Pap Flashcards
what is a pap?
A screening tool for premalignant cervical changes, NOT a diagnostic test
cervical cells are removed from where?
from the ectocervix, transforamtion zone, and endocervical areas
pt symptoms very important because why?
false positives and false negatives can occur
the benefits of screening in decreasing the incidence and mortality of cervical cancer
need to be weighted against the risks of over diagnosis
2 main types of cervical cancer
squamous cell carcinoma (more prevalent) adenocarcinoma
screening can ??
detect precursors and early- stage disease for both types
treatment of precursors and early- stage disease can prevent ?
the development of invasive cervical cancer
cervical cancer screening recommended, however
whom to screen/ the optimal testing method (pap, HPV, both) and frequency are debated
how are squamous cervical cytologic abnormalities reported (those detected with Pap tests)
using the term cervical squamous intraepithelial lesions (CSIL)
cervical squamous intraepithelial lesions (CSIL) is stratified into 2 categories which are ??
low- grade squamous intraepithelial lesion (LSIL) high- grade squamous intraepithelial lesion (HSIL)
LSIL (especially in young women) associated with
generally a transient HPV infection
HSIL is more likely associated with
persistent HPV infection and a higher risk of progression to cervical cancer
cytologic (Pap) findings were described with the following term
squamous intraepithelial lesion (SIL)
histologic changes (always talking about a biopsy) described with the following term
cervical intraepithelial neoplasia (CIN)- this term CIN has 3 degrees of severity (grades 1 through 3, the higher the number the more serious the neoplastic changes are)
CIN 1 is
a low grade lesion, refers to MILDLY atypical cellular changes in the lower third of the epithelium. HPV cytopathic effect ( koilocytotic atypia) is often present
CIN 2 is
considered a high- grade lesion, refers to MODERATELY atypical cellular changes confined to the basal 2/3s of the epithelium (formally called moderate dysplasia) with preservation of epithelial maturation. There is considerable variability in this category
CIN 2 is stratified according to p16 immunostaining to identify precancerous lesion but
it has poor reproducibility and is likely a heterogeneous mix that includes lesions that could be called CIN 1 or 3.
specimens that are p16- negative are referred to are referred to as
LSIL
specimens that are p16- positive are referred to as
HSIL
CIN 3 is a ??
high- grade lesion, refers to SEVERELY atypical cellular changes encompassing GREATER than 2/3rds the epithelial thickness and includes full thickness lesions (previous terms were severe dysplasia or carcinoma in situ) referred to as HSIL
this is?
mild dysplasia, CIN 1
this is?
moderate dysplasia, CIN 2, p16 staining should be performed
this is?
severe dysplasia, CIN 3
this is?
Carcinoma in situ, CIN 3
changes in Bethesda guidelines
LSIL cervical cytologic specimens that contain a few cells that are suspicious but not diagnostic of HSIL are reported as atypical squamous cells and cannot exclude high- grade squamous intraepithelial lesion (previosuly there was no recommendation on how to report these)
another change in Bethesda guidelines
benign- appearing endometrial cells are reported only in women 45 years and older. (old threshold was 40 years old)
factors that may interfere with Pap
meds that alter results- digitalis and tetracylcine
vaginal meds/ contraceptives within 48 hrs of exam
use of lub on speculum
douching or tub baths within past 24 hrs
poor collection or fixation technique
contraindication for pap
menstruation
related test to pap
colposcopy- main role is to locate abnormal appearing epithelium and to dorect biopsies to areas in which cervical intraepithelial neoplasia (CIN) 2,3 or invasive ca is suspected
what is transformation zone
defined colposcopically as the area bordered laterally by the original squamocolumbnar junction and medially by the new sqiamocolumnar junction. Photo is showing: The original or native squamocolumnar junction (SCJ) migrates onto the portio as the result of changes in the hormonal milieu or of vaginal deliveries
teaching point- ASC-US
atypical squamous cells with uncertain significance- some cells not normal, but we don’t know why they changed or what impact they may have, usually not serious and may be d/t a vaginal infection or HPV, usually want a f/u exam repeat Pap or HPV testing
teaching point- ACS-H
atypical squamous cells- high- some cells are not normal and there is a small possibility that they may be pre cancerous, we will perform a colposcopy to better look at cervix
teaching point- AGC
atypical glandular cells- glandular cells produce mucus and are located in cervix or utuerus, these results mean some glandular cells are not normal but etiology is unclear. these changes are usually more serious, women with AGC have higher risk of cervical cancer, colposcopy recommended to examine any irregular tissue
teaching point- LSIL
low grade squamous intraepithelial lesion- low grade means there are early changes in teh size/ shape of cells. often associated with presence of HPV, which may also cause genital warts. colpocopy, HPV testing recommended, or repeat pap
teaching point- HSIL
high- grade squamous intraepithelial lesion- high grade means cells are very different from normal cells, usually precancerous and are more likely to lead to cervical cancer. colposcopy recommended to determine cancer risk
teaching point- inflammation
if inflammation is present in the cells on the pap, it means that some WBCs were seen, its very common and usually does not signify a problem. if the inlammation is severe, we want to figure out the cause there may be an infection, we may want a repeat pap to see if the inflamation has improved
teaching point- hyperkeratosis
this is a finding of dried skin cells on the pap. this change often occurs from using a cervical cap or diaphragm or from having a cervical infection. this rarely needs any more evaluation than a repeat pap in 6 mos- 1 year. if its still present we may want another pap or a colposcopy
