بسم الله الرحمن

الرحيم

Gynecologic Cytopathology

Conventional Pap Smear

Historical overview

Cervical cytology practice guidelines

Tips for making good pap smear

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

Historical overview

Donne’s Atlas, Paris, 1845

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

1947 Ayre Cervical scraper

1986 Boon et al Endocervical brush

Period of critique (1970-1985)

CLIA (Clinical Laboratory Improvement Act)

Historical overview

CLIA (1988)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 FNThree separate situations

1 FP

4) Reported results are not appropriately understood

and the clinical follow-up is inadequate

Historical overview

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)

Cervical cytology practice guidelines

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

Tips for making good pap smear