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What Does a Pap Smear Test For?

A Pap smear test, short for Papanicolaou test, is a preventative care examination for women. This vitally important exam is meant to identify HPV (human papillomavirus) as well as early signs of cervical cancer. What gynecologists are testing for in a pap smear are abnormal or cancerous cells in the cervix.

Why Get a Pap Smear Test?

Cervical cancer is one of the leading causes of cancer-related deaths. Both cervical cancer and HPV rarely show in systems, therefore, regular testing is one of the only methods of detection.

Regular pap smear testing can be lifesaving, as early identification of cervical cancer is almost always treatable. All adult women under 65 are recommended to get Pap smears once every few years depending on their age. That frequency increases for those with medical complications or impairments such as HIV or who have had cervical cancer in the past.

How to Get a Pap Smear

Because a Pap smear test falls under preventive care, it is covered by most insurances. When scheduling an appointment, there are a few requirements by doctors in order to ensure the most accurate result possible. The first is to not schedule a Pap smear during your period; wait at least 10 days after your period has ended. The second is that two days before the exam, refrain from using tampons, vaginal creams, and suppositories, douches or deodorant sprays, and having sex. Partaking in any of the aforementioned can affect the quality of the cervix samples and cause an erroneous result reading.

The procedure itself is virtually painless and quite simple. During a pelvic exam, the doctor inserts a speculum into the vagina to hold it open. Once there is clear access to the cervix (the entryway to the vagina/womb) a special smear brush is inserted to swab the surface and gather a sample of cervix cells and mucus. Spotting may occur after the exam but this is normal.

Pap Smear Test Results

It takes approximately one to three weeks for Pap smear test results to be determined. The results will either be “negative” meaning the cervix is healthy and negative for any potentially cancerous cells or “positive,” meaning that the cells within the sample were of various shapes and sizes when they should be uniform. If this is the case, it does not necessarily mean that one has cervical cancer.

A cervical infection might be a potential cause for the abnormality. This can be caused by a yeast infection or STD. Although a Pap smear may be an indirect source of STD detection, by no means is it meant to serve as a test for other sexually transmitted disease or other types of cancer.

If it has been more than three years since your last PAP smear test, visit a clinic that is part of UrgentMED. The friendly and helpful staff can perform all the routine gynecological examinations a woman needs. While most insurances cover Pap smear tests at no cost to the patient, UrgentMED offers affordable options for those without insurance. Don’t put off such an important test of health, visit one of their 13 Southern California locations today!

When Cervical Screening Test Results are Abnormal

Finding cervical cancer often starts with an abnormal HPV (human papillomavirus) or Pap test result. This will lead to further tests, which can diagnose cervical cancer or pre-cancer.

Cervical cancer may also be suspected if you have symptoms like abnormal vaginal bleeding or pain during sex. Your primary doctor or gynecologist often can do the tests needed to diagnose pre-cancers and cancers and may also be able to treat a pre-cancer.

If there is a diagnosis of invasive cancer, your doctor should refer you to a gynecologic oncologist, a doctor who specializes in cancers of women’s reproductive systems.

What other tests will I need?

 Your current screening test results along with your past test results, determine your risk of developing cervical cancer. Your doctor will use them to figure out your next test or treatment. It could be a follow-up screening test in a year, a colposcopy, or one of the other procedures discussed below to treat any pre-cancers that might be found.  

Because there are many different follow-up or treatment options depending on your specific risk of developing cervical cancer, it is best to talk to your healthcare provider about your screening results in more detail, to fully understand your risk of cervical cancer and what follow-up plan is best for you.

The Pap test and HPV test are screening tests, not diagnostic tests. They cannot tell for certain if you have cervical cancer. An abnormal Pap test or HPV test result may mean more testing is needed to see if a cancer or a pre-cancer is present. The tests that are used include colposcopy (with biopsy), endocervical scraping and cone biopsies.

Tests for people with symptoms of cervical cancer or abnormal screening test results

Medical history and physical exam

First, the doctor will ask you about your personal and family medical history. This includes information related to risk factors and symptoms of cervical cancer. A complete physical exam will help evaluate your general state of health. You will have a pelvic exam and maybe a Pap test if one has not already been done. In addition, your lymph nodes will be felt to see if the cancer has spread (metastasis).

Colposcopy

If you have certain symptoms that could mean cancer, if your Pap test shows abnormal cells, or if your HPV test is positive, you will most likely need to have a test called colposcopy. You will lie on the exam table as you do with a pelvic exam. A speculum will be placed in the vagina to help the doctor see the cervix more easily with a colposcope. The colposcope is an instrument that stays outside the body and has magnifying lenses. It lets the doctor see the surface of the cervix up close and clearly. Colposcopy itself usually causes no more discomfort than any other speculum exam. It can be done safely even if you are pregnant. Like the Pap test, it is better not to have it during your menstrual period.

