Embed Size (px)
Citation preview
بسم الله الرحمن
الرحيم
Gynecologic Cytopathology
Conventional Pap Smear
Historical overview
Cervical cytology practice guidelines
Tips for making good pap smear
1845 Donne’s ATLAS (Paris) Vaginal Cells
1847 Pouchet’s Book (Paris) Vaginal Cells
1912 Schottlaender & Kermauner CIS
1928 Schiller
1925 Hinselmann Colposcope
1928 George N.Papanicolaou Observe &
1928 Aureli Babes & C.Daniel Report of cancer
cell in CVS
Historical overview
Donne’s Atlas, Paris, 1845
1941(article) George N.Papanicolaou
1943(book) & Herbert Traut
The value of vaginal smear in the discovery of occult
cancer of cervix and endometrium
Historical overview
1947 Ayre Cervical scraper
1986 Boon et al Endocervical brush
Period of critique (1970-1985)
CLIA (Clinical Laboratory Improvement Act)
Historical overview
CLIA (1988)1) Targets of population screening
2) Nonrepresentative or inadequate smear (F.N.)
3) The techniques of fixation, staining, microscopic
screening and interpretation are not adequate
2 FNThree separate situations
1 FP
4) Reported results are not appropriately understood
and the clinical follow-up is inadequate
Historical overview
Specimen collection and submission
Cervical Cytology Practice Guidelines
Patient preparation
1) Two weeks (10-18 days) after LMP
2) Not douche 48h prior to the test
3) Not use tampons, birth control foam, jellies or
other vaginal cream of medications for 48h prior
to the test
4) Refrain from intercourse 48h prior to the test
Cervical cytology practice guidelines
Sampling principles
Sampling techniques
Smear preparation
Smear labeling and test requisition
Cervical cytology practice guidelines
Sampling techniques
Exfoliative cytology and abrasive cytology
Vaginal smear and cervical smear
Cervical cytology practice guidelines
Smear preparation
Fixation and fixatives
Common fixatives for cervical smears
Cervical cytology practice guidelines
Test Requisition
The minimal clinical data:
Age
Date of LMP or onset of menopause
Past or Current history of any abnormalities or
treatment
Pregnancy status
Cervical cytology practice guidelines
Important factors in assessing the results :
Patient preparation
Sampling
Fixation
Staining
Interpretation
Reporting
Quality control and Quality assurance
Cervical cytology practice guidelines
Definition of an adequate smear:
Cells of all epithelial surfaces
Sufficient number of cells
Two of the three component (EC, MC, EM)
Cervical cytology practice guidelines
Problem: Air-drying
Solution: Spray-fix the smear immediately
Problem: Blood, mucus and pus
Solution: Remove excess mucus,
Spatula first, Then the brush
Problem: Traumatized cells
Solution: Spatula, Rotate no more than 360
Brush, Rotate only 90 to 180
Tips for making good pap smear
Problem: Incomplete clinical information
Solution: Fill out the requisition completely
Problem: Dueling laboratories
Solution: The abnormal pap and follow-up biopsy
MUST be examined simultaneously by the
same pathologist
Tips for making good pap smear
