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Cytology makes it possible to diagnose conditions that can lead to cancer. Their detection allows them to be eliminated and healed. How to read this test result?
Regular smear tests allow for the detection and treatment of changes that lead to the formation of cervical cancer. For some time now, the results of the pap smear have been reported according to the new Bethesda system. There are no groups anymore, but a detailed description of the changes found.
A study that changes epidemiology
Previously, the Pap test result was assigned to one of the five groups classified by Georgios Papanikolaou, an American gynecologist of Greek origin, a pioneer of pap smear and early detection of precancerous cervical lesions. As early as 1928, Papanikolaou announced that cancer cells could be found on a vaginal smear. His discovery, however, remained underestimated until 1943, when a gynecologist published his research on the subject. Since the Papanicolau cervical smear test appeared in the 70s among diagnostic tests, for the first time the death rate from cervical cancer fell by 1988%. However, the development of medicine meant that the Papanicolau classification turned out to be insufficient in the transmission of essential information between the cytologist and the gynecologist. Therefore, in place of the Papanicolau classification, the US National Cancer Institute at Bethesda proposed a new classification, which was first published in XNUMX.
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New description – more information
In the description of the Pap test result, a more detailed discussion of the Bethesda system is introduced instead of the Papanicolau groups. – The Bethesda system has significantly changed the quality of the cytology reading. Many intermediate stages of diagnosis have been introduced, which until now have been thrown into one group in the Papanicolau system. Now the evaluation is heavily geared towards identifying viral infections, including HPV which carries cancer risk. The diagnosis of this virus gives the chance to treat or remove the lesions and, consequently, reduce the cancer risk. It is also worth noting that in the Bethesda system it is important to evaluate the preparation. If it does not meet certain diagnostic criteria, it is not assessed because it is not reliable. However, in the Papanicolau system this was not the case, says Dr. Grzegorz Południewski, a Warsaw gynecologist.
Proper preparation
You should prepare yourself properly for the Pap smear test. Following a few simple rules reduces the risk of distorting the result. It is important to choose when the cytology should be performed. It is best to see a doctor a few days after the end of menstruation, four or five days after it. The optimal time is in the middle of the cycle, from the tenth to about the eighteenth day. The test should not be done later than four or five days before your next period. Before the smear test, you should not use any vaginal medications, neither drugs nor contraceptives. If a woman has used any vaginal medications, including contraceptives or irrigations, she must wait at least three days. It is best to give up sexual activity one day before the examination. Before the examination itself, you should also take care of intimate hygiene.
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Proper download
Taking the material for testing is painless. The patient is lying on the gynecological chair and the doctor uses a suitable device to collect the material. Swabs placed on a stick, metal or plastic spatulas and professional brushes are used to collect swabs. The latter are actually the only device that allows you to collect an appropriate amount of good-quality material, i.e. containing cells not only from the cervical disc, but also from the canal. Therefore, it is worth finding out what tools are used for the study before the test. The trident-shaped brush reaches both the canal and the entire surface of the neck disc with equal effect. It also does not cause pain while collecting the material. Only after taking the smear, the doctor should conduct a thorough gynecological examination.
Material for research
Only a properly prepared Pap smear allows the pathologist to properly evaluate it and identify or exclude neoplastic disease. – First of all, the right amount of cells must be taken. The presence of cervical cells is important. The preparation must be clean, e.g. it should not contain blood cells. Otherwise, the result will be distorted – says Dr. Południewski. The Bethesda system also diagnoses infections, e.g. vaginal candidiasis, chlamydia, which was not present in the previous cytology assessment. The currently used scale also allows the diagnosis of viral infections, including HPV infections. Certain types of the human papillomavirus – HPV are responsible for the formation of cervical cancer. Cancer develops when damaged HPV-infected epithelial cells begin to divide out of control. The disease takes a long time to develop. Early detection of the lesion allows for its healing. Do not wait and buy a Pap smear performed at the Polmed medical center.
Skala Bethesda
The Bethesda grade tells us a lot of information, including what is the type of preparation, or its quality and general characteristics. For women, the most important criterion is F, i.e. the description and interpretation of the result. On the Bethesda scale, we have the following classification of the cytological picture:
Glossary:
Intraepithelial neoplasia – uncontrolled multiplication of cells that transformed into neoplastic cells as a result of transformation.
Intraepithelial dysplasia – an abnormality in the appearance of cells in the cervix, also known as a precancerous condition. Dysplasia is a gradual reconstruction of a previously healthy organ. This term refers to the epithelial layer of the cervix.
Endothelium – the lining of blood and lymph vessels, made up of a single layer of flat cells
If the description of the test result shows: AGUS / ASCUS, it means that the result is incorrect. It indicates inflammation, but no cancer cells were found in the sample. The abbreviations used are the names of cells that are difficult to unambiguously classify: atypical AGUS (cervical canal) or ASCUS (part of the outer cervix) cells. So you have to cure the infection, and then do another, follow-up cytology. The LSIL result shows that there are single cells in the sample that can develop into tumors. Perhaps it is also inflammation. The cytological picture of HSIL shows that there are many cells in the smear, from which neoplasms can arise. Along with the cytology result, information about whether the sample collected for analysis is suitable for evaluation is also provided. If not, the test must be repeated.
