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Sample Taker Sample Taker TrainingTraining
Cervical CytologyCervical Cytology
&&
Management of Management of AbnormalitiesAbnormalities
Cervical Cytology ResultsCervical Cytology Results
•Negative•Negative with infection•Unsatisfactory•Abnormal
Types of Cells SeenTypes of Cells Seen
Mature Cell PatternMature Cell Pattern
• Pre-menopause• HRT• Oestrogen cream• Tamoxifen• Obese women
Immature Cell Pattern – Immature Cell Pattern – Oestrogen DeficientOestrogen Deficient
• Post menopausal• Post-natal• Depoprovera
Evidence of Transformation Evidence of Transformation Zone SamplingZone Sampling
Endocervical Cells
and/or
Metaplastic Cells
Background Blood CellsBackground Blood Cells
Polymorphs Red Blood Cells
A lot of the blood is removed during processing but occasionally may be noticeable in the background of the sample
Endometrial CellsEndometrial Cells
These come from the womb lining
May be shed during menstruation together with blood
Late Menstrual CycleLate Menstrual Cycle
Cells break up & some detail is lost
Best time to take a smear?Best time to take a smear?
• Menstruation – no (Days 1-5)• Proliferative phase – OK• Ovulation – OK• Avoid the later days of the cycle
if possible
InfectionsInfections
• Candida
• Trichomonas (TV)
• Herpes
Rarely worm eggs maybe seen = contaminant
Unsatisfactory SamplesUnsatisfactory Samples• Reason for unsatisfactory given in
report– May help when taking repeat sample
e.g. treatment of infection or topical oestrogen treatment
• Repeat in 3 months (minimum)
• After 3 unsatisfactory samples – refer to colposcopy
Abnormal Abnormal ResultsResults
Cervical AbnormalitiesCervical Abnormalities• May be squamous or glandular in
origin
• Non-cervical abnormalities including metastatic cancer may be seen (rare)
Abnormalities That May Be Abnormalities That May Be Seen On Cervical SamplesSeen On Cervical Samples
Squamous Abnormalities - CIN (Cervical Intraepithelial Neoplasia)
Endocervical Abnormalities (Glandular Neoplasia)
Glandular Neoplasia (non-cervical) – cells may shed but NOT directly sampled
Squamous DyskaryosisSquamous Dyskaryosis• Cytological term
meaning abnormal nucleus
Progression of CINProgression of CIN
Normal Cells
Low grade dyskaryosis
Borderline changes
Moderate dyskaryosis
Severe dyskaryosis
Cancer
Treatment
Normal
If left untreated (36%)
HPV / Smoking etc.
Squamous AbnormalitiesSquamous Abnormalities• Borderline Changes• Mild dyskaryosis
• Moderate dyskaryosis• Severe Dyskaryosis
• Severe/?invasive carcinoma
Low Grade
High Grade
Borderline ChangesBorderline Changes
Minor changes seen but not dyskaryotic
CIN 1 CIN 2 CIN 3
mild moderate severenormal
CIN1 CIN2 CIN3 (in a crypt) CANCER
MILD DYSK MODERATE SEVERE SEV/?INV
Basement membrane
Cervical Cancer - SquamousCervical Cancer - Squamous
ManagementManagement• Low grade
• High grade
• Severe dyskaryosis / ?invasion
HPV test to decidemanagement
Colposcopy referral
URGENT colposcopyreferral
Glandular Abnormalities That May Be Glandular Abnormalities That May Be Seen On Cervical SamplesSeen On Cervical Samples
Endocervical Abnormalities (Glandular Neoplasia)
Glandular Neoplasia (non-cervical) – cells may shed but NOT directly sampled
Glandular AbnormalitiesGlandular AbnormalitiesBorderline Changes
?Glandular Neoplasia(Cervix)
?Glandular Neoplasia(Other)
HPV Test to decide management
Urgent referral to colposcopy
Urgent referral to gynae
Do not delay referrals if Do not delay referrals if clinical symptomsclinical symptoms
• A negative cervical sample does NOT exclude a non-cervical abnormality e.g. womb cancer, ovarian cancer
• Post menopausal bleeding – refer to gynae
• If cervix looks suspicious refer to colposcopy
• Don’t wait for cytology result
Malignant looking cervixMalignant looking cervix
Summary of ManagementSummary of Management
Low grade abnormalities
HPV test
High grade dyskaryosis
Colposcopy
Glandular abnormalities
Cervical
Non-cervical
+ve
-ve Routine Recall
Gynae
Early Repeat TestsEarly Repeat Tests• If HPV testing is not performed early
repeat tests may be requested.– Repeat interval indicated on report– Patient recalled by letter
Early Repeat SamplesEarly Repeat Samples- HPV Test - HPV Test NOTNOT Performed Performed
• Low grade abnormalities– 6 or 12 month repeat samples
• (3 negative results before return to routine recall)
• High grade abnormalities after treatment – 12 month repeat samples
• (10 annual repeats before return to routine recall)
Management after Management after HysterectomyHysterectomy
• NOT followed up by the CERVICAL screening programme – cease recall
– Follow up is the responsibility of the Gynaecologist
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