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Gynecologic Cytopathology Conventional Pap Smear

Historical overview Cervical cytology practice guidelines Tips for making good pap smear

Historical overview 1845 Donne’s ATLAS (Paris) Vaginal Cells 1847 Pouchet’s Book (Paris) Vaginal Cells 1912 Schottlaender & Kermauner CIS 1928 Schiller 1925 Hinselmann Colposcope 1928 George N.Papanicolaou Observe & 1928 Aureli Babes & C.Daniel Report of cancer cell in CVS

Donne’s Atlas, Paris, 1845

Historical overview 1941(article) George N.Papanicolaou 1943(book) & Herbert Traut The value of vaginal smear in the discovery of occult cancer of cervix and endometrium

Historical overview Period of critique (1970-1985) 1947 Ayre Cervical scraper 1986 Boon et al Endocervical brush Period of critique (1970-1985) CLIA (Clinical Laboratory Improvement Act)

CLIA (1988) Historical overview 1) Targets of population screening 2) Nonrepresentative or inadequate smear (F.N.) 3) The techniques of fixation, staining, microscopic screening and interpretation are not adequate 2 FN Three separate situations 1 FP 4) Reported results are not appropriately understood and the clinical follow-up is inadequate

Specimen collection and submission Cervical Cytology Practice Guidelines Specimen collection and submission

Cervical cytology practice guidelines Patient preparation 1) Two weeks (10-18 days) after LMP 2) Not douche 48h prior to the test 3) Not use tampons, birth control foam, jellies or other vaginal cream of medications for 48h prior to the test 4) Refrain from intercourse 48h prior to the test

Cervical cytology practice guidelines Sampling principles Sampling techniques Smear preparation Smear labeling and test requisition

Cervical cytology practice guidelines Sampling techniques Exfoliative cytology and abrasive cytology Vaginal smear and cervical smear

Cervical cytology practice guidelines Smear preparation Fixation and fixatives Common fixatives for cervical smears

Cervical cytology practice guidelines Test Requisition The minimal clinical data: Age Date of LMP or onset of menopause Past or Current history of any abnormalities or treatment Pregnancy status

Cervical cytology practice guidelines Important factors in assessing the results : Patient preparation Sampling Fixation Staining Interpretation Reporting Quality control and Quality assurance

Cervical cytology practice guidelines Definition of an adequate smear: Cells of all epithelial surfaces Sufficient number of cells Two of the three component (EC, MC, EM)

Tips for making good pap smear Problem: Air-drying Solution: Spray-fix the smear immediately Problem: Blood, mucus and pus Solution: Remove excess mucus, Spatula first, Then the brush Problem: Traumatized cells Solution: Spatula, Rotate no more than 360 Brush, Rotate only 90 to 180

Tips for making good pap smear Problem: Incomplete clinical information Solution: Fill out the requisition completely Problem: Dueling laboratories Solution: The abnormal pap and follow-up biopsy MUST be examined simultaneously by the same pathologist