Additional studies
When the results are in doubt, your doctor may perform additional tests. Colposcopy is an important test specifying the direction of treatment, which gives information about whether or not a procedure should be performed. – This examination allows to assess the basis of the lesion, the presence of abnormal vessels, or to determine the place of a possible specimen collection. Hence, it is recommended when we are dealing with large cytological changes – explains Dr. Południewski. Another examination is taking a sample, i.e. removing a tissue fragment, and subjecting it to a histopathological examination. Often, taking a sample is also a healing process because the entire lesion is taken. – At the moment, there is a lot of availability of this specific form of treatment, the so-called loop, where we remove the entire lesion from the neck with an electric loop and can be tested immediately. There is a possibility of introducing minor procedures to remove the lesion on the cervix after colposcopy, or after taking the sample, the lesion can be removed by laser, freezing or electroconization. Most often, we decide on this type of procedure when the changes are large, chronic, or the patient does not plan to become pregnant in the near future, then we can operate the cervix – adds the gynecologist.
Management of individual cytology results
ASC-US lesions and even CIN I lesions, i.e. small dysplastic lesions, are treated conservatively, without the need for surgical intervention, because they are inflammatory lesions of varying severity. In the case of HSIL lesions, i.e. CIN II, CIN III, we must take into account high-grade dysplasia, which should be treated surgically. These changes require further detailed diagnosis. In addition, colposcopic verification is recommended – on its basis, we can work out a specific decision, e.g. about taking a sample or surgery to remove these changes from the cervix. It is a sparing procedure. It is worth noting that changes with high-grade dysplasia do not mean that there are cancer cells there. – It may happen that we find cancer cells in large dysplasia, but we can only recognize them histopathologically, i.e. by taking a sample. Non-invasive and non-threatening changes to the Bethesda system are often interpreted as severe changes. Then, less sparing operations are performed – says Dr. Południewski. In the case of neoplastic conditions, the description includes: squamous cell carcinoma. This is a diagnosis typical of cancer cells. This is when oncological treatment begins.
The presence of HPV
We cannot cure the HPV virus, because there are no drugs to eliminate it directly. HPV infections are very common, affecting 40-50% of the population. However, only those that are chronic are dangerous. Then the HPV virus exists in the epithelium for a long time, causing moderate and high degree of dysplasia changes. In many cases, it can heal itself. Then the epithelium is shed and everything returns to normal, and the HPV infection may or may not remain. Thanks to anti-inflammatory treatment, we can prevent a chronic infection from developing. Exfoliating treatment or maintaining a normal bacterial flora favor the body’s natural defenses against viral infection. – With viruses it is not as easy as with bacteria, where we have an antibiotic and the bacteria dies. In the case of viruses, administering even antiviral drugs does not destroy them all. Therefore, we need to strengthen and create the immunity of the body that defends itself against this virus. Pre-vaccination is such a method. If the body has information on how to deal with this virus, it will also not lead to this type of changes in the epithelium, argues Dr. Południewski. It is best to vaccinate yourself against HPV infection before having sex. However, there are studies, e.g. in Australia, where the entire population is vaccinated. Preliminary results show that people who have even been exposed to the virus and are vaccinated have a significantly lower risk of developing CIN II and CIN III lesions due to the presence of antibodies. This looks a bit like a therapeutic vaccination.
Surgical intervention
Surgical intervention is necessary when dealing with moderate or high degree of dysplasia (CIS, CIN II, CIS III). – However, in the case of LSIL, we do not use surgical treatment. However, if someone decides to cut out such changes, it does not mean that they will suffer any health damage. In my opinion, this is an exaggerated solution. Keep in mind that some of these infections go away on their own. We must be aware that in this type of lesions, processes that lead to cancer take years. It could be 5 or even 15 years. Maintaining this state for many years may have negative consequences – explains Dr. Południewski. The only procedure that may cause complications is cervical amputation – partial or complete. Excessive, unnecessary excision of lesions may affect the function of the uterus, i.e. increase the risk of miscarriages, premature births due to damage to the cervical muscular apparatus. – It does not mean, however, that such a patient will not be able to have children. The risk is greater, but it is a risk that gives you a chance to report. Every year I have 2-3 patients after cervical amputation who give birth to children – says Dr. Południewski.
Prognosis in individual cytology results
— The prognosis is very good in all cases. It all depends on our conduct. If we are dealing with larger cytological changes (CIS, CIN II and CIN III), the prognosis is very good, because even in the presence of neoplastic cells, the cure rate is 95-98%. We just delete the change and nothing happens. In the case of microinvasion with early stage squamous cell carcinoma, as is evidently described, the cure rate is 95%. In the case of advanced invasion with infiltration, there is a greater problem because the effectiveness of the therapy drops sharply – explains Dr. Południewski. Therefore, the Bethesda cytology and system is designed to detect changes as early as possible, determine what type of change it is and remove these changes as early as possible, potentially with a chance of transforming into a neoplastic change.