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Encyclopedia > Pap smear

In gynecology, the Papanikolaou test or Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a medical screening method, invented by Georgios Papanikolaou, primarily designed to detect premalignant and malignant processes in the ectocervix. It may also detect infections and abnormalities in the endocervix and endometrium. The shamefulness associated with the examination of female genitalia has long inhibited the science of gynaecology. ... Screening, in general, is the investigation of a great number of something (for instance, people) looking for those with a particular problem or feature. ... George Papanikolaou on a Greek 10,000 Drachma note. ... The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ...


The endocervix may be partially sampled with the device used to obtain the ectocervical sample, but due to the anatomy of this area, consistent and reliable sampling cannot be guaranteed. As abnormal endocervical cells may be sampled, those examining them are taught to recognize them.


The endometrium is not directly sampled with the device used to sample the ectocervix. Cells may exfoliate onto the cervix and be collected from there, so as with endocervical cells, abnormal cells can be recognised if present but the Pap Test should not be used as a screening tool for endometrial malignancy.


The pre-cancerous changes (called dysplasias or cervical or endocervical intraepithelial neoplasia) are usually caused by sexually transmitted human papillomaviruses (HPVs). The test aims to detect and prevent the progression of HPV-induced cervical cancer and other abnormalities in the female genital tract by sampling cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix. The sampling technique changed very little since its invention by Georgios Papanikolaou (1883–1962) to detect cyclic hormonal changes in vaginal cells in the early 20th century until the development of liquid based cell thinlayer technology. The test remains an effective, widely used method for early detection of cervical cancer and pre-cancer. The UK's call and recall system is among the best; estimates of its effectiveness vary widely but it may prevent about 700 deaths per year in the UK. It is not a perfect test. "A nurse performing 200 tests each year would prevent a death once in 38 years. During this time she or he would care for over 152 women with abnormal results, over 79 women would be referred for investigation, over 53 would have abnormal biopsy results, and over 17 would have persisting abnormalities for more than two years. At least one woman during the 38 years would die from cervical cancer despite being screened."[1] HPV vaccine may offer better prospects in the long term. Dysplasia (latin for bad form) is an abnormality in the appearance of cells indicative of an early step towards transformation into a neoplasia. ... “HPV” redirects here. ... Cervical cancer is a malignancy of the cervix. ... A sex organ, or primary sexual characteristic, narrowly defined, is any of those parts of the body (which are not always bodily organs according to the strict definition) which are involved in sexual reproduction and constitute the reproductive system in an complex organism; namely: Male: penis (notably the glans penis... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell. Cells in culture, stained for keratin (red) and DNA (green). ... Schematic frontal view of female anatomy The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... George Papanikolaou on a Greek 10,000 Drachma note. ... Human papillomavirus vaccine (HPV) is a vaccine designed to immunize against certain sexually transmitted diseases, such as cervical cancer and genital warts, which are caused by human papillomaviruses. ...


It is generally recommended that sexually active females seek Pap smear testing annually, although guidelines may vary from country to country. If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in three to twelve months. If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by colposcopy. The patient may also be referred for HPV DNA testing, which can serve as an adjunct (or even as an alternative) to Pap testing. A colposcopy or colcoscopy is a diagnostic procedure in which a colposcope is utilized to examine an illuminated, magnified view of the cervix, vagina, and vulva. ... It has been suggested that this article or section be merged into Human papillomavirus. ...


About 5% to 7% of pap smears produce abnormal results, such as dysplasia, possibly indicating a pre-cancerous condition. Although many low grade cervical dysplasias spontaneously regress without ever leading to cervical cancer, dysplasia can serve as an indication that increased vigilance is needed. Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including yeast and Trichomonas vaginalis. A small proportion of abnormalities are reported as of "uncertain significance". Dysplasia (latin for bad form) is an abnormality in the appearance of cells indicative of an early step towards transformation into a neoplasia. ... Cervical cancer is a malignancy of the cervix. ...

Contents

Technical aspects

Samples are collected from the outer opening or os of the cervix using an Aylesbury spatula or (more frequently with the advent of liquid-based cytology) a plastic-fronded broom. The cells are placed on a glass slide and checked for abnormalities in the laboratory. For other uses of lab, see Lab. ...


The sample is stained using the Papanicolaou technique, in which tinctorial dyes and acids are selectively retained by cells. Unstained cells can not be visualized with light microscopy. The stains chosen by Papanicolau were selected to highlight cytoplasmic keratinization, which actually has almost nothing to do with the nuclear features used to make diagnoses now.