At the time of the procedure, the doctor will apply a weak solution of acetic acid (similar to vinegar) to your cervix to make any abnormal areas easier to see. If an abnormal area is seen, a small piece of tissue will be removed (biopsy) and sent to a lab to be looked at carefully. A biopsy is the best way to tell for certain if an abnormal area is a pre-cancer, a true cancer, or neither.

Cervical biopsies

Several types of biopsies can be used to diagnose cervical pre-cancers and cancers. After these procedures, patients may feel mild cramping or pain and may also have some light bleeding.

Colposcopic biopsy

For this type of biopsy, the cervix is examined with a colposcope. Using biopsy forceps, a small section of the abnormal area is removed.

Endocervical curettage (endocervical scraping)

If colposcopy does not show any abnormal areas or if the transformation zone (the area at risk for HPV infection and pre-cancer) cannot be seen with the colposcope, another method must be used to check that area for cancer.

A narrow instrument (either a curette or brush) is inserted into the endocervical canal (the part of the cervix closest to the uterus). The curette or brush is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the lab to be checked.

Cone biopsy

In this procedure, also known as conization, the doctor removes a cone-shaped piece of tissue from the cervix. The tissue removed in the cone includes the transformation zone where cervical pre-cancers and cancers are most likely to start. A cone biopsy is not only used to diagnose pre-cancers and cancers. It can also be used as a treatment since it can sometimes completely remove pre-cancers and some very early cancers.

Two common types of cone biopsies are:

  • Loop electrosurgical procedure (LEEP or LLETZ):  In this method, the tissue is removed with a thin wire loop that is heated by electricity and acts as a small knife. For this procedure, a local anesthetic is used, and it can be done in your doctor’s office. 
  • Cold knife cone biopsy: This method uses a surgical scalpel or a laser instead of a heated wire to remove tissue. You will receive anesthesia during the operation (either a general anesthesia, where you are asleep, or a spinal or epidural anesthesia, where an injection into the area around the spinal cord makes you numb below the waist) and it is done in a hospital.

Possible complications of cone biopsies include bleeding, infection and narrowing of the cervix.

Having any type of cone biopsy will not prevent most women from getting pregnant, but if a large amount of tissue has been removed, women may have a higher risk of giving birth prematurely.

Pap Tests: When you need them and when you don’t

Pap Tests: When you need them and when you don’t

A Pap test is a test of cells of the cervix. The cervix is the opening between the vagina and the uterus. The Pap test looks for cells that are not normal and can cause cervical cancer.

You may receive a regular pap test if you are between the ages of 21 to 69 – but it may not always be necessary. Here’s why:

Pap tests usually don’t help if you are low-risk.

Many people have a very low risk for cervical cancer.

  • Cervical cancer is rare if you are younger than 21, even if you are sexually active. Abnormal cells in this age group usually return to normal without treatment.
  • Cervical cancer is rare if you are over 69 and have had regular Pap tests with normal results.
  • Pap tests are not useful for anyone who has had their cervix removed during a hysterectomy, unless the hysterectomy was done because there were cancer or pre-cancer cells in the cervix.

Pap tests can have risks.

A Pap test can be uncomfortable and cause a little bleeding.

The test may show something that does not look normal but would go away on its own. Abnormal results cause anxiety. And they can lead to repeat Pap tests and follow-up treatment that you may not need.

So, when do I need a Pap test?

That depends on your age, your medical history, and your risks.

  • Ages 21 to 29: Most provincial and territorial guidelines recommend that if you are at least 21 years of age and are sexually active you should have a Pap test every three years.
  • Ages 30 to 69: The guidelines from the Canadian Task Force on Preventive Health Care and others say that you should have the Pap test every three years.
  • Age 70 or older: You do not need any more Pap tests if your three previous tests have been normal.

How can you protect yourself against cervical cancer?

The best way to protect yourself against cervical cancer is to protect yourself against human papilloma virus (HPV). HPV is a sexually transmitted infection that can cause cervical cancer.

Get the HPV vaccine.

  • The HPV vaccine is recommended for people before becoming sexually active, usually around age 11 or 12.
  • If you have not been vaccinated and are sexually active, speak with your health care provider about the vaccine.
  • You will still need regular Pap tests because the vaccine does not protect against all types of HPV that can cause cancer.

Reduce your risk.

  • Use condoms. Condoