without significant health consequences.

2.What increases the risk of an abnormal test result?

According to statistics, the risk of becoming infected with the human papillomavirus is higher in those people who have more than one sexual partner (or a partner who, in turn, has other sexual partners). There is also a risk of infection associated with having sex without a condom, especially if the first condition is present. And the risk of HPV infection automatically increases the risk that after the next smear from the cervix, the test results will show a deviation from the norm.

In addition, smoking and disorders of the immune system increase the chance of developing abnormal cells in the cervix.

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What is done if the Pap smear is abnormal?

The plan of action depends on the degree of cellular changes described by the cytologist. If the changes are associated with inflammation, the smear is usually repeated several months later. If necessary, appropriate treatment can be prescribed. Smears in which low-grade abnormalities are detected can be repeated after a few months with a follow-up colposcopy. High degree deviations are always an indication for colposcopy. Patients with abnormal smears are advised to use condoms or abstain from sexual intercourse until the examination is completed.

3.Do pathological changes in the cells of the cervix cause any symptoms?

No, changes in cells are usually not associated with poor health or other noticeable symptoms. The human papillomavirus, which is most often associated with abnormal Pap test results, also usually does not cause any obvious symptoms.

But if the cause of an abnormal test result is another sexually transmitted infection, the following may occur:

Vaginal discharge that is not typical for you. The amount, color, smell, or texture of the discharge may change.
Pain, burning or itching in the pelvic or genital area when urinating or having sex.
Sores, blisters, rashes, or warts on or around the genitals.

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What is colposcopy?

A colposcope is an instrument, much like a microscope, that allows the doctor to examine the external genital area (vulva), vagina, and cervix under magnification, so that areas of change can be more easily detected. The patient is placed on a gynecological chair and a gynecological speculum is inserted into the vagina. The doctor lubricates the cervix with special solutions, which make it easier to see cellular abnormalities. The colposcope itself does not touch the patient. Colposcopy is not performed during menstruation. 24 hours before colposcopy, the patient should not douche, use vaginal gels, ointments or tampons, because this may affect the accuracy of the study.

Analysis of a smear for oncocytology has greater diagnostic quality when carried out by colposcopic targeted examination of cervical tissue.

4.What should I do if my Pap test results are abnormal?

If this is the case, you may need additional tests and examinations to find out whether you have an infection and how severe the cervical cell changes are. For example, you may need:

Colposcopy
is a test that helps examine the vagina and cervix using a lighted magnifying instrument. During a colposcopy, your doctor may take a small sample of cervical tissue for further examination. This is called a biopsy.
HPV test
. Like the Pap smear, the HPV test is done using a sample of cells taken from the cervix.

Repeat Pap test after some time.

Treatment, if necessary, will depend on the degree of cell pathological change - mild, moderate or severe. In the latter two cases, treatment may be needed to kill or remove the abnormal cells. Treatment methods in this case are selected individually. This may be a cone biopsy, an electrosurgical excision procedure, cryotherapy or laser therapy

. Treatment for cervical cancer, a rare cancer, aims to kill or remove cancer cells.

In most cases, however, treatment is not prescribed immediately. Instead, the doctor regularly takes a second smear and examines the dynamics of changes in the cells. This tactic is used if the patient is diagnosed with an infection that can be treated. And even if human papillomavirus is detected during the tests, in most cases the type of virus is one that goes away on its own within 6-18 months and does not cause serious pathologies.

How is a Pap test performed and interpreted?

For the study, a scraping is taken from the surface of the cervix and cervical canal, as well as from the transformation zone, in which most often, up to 80%, the pathological process occurs, which is an advantage of the study using liquid cytology.

Cytological classification according to Papanicolaou:

1st class - normal cells;
2nd class - change in cell shape caused by an inflammatory process in the vagina and/or cervix;
3rd class - there are single cells with an abnormality of the nuclei and cytoplasm (suspicion of a malignant neoplasm);
grade 4 - individual cells suspicious for malignancy are present;
Class 5 - a large number of typical cancer cells are present.