The sample is then screened by a specially trained and qualified cytotechnologist using a light microscope. The terminology for who screens the sample varies according the country; in the UK, the personnel are known as Cytoscreeners, Biomedical scientists (BMS), Advanced Practitioners and Pathologists. The latter two take responsibility for reporting the abnormal sample which may require further investigation. Robert Hookes microscope (1665) - an engineered device used to study living systems. ... This article needs to be cleaned up to conform to a higher standard of quality. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...


Studies of the accuracy of conventional cytology report:

In the United States, physicians who fail to diagnose cervical cancer from a pap smear have been convicted of negligent homicide. In 1988 and 1989, Karen Smith had received pap smears which were argued to have "unequivocally" shown that she had cancer; yet the lab had not made the diagnosis. She died on March 8, 1995. Later, a physician and a laboratory technician were convicted of negligent homicide. These events have led to even more rigorous quality assurance programs, and to emphasizing that this is a screening, not a diagnostic, test, associated with a small irreducible error rate. The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The Doctor by Luke Fildes This article is about the term physician, one type of doctor; for other uses of the word doctor see Doctor. ... Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ... Negligent homicide is a charge brought against persons, who by inaction, allow others under their care to die. ... Year 1988 (MCMLXXXVIII) was a leap year starting on Friday (link displays 1988 Gregorian calendar). ... Year 1989 (MCMLXXXIX) was a common year starting on Sunday (link displays 1989 Gregorian calendar). ... is the 67th day of the year (68th in leap years) in the Gregorian calendar. ... Year 1995 (MCMXCV) was a common year starting on Sunday (link will display full 1995 Gregorian calendar). ...


Liquid based monolayer cytology

Since the mid-1990s, techniques based around placing the sample into a vial containing a liquid medium which preserves the cells have been increasingly used. The media are primarily ethanol based. Two of the types are Sure-Path (TriPath Imaging) and Thin-Prep (Cytyc Corp). Once placed into the vial, the sample is processed at the laboratory into a cell thin-layer, stained, and examined by light microscopy. The liquid sample has the advantage of being suitable for low and high risk HPV testing. Proper sample acquisition is crucial to the accuracy of the test; clearly, a cell that is not in the sample cannot be evaluated. Grain alcohol redirects here. ...


Studies of the accuracy of liquid based monolayer cytology report:

Some, but not all studies[2][3][4], report increased sensitivity from the liquid based smears. The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ...


Human papillomavirus testing

The presence of HPV indicates that the person has been infected, the majority of women who get infected will successfully clear the infection within 18 months. It is those who have an infection of prolonged duration with high risk types[5] (e.g. types 16,18,33,35) that are more likely to develop Cervical Intraepithelial Neoplasia due to the effects that HPV has on DNA. “HPV” redirects here. ...


Studies of the accuracy of HPV testing report: “HPV” redirects here. ...

  • sensitivity 88% to 91% (for detecting CIN 3 or higher)[3] to 97% (for detecting CIN2+)[6]
  • specificity 73% to 79% (for detecting CIN 3 or higher)[3] to 93% (for detecting CIN 3 or higher)[6]

By adding the more sensitive HPV test, the specificity may decline. However, the drop in specificity is not definite. [7] If the specificity does decline, this results in increased numbers of false positive tests and many women who did not have disease having colposcopy[8] and treatment. A worthwhile screening test requires a balance between the sensitivity and specificity to ensure that those having a disease are correctly identified as having it and equally importantly those not identifying those without the disease as having it. Due to the liquid based pap smears having a false negative rate of 15-35%, the American College of Obstetricians and Gynecologists[citation needed] and American Society for Colposcopy and Cervical Pathology[9] have recommended the use of HPV testing in addition to the pap smear in all women over the age of 30. The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... Screening, in medicine, is a strategy used to identify disease in an unsuspecting population. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. ... “HPV” redirects here. ...


Regarding the role of HPV testing, randomized controlled trials have compared HPV to colposcopy. HPV testing appears as sensitive as immediate colposcopy while reducing the number of colposcopies needed.[10] Randomized controlled trial have suggested that HPV testing could follow abnormal cytology[3] or could precede cervical cytology examination.[6] “HPV” redirects here. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... “HPV” redirects here. ... A colposcopy or colcoscopy is a diagnostic procedure in which a colposcope is utilized to examine an illuminated, magnified view of the cervix, vagina, and vulva. ... “HPV” redirects here. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... A colposcopy or colcoscopy is a diagnostic procedure in which a colposcope is utilized to examine an illuminated, magnified view of the cervix, vagina, and vulva. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... “HPV” redirects here. ...


Automated analysis

In the last decade there have been successful attempts to develop automated, computer image analysis systems for screening.[11] One of these has been FDA approved and functions in high volume reference laboratories, with human oversight.


