15.) Technique Of Cervical And Vaginal Cytological And Microbiological Test Flashcards
What is the purpose of a Pap smear, and how does it help in cancer prevention?
A Pap smear screens for cervical cancer and precancerous changes by detecting abnormal cells in the cervix, especially at the transformation zone, where high cell turnover and HPV infection risks are greatest. It acts as secondary prophylaxis, allowing early detection and treatment to prevent cancer progression.
Describe the anatomy relevant to Pap smear collection: ectocervix, endocervix, and the transformation zone.
The ectocervix (outer cervix) has nonkeratinized squamous epithelium, while the endocervix (cervical canal) has a single layer of columnar cells. The transformation zone, where these two cell types meet, is highly susceptible to abnormal changes and HPV infection, making it a key area for Pap smear sampling.
What is the significance of the transformation zone in cervical cytology?
The transformation zone is where squamous and columnar epithelial cells transition, creating a site of high cell turnover. This area is more vulnerable to DNA mutations, particularly due to HPV infection, which can lead to dysplasia or precancer.
What tools are needed for a Pap smear?
A speculum, endocervical brush, ectocervical spatula, glass slides, and a saline container.
Describe the process of taking a Pap smear.
Insert the speculum, then use a swab in the endocervix, rotating it 360° and smearing it on a glass slide. Repeat in the ectocervix. The slides are fixed with ethanol and sent to cytology.
What are the key results categories in a Pap smear and their implications?
Group 1 & 2: Normal histology, no treatment needed.
Group 3: Atypical cells needing repeat testing in 2 weeks, often with anti-inflammatory treatment.
Group 4 & 5: Abnormal cells suggesting potential cancer, requiring colposcopy and biopsy.
How is dysplasia classified based on the extent of atypical cell presence?
Mild dysplasia (CIN I): Atypical cells cover 1/3 of the epithelium.
Moderate dysplasia (CIN II): Atypical cells cover 1/2 of the epithelium.
Severe dysplasia (CIN III): Atypical cells cover more than 3/4 of the epithelium, potentially leading to carcinoma in situ if untreated.
What is conization, and when is it indicated?
Conization is the excision of a cone-shaped portion of the cervix, including the transformation zone. It is indicated in cases of severe dysplasia (CIN III) or carcinoma in situ, to remove precancerous or early cancerous cells.
What is the procedure for microbiological testing of cervical and vaginal secretions?
After placing a speculum, swab the exocervix and vaginal fornix without rotation. Roll the swab onto a glass slide for microscopic examination and place it in a sterile tube for further analysis. The slide is not ethanol-fixed, as it needs to be examined in its native state.
What is colposcopy, and why is it performed?
Colposcopy provides a magnified view of the cervix, vulva, and vagina, often after abnormal Pap results or post-coital bleeding. It involves applying 5% acetic acid or Lugol’s iodine to highlight abnormal areas for targeted biopsy.
Describe the findings in colposcopy that may indicate pathology.
Pathological signs include:
Leukoplakia: White patches on the cervix.
Erythroplakia: Red patches indicating abnormal vascularity.
Atypical blood vessels or erosions: May suggest high-grade lesions or cancer.
Papillary growths: Potential sign of HPV-related lesions.
How is a biopsy taken and processed after colposcopy?
After identifying abnormal areas, a punch biopsy is taken and preserved in 10% formalin for histological analysis. This step confirms the presence and extent of dysplasia or malignancy.
