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 Pap Smear Primer
"The most important thing women should realize about the Pap smear is that it is a screening test," said M. Denice Leonard, D.O., Department of Obstetrics and Gynecology at Allegheny General Hospital. "The test helps ensure that women with cervical disease can be found. There will be false positives with the Pap just as there are with other screening tests." During a Pap smear, the physician collects a sample of cells from the cervix using a small endocervical brush. Pap smears are sent to Allegheny General's Cytology Laboratory, accredited by the College of American Pathologists. A cytotechnologist screens each slide and looks for abnormalities. If an abnormality is detected, the slide is reviewed by a pathologist. For quality assurance, 10 percent of all normal slides also are rescreened by pathologists, all of whom are board-certified in cytopathology. ThinPrepPap smears may be processed in different ways. With ThinPrep, the procedure used at AGH, the sample is placed in a fluid-filled vial. Once at the laboratory, a technician centrifuges the vial and evenly spreads a sample of the cells on a slide. "With this method, the cytotechnologist gets a thin layer of cells on the slide, making it easier to see the individual cells," Dr. Leonard said. In the traditional method, technical problems may occur in preparing the slide: Some may be too thick with cells; others may not be properly fixed. With the ThinPrep sample, if an abnormality is found on the Pap smear, the cytotechnologist can use the remaining cervical cells in the fluid to screen another slide for verification or perform additional studies. With a traditional Pap smear, this is not possible without a repeat test..
What the results meanOnce the Pap smear results are determined, they are sent to the gynecologist's office. An abnormal finding can mean different things, depending on the specific results of your test. When physicians receive Pap smear reports, screening results may state negative for intrepithelial lesion or malignancy or it may identify benign changes. Benign changes can represent an infection, such as a yeast infection, and basically are normal, according to Dr. Leonard. Low-grade squamous intraepithelial lesion (SIL), high-grade SIL, atypical squamous cells of undetermined significance or other abnormal result require further evaluation to determine if a problem exists. "Depending on the patient's history, a repeat Pap smear may be all that is needed. If another Pap smear is completed in a few months and the results are normal, often no further steps are required," said Dr. Leonard. SIL results may require a colposcopy, which is a diagnostic test for cervical disease. A magnifying instrument called a colposcope allows physicians to look at the cervix and delineate abnormal areas. A biopsy instrument takes a small piece of the tissue as a representative segment of the abnormal area. The biopsy is sent to the laboratory to be evaluated by a pathologist for a diagnosis. Preparing for your Pap smearWomen can take some steps to help ensure their Pap smears will provide a good sample for screening. The following list represents the ideal -- with busy lifestyles and scheduling, it may not be possible to follow each suggestion.
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