Professional Documents
Culture Documents
Pap Smear and HPV Vaccine: Dr. Arivendran M.D (Ukm) Mrcog (Uk)
Pap Smear and HPV Vaccine: Dr. Arivendran M.D (Ukm) Mrcog (Uk)
DR. ARIVENDRAN
M.D (UKM ) MRCOG (UK)
PAP SMEAR
Papanicolaou test –
exfoliative cytology
test
cells collected are
from normally
shedding epithelium .
collected using
spatulas or brushes.
Specimen is fixed,
stained and studied
for morphology
under microscope.
HISTORY
Initially using vaginal pool smears to
study hormonal status .
OLD SCJ
TRANSFORMATION ZONE
COLLECTING PAP SMEAR : SPATULA
Endocervical brush
Endocervical brush
Spatula / Cervix brush
Endocervical brush
Alcohol fixation
Slide jacket
BETHESDA 2001
REPORTING SYSTEM
The Bethesda System Report Includes:
B. Glandular / Columnar
Atypical (undetermined or favour neoplastic)
Adenocarcinoma in situ (AIS)
Invasive adenocarcinoma
Atypical (ASCUS/ASC-H)
LSIL ( Mild Dyskaryosis / HPV/CIN 1)
HSIL (Mod or Severe Dyskaryosis / CIN 2,3)
Invasive Squamous Carcinoma
Glandular
Sampling
Scanty cells
Blood, mucous, pus
Mainly endocervical cells *
Preparation
Too thick due to poor spreading
Air drying artifact
How to deal with Inadequate smears
Infection
Chronic cervicitis
Atrophic cervicitis
MANAGEMENT OF
ABNORMAL PAP
SMEAR
Management of Abnormal Pap
Smear : Options
Unsatisfactory/Inadequate smear
HPV effect
TREAT AND REPEAT
1. INFECTIONS
Trichomonas vaginalis ( Metronidazole 400mg
tds and Doxycyline 100mg bd for 1 week)
Fungal infection : Antifungal
Bacterial vaginosis (Metronidazole, Clindamycin)
Actinomyces species : Penicillin
Herpes simplex : Acyclovir
2. ATROPHIC SMEAR
Local oestrogen cream/tab (1 gm nighty
for 2 weeks then twice weekly) 6-8 weeks
and repeat pap smear in 3-4 months.
COLPOSCOPY
UNSATISFACTORY
FOR EVALUATION
* NOTE
Repeat smear in •Treat any infection.
3 months •Give a course of estrogen if there are
atrophic changes.
Satisfactory
Repeat smear and negative
in 3 months
3rd smear
unsatisfactory
3rd smear
with similar
changes
•NOTE
Cannot exclude Undetermined •HPV DNA testing should
high grade significance be considered if available
lesion (ASC-H) (ASC-US) •If positive for high risk
HPV, to refer for
colposcopy
Refer for Repeat smear
colposcopy in 6 months
LOW-GRADE SQUAMOUS
INTRAEPITHELIAL LESION
(LSIL)
Yes No
Assessm
Presence of at least one ent of
criteria: client
•Age > 30 years
•Poor compliance
•Immunocompromised
•Symptomatic
•History of pre invasive Repeat smear
lesion in 6 months
•High risk HPVpositive.