Teja Koswara, dr., Sp.

PA
 Cytopathology refers to diagnostic techniques that are used
to examine cells from various body sites to determine the
cause or nature of disease

 The most important application of cytopathology in the area

of cancer prevention is examination of scrapings and
brushings from the uterine cervix.

 In 1928, George Papanicolaou introduced a cytologic method

for detection of malignant and precancerous lesions of the
uterine cervix : “Pap smear”

 Widespread screening of women by Pap smears has reduced

the incidence of cervical cancer in the United States and
many other countries by 70%
Cytology of Pap smear
 Estimated false negative rate is 30-50% :

 Requires adequate :
◦ Specimen collection
◦ Cytological review by pathologist
 Any woman with a cervix who has had sexual
intercourse

 Risk factors for cervical cancer :

◦ Early onset of sexual activity
◦ Multiple sexual partners
◦ Tobacco
◦ Oral contraceptives, a.k.a. no condoms
◦ Low sosio-economic
 Start within 3 years of onset of sexual activity
or by age of 21 (whichever is first)
 Yearly until three consecutive normal pap
smears, then may decrease frequency to
every three years
 Age 65 and “adequate recent screening” :

◦ Three consecutive normal pap smears

◦ No abnormal pap smears in last 10 years
◦ No history of DES exposure
◦ No history of cervical or uterine cancer

 Female with total histerectomy’ for benign

conditions
 Visualize entire cervix if possible
 Carefully remove any obscuring discharge
 Sample ectocervix first with spatula
 Sample endocervix with gentle cytobrush
rotation
 Apply material uniformly to slide (conventional
technic-direct smear)
 Fixation with : Liquid fixative (alcohol 95%) or
fixative spray.
 is a widely adopted technique that replaces
direct smearing of collected samples.
 In this method, specimens from the uterine
cervix or vagina are collected by means of a
brush and placed in an alcohol-based
solution.
 An automated machine is used to transfer
cells from the liquid onto a glass slide and
stain them by the “Papanicolaou method”.