What is done if cellular changes are detected during colposcopy?

If cellular abnormalities are detected, the doctor may do a biopsy. A biopsy is the removal of a small piece of tissue from the changed area. A woman may feel a sharp prick or discomfort (some women may not feel anything at all). There may be some light bloody or spotting discharge from the genital tract for several days after the biopsy. The tissue sample is sent to a histology laboratory, where it is examined by a specialist under a microscope in all sections.

How often can you get a Pap scraping?

Papanicolaou scrapings should not be taken too often - time must be given to restore the surface of the cervix after collecting biological material. To obtain reliable results, doctors recommend conducting such a study no more often than once every 6 months; it is better to limit it to a schedule of once a year.

A woman should not worry about late diagnosis of a malignant process - a feature of cervical cancer is its long development. The stage when metastases spread in the body and treatment is considered inappropriate occurs within 5-20 years. Regular tests will still give results and allow you to start therapy or surgery on time.

Preparing for the test

The analysis is carried out during a routine examination by a gynecologist. You should tell your doctor about any contraceptives or other hormonal medications you are taking.

Special preparation for the Pap test:

refrain from vaginal intercourse for 48 hours before the test;
at the same time, do not use vaginal tampons, douche, or use medications or contraceptives inserted into the vagina;
It is advisable to first treat cervicitis, if present.

Pap test, in other words Pap smear

On what day of the cycle should I take the test?

There are no special restrictions. The only condition is the absence of menstrual or other uterine bleeding. However, the analysis can be taken even during menstruation, but its accuracy is reduced.

If a woman has bleeding or cervicitis (inflammation of the cervix), this is not a contraindication for the study. These symptoms may be caused by precancer or malignancy, which can be detected during screening.

Price of Pap test in gynecology

The price of a Pap test in gynecology is set only by private laboratories and can range from 1200-1800 rubles. In public clinics/polyclinics/hospitals such studies are carried out free of charge.

We recommend reading about why cervical erosion occurs. From the article you will learn about the causes of cervical erosion, why and after what time it can appear again.

And here is more information about when a cervical biopsy is performed for erosion.

The Pap test is the only reliable method for the early diagnosis of cervical cancer and the precancerous state of the cells of this organ. Regular examination allows you to avoid terrible consequences, because for many years cervical cancer is asymptomatic and it is impossible to diagnose it without such laboratory testing of biomaterial.

Indications

For timely diagnosis of malignant tumors, a simple method that has no contraindications is needed. A cervical Pap test is a screening test that allows most women to be examined regularly.

According to the latest recommendations of the American Cancer Society and the American College of Obstetricians and Gynecologists, the test should be performed starting at age 21, regardless of the onset of sexual activity.

Table. When is the best time to do a Pap test?

Complications after a cervical PAP test and risks from the procedure

After a PAP test of the cervix, the following complications are possible:

slight bleeding from the vagina - this is considered the conditional norm, the doctor simply warns about this possibility;
infection at the site of collection of biological material is diagnosed extremely rarely, because the procedure is carried out with sterile instruments.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

The Pap test is considered a safe procedure, so there are no risks. But the absence of such a study means a risk of late diagnosis of cervical cancer, when treatment is either impossible or extremely difficult to implement and may result in remission rather than complete recovery.

Complications and limitations

Adverse effects from a Pap smear are very rare. The woman should be warned about the possibility of light bleeding. This is fine. Another complication is the addition of an infection. However, its likelihood is very low, since the procedure does not damage blood vessels and sterile instruments are used.

Although the Pap smear is one of the best screening methods, it has its limitations. The sensitivity of a single Pap test in detecting cervical dysplasia averages 58%. This means that the existing disease will be detected in only half of the women who actually have it. Approximately 30% of women newly diagnosed with cervical cancer had a negative test result.

HPV testing has higher sensitivity. In the group of women over 30 years of age, it allows diagnosing dysplasia in 95% of cases. However, in younger women such analysis becomes less informative.

Pap test. Abnormal Pap smear results.