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How is a Pap Smear Performed?
Patients will be asked to remove
clothing below the waist and drape a paper cloth around the waist prior to the Pap smear. A
nurse or other healthcare professional maybe present to assist the physician.
To perform a Pap smear, the physician will begin by inserting a metal or plastic
instrument (called a speculum) into the vagina to keep it open so that the cervix may be
clearly seen. Next, he or she will use a small brush, cotton-tipped swab, or wooden
spatula to obtain a sample of cells and mucus from the outer part of the cervix (the
ectocervix). For women who have had their uteruses removed, a sample of vaginal cells is
collected. The samples of cells and fluid are then smeared on glass slides and taken to
the lab for examination under a microscope.
After the Pap smear is completed, the
physician will usually perform a pelvic exam to check the woman’s uterus, vagina,
ovaries, and fallopian tubes for any abnormalities in shape or size. Typically, the Pap
smear and pelvic exam take only a few minutes to complete. Though most women do feel some
discomfort, pressure, or cramping during the exams, neither test should be painful. Women
with tender, narrow, or irritated vaginas may experience more discomfort than others. Some
women experience slight vaginal bleeding after the Pap smear is completed.
Pap smears and pelvic exams may be
performed by physicians, physician assistants, nurse practitioners, or other specially
trained medical professionals.
Are There Any Risks to a Pap Smear?
While there is a very remote chance of
infection from a Pap smear, there are generally no risks.
How are Cervical Cells Evaluated?
After the physician obtains the
cervical cells, he or she will usually give the specimen to a nurse, physician’s
assistant, or other specially trained medical professional in the exam room who will smear
them on glass slides and take them to the lab to be evaluated. A new way of collecting
cervical cells involves placing the sampling device (spatula, brush, or broom) directly
into a liquid (see section below). The cells are then placed on slides in the laboratory.
In the lab, a pathologist or specially
trained laboratory technologist will analyze the cells under a microscope to determine
whether they are cancerous, pre-cancerous, or benign (non-cancerous).
How are the Results of a Pap Smear
Described?
Pap smear results are usually available
to patients within two weeks. The Bethesda System (TBS) is the most commonly used system
to describe Pap smear results, though some labs use older system such as the CIN (cervical
intraepithelial neoplasia) system or the Class system. The Bethesda system involves using
a number of descriptive terms instead of a number system.
First, the technologist or physician
will determine whether the cell sample is satisfactory for evaluation. If it is, he or she
will proceed with the analysis. A common reason why the cells may not be satisfactory for
evaluation is that too few cells were removed during the Pap smear. In this case, the Pap smear should be repeated.
If no abnormalities are found, the Pap
smear results are called negative. If an abnormality is found, then the results of the
test are positive.
The following terms may be used to
describe abnormal cervical cells:
- ASCUS: Minor cells changes of
unknown cause. The situation will be assessed.
- LSIL: Minor cell changes
unlikely to progress to cancer. For example, Certain strains of the human papillomavirus (HPV) may cause genital
warts.
- HSIL: Cell changes that may
progress to or are in the early stages of cancer.
- SIL: Abnormal cells are present in
the cervix. The term CIN is accompanied by a number (1 to 3) to describe how much of the
cervix contains abnormal cells.
- CIN 1: Mild cellular dysplasia. The
term dysplasia is used to describe cells that undergo a series of changes in their
appearance. They appear abnormal under a microscope but do not invade nearby healthy
tissue.
- CIN II: Moderate cellular dysplasia.
- CIN III: Severe cellular dysplasia.
- CIS: Carcinoma in situ. The term
"in situ" literally means "in place." Cancer is present but has not
spread into nearby tissue.
- Cervical cancer
- Endometriosis: Cells from the
lining of the uterus (endometrial cells) have moved outside of the uterus to the cervix.
- AGUS: Glandular cells are
found and the reason for their presence on the cervix is unknown.
- Glandular cancer: Cancer from
glandular cells in the cervix.
- Endometrial cancer: Cancer
from cells that line the uterus (endometrial cells).
- Other types of cancer: Cancer
that has spread to the cervix from other parts of the body.
- Other types of glandular cell cancer:
Glandular cell cancer that has spread to the cervix from other parts of the body.
If a patient has had her uterus removed
(hysterectomy), then cells from the vagina will be tested for abnormalities. In this case,
the description of the laboratory analysis is typically as follows:
- Normal findings for the patient’s
age and medical history.
- Abnormal findings for the patient’s
age and medical history, followed by specific reason.
- Evaluation not possible, followed by
specific reason.
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