Practical aspects

The physician or operator collecting a sample for the test inserts a speculum into the patient's vagina, to obtain a cell sample from the cervix. A pap smear appointment is normally not scheduled during menstruation, and patients should avoid contamination of the vagina and uterus (for example by a douche) before the exam, to avoid false results. The procedure is usually just slightly painful, because of the neuroanatomy of the cervix. However, this can depend on the patient's anatomy, the skill of the practitioner, psychological factors, and other conditions. Results usually take about 3 weeks. Slight bleeding, cramps, and other discomfort can occur afterwards. A vaginal speculum, such as this Ricord-type speculum, is used to hold the vagina open for visual examinations, taking of samples, or surgery. ... Schematic frontal view of female anatomy The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... A douche (IPA: ) is a device used to introduce a stream of water into the body for medical or hygienic reasons, or the stream of water itself. ... Human heart and lungs, from an older edition of Grays Anatomy. ...


Popular culture

  • On the TV series Scrubs, John Dorian mentions having to give pap smears to all the smoke detectors in the hospital and finding one with a bit of a yeast problem.
  • A villain in the Naked Gun films is called Papschmir, in an obvious reference to this kind of test.
  • Georg Ruthenberg, guitarist for L.A. punk rock band the Germs, Nirvana and The Foo Fighters, renamed himself "Pat Smear" in reference to the procedure.
  • Haru, played by Chris Farley, in Beverly Hills Ninja tries to convince the film's villain he is a money printing technician by saying he needs to run 'a pap smear...test' when he misprints pages of money.
  • In the film Slacker, a girl, played by Butthole Surfers' drummer Teresa Taylor, tries to sell Madonna's pap smear. [1].
  • On the TV series Scrubs, Jordan Sullivan is noted to have had seven Pap Smears in one month; she states "I've got a lot of Pap".
  • In the film White Chicks, Shawn Wayans says during the girl fight, "Your mother is so dumb, she went to Dr. Dre for a pap smear. 'Something's wrong, Dr. Dre, my coochie is doing a beatbox.'"
  • In the TV show Dead Like Me, George attempts to get out of work by saying she has a pap test appointment
  • Often referred to as an unofficial nickname of the Port Adelaide Football Club currently in the Australian Football League.
  • Title of the 11th episode of the tv show Dirt starring Courtney Cox.
  • In the US version of The Office, Michael asks what a Pap Smear is "or is it Shmear, like cream cheese?"

Scrubs is an Emmy- and Peabody Award-winning American situation comedy/dramedy that premiered on October 2, 2001 on NBC. Scrubs was created by Bill Lawrence, who also co-created Spin City. ... John Dorian (portrayed by Zach Braff) Dr. Jonathan Michael Dorian (most commonly referred to as J.D.) is a fictional character played by Zach Braff in the American sitcom Scrubs. ... The Naked Gun is the name of a series of comedy movies starring Leslie Nielsen, Priscilla Presley and OJ Simpson. ... Pat Smear, born Georg Ruthenberg, is a rock guitarist. ... Punk rock is an anti-establishment music movement beginning around 1976 (although precursors can be found several years earlier), exemplified and popularised by The Ramones, the Sex Pistols, The Clash and The Damned. ... The Germs are a punk rock band from Los Angeles formed in the late 1970s. ... Nirvana was an American Grunge band that formed in Aberdeen, Washington. ... This article is about the band. ... Beverly Hills Ninja is a 1997 film staring Chris Farley as a bumbling Beverly Hills ninja hot on the tracks of the Criminal Element. ... Slacker (1991) is an American independent film directed by Richard Linklater. ... Butthole Surfers are an American punk band, founded by lead vocalist Gibby Haynes and guitarist Paul Leary in San Antonio, Texas, in 1981. ... Teresa Taylor was the drummer for the band Butthole Surfers from Houston, Texas and featured in the film Slacker selling a Pap smear from Madonna. ... Madonna Louise Ciccone Ritchie (born August 16, 1958), better known as simply Madonna, is a six-time Grammy[1] and one-time Golden Globe award winning American pop singer, songwriter, record and film producer, dancer, actress, author and fashion icon. ... Scrubs is an Emmy- and Peabody Award-winning American situation comedy/dramedy that premiered on October 2, 2001 on NBC. Scrubs was created by Bill Lawrence, who also co-created Spin City. ... Information Gender Female Age late 30s Occupation Board member Family Quinn (father),Ben (brother), Danni (sister) Relationships Perry Cox (divorced) Children Jack, Jennifer Dylan Portrayed by Christa Miller Created by Bill Lawrence Jordan Sullivan, played by Christa Miller, is a character on the TV series Scrubs. ... White Chicks is a 2004 American comedy film directed by Keenen Ivory Wayans and written by Keenen Wayans, Shawn Wayans and Marlon Wayans. ... Shawn Wayans (born January 19, 1971 in New York City, New York) is an American actor and comedian who starred in In Living Color and The Wayans Bros. ... This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ... Dead Like Me is an American television comedy-drama created by Bryan Fuller for the Showtime network starring Ellen Muth and Mandy Patinkin as grim reapers in Seattle, Washington. ... George Lass, portrayed by Ellen Muth Photo by Carole Segal/Showtime Georgia George Lass (1985–2003) is a fictional character on the Showtime comedy-drama Dead Like Me. ... The Port Adelaide Football Club, often referred to as simply Port, is an Australian rules football club based in Adelaide, South Australia. ... This article is about the national league in Australian rules football. ... DiRT (also Colin McRae: DiRT) is the sixth series of Colin McRae Rally, developed by Codemasters. ... Courteney Cox in Misfits of Science Courteney Cox Arquette (born June 15, 1964 in Birmingham, Alabama, USA) is an American actress. ...

References

  1. ^ Raffle AE, Alden B, Quinn M, Babb PJ, Brett MT (2003). "Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented". BMJ 326 (7395): 901. DOI:10.1136/bmj.326.7395.901. PMID 12714468. 
  2. ^ a b c d e Coste J, Cochand-Priollet B, de Cremoux P, et al (2003). "Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening". BMJ 326 (7392): 733. DOI:10.1136/bmj.326.7392.733. PMID 12676841.  [ACP Journal Club]
  3. ^ a b c d e f Kulasingam SL, Hughes JP, Kiviat NB, et al (2002). "Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: comparison of sensitivity, specificity, and frequency of referral". JAMA 288 (14): 1749-57. PMID 12365959. 
  4. ^ Ronco G, Cuzick J, Pierotti P, et al (2007). "Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening randomised controlled trial". BMJ. DOI:10.1136/bmj.39196.740995.BE. PMID 17517761. 
  5. ^ Cuschieri KS, Cubie HA, Whitley MW, et al (2005). "Persistent high risk HPV infection associated with development of cervical neoplasia in a prospective population study". J. Clin. Pathol. 58 (9): 946-50. DOI:10.1136/jcp.2004.022863. PMID 16126875. 
  6. ^ a b c Cuzick J, Szarewski A, Cubie H, et al (2003). "Management of women who test positive for high-risk types of human papillomavirus: the HART study". Lancet 362 (9399): 1871-6. PMID 14667741. 
  7. ^ Arbyn M, Buntinx F, Van Ranst M, Paraskevaidis E, Martin-Hirsch P, Dillner J (2004). "Virologic versus cytologic triage of women with equivocal Pap smears: a meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia". J. Natl. Cancer Inst. 96 (4): 280-93. PMID 14970277. 
  8. ^ http://screening.iarc.fr/colpochap.php?lang=1&chap=4
  9. ^ Wright TC, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ (2002). "2001 Consensus Guidelines for the management of women with cervical cytological abnormalities". JAMA 287 (16): 2120-9. PMID 11966387. 
  10. ^ ASCUS-LSIL Traige Study (ALTS) Group. (2003). "Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance". Am. J. Obstet. Gynecol. 188 (6): 1383-92. PMID 12824967. 
  11. ^ Biscotti CV, Dawson AE, Dziura B, et al (2005). "Assisted primary screening using the automated ThinPrep Imaging System". Am. J. Clin. Pathol. 123 (2): 281-7. PMID 15842055. 

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links


  Results from FactBites:
 
Abnormal pap smear: cervical dysplasia, and treatment of abnormal pap test (288 words)
Although cervical cancer is the first thing that may comes to mind, most of the time an abnormal pap smear indicates a minor problem with the cervix that may or may not need treatment.
During a pap smear some cells are scraped or brushed off the cervix, and prepared on a slide that can be examined under a microscope.
Years ago, pap smears were graded on a scale from 1 to 5, with 1 being normal and 5 being cancer.
Pap smear information on MedicineNet.com (810 words)
A Pap smear (also known as the Pap test) is a medical procedure in which a sample of cells from a woman's cervix (the end of the uterus that extends into the vagina) is collected and spread (smeared) on a microscope slide.
The Pap smear is not intended to detect other forms of cancer such as those of the ovary, vagina, or uterus.
Pap smear testing is not indicated for women who have hysterectomy (with removal of the cervix) for benign conditions.
  More results at FactBites »

 
 

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