Papanicolaou Test (Pap Smear)
The Papanicolaou test (Pap smear) is a widely known cystologic test for early detection of cervical cancer. The can also be used to detect cancerous cells of the breast, lung, stomach, and renal system. A physician or specifically trained nurse scrapes secretions from the patient’s cervic and spreads them on a slide, which is sent to the laboratory for cystologic analysis.
An alternative method is to use the ThinPrep preservative solution rather than a slide. The ThinPrep was introduced in 1996 and allows testing for malignancy cells from the cervix and shows the cell maturity, metabolic activity, and morphology variations.
The American Cancer Society recommends a Pap test every 3 years for women between ages 20 and 40 who aren’t in a high-risk category and who have had negative results from three previous Pap tests. Yearly tests (or tests at physician-recommended intervals) are advised for women older than age 40, for those in a high risk category, and for those who had a positive test previously. If a Pap test is positive or suggest malignancy, cervical biopsy can confirm the diagnosis.
Purpose of Pap Smear
- To detect malignant cells.
- To detect inflammatory changes in tissue.
- To assess response to chemotherapy and radiation therapy.
- To detect viral, fungal, and occasionally, parasitic invasions.
Pap Smear Procedure
- Instruct the patient to avoid intercourse for 24 hours, douching for 48 hours, and vaginal creams or medication for 1 week.
- Just before the test, instruct the patient to empty her bladder.
- During the procedure, she might experience a slight discomfort but no pain from the speculum; however, she may feel some pain when the cervix is scraped.
- Explain the procedure takes only 5 to 10 minutes to perform.
- Instruct the patient to disrobe from the waist down and to drape herself.
- Ask her to lie on the examining table and to place her heels in the stirrups.
- Tell her to slide her buttocks to the edge of the table.
- The patient is assisted into the lithotomy position with her feet in the stirrups.
- An unlubricated speculum is inserted into the vagina.
- The cervix is located.
- Secretions from the cervix and material from the endocervical canal are collected with an endocervical brush and wooden spatula.
- Specimens are spread on slides and immediately immersed in fixative or sprayed with a fixative.
- Specimens are appropriately labeled with date of last menses, collection site, and method.
- If vaginal or vulval lesions are present, scrapings taken directly from the lesion are preferred.
- The slides are preserved immediately.
- Help the patient up and ask her to dress when the examination is completed.
- Supply the patient with a sanitary napkin if cervical bleeding occurs.
- Tell the patient when to return for her next Pap test.
- No malignant cells or abnormalities are present.
- Cells with relatively large nuclei, only small amounts of cytoplasm, abnormal nuclear chromatin patterns, and marked variation in size, shape, and staining properties, with prominent nucleoli, suggest malignancy.
- Atypical but nonmalignant cells suggest a benign abnormality.
- Atypical cells may suggest dysplasia.
- Douching within 24 hours of testing.
- Excessive use of lubricating jelly on the slide.
- Collection of specimen during menstruation
- Delay in fixing the specimens
- Consistency of specimen too thin or too thick.
- Preserve the slides immediately after the specimen is collected.
- Preserve the ThinPrep solution by immediately placing the lid back on the container, as exposure to air or light can cause distortion of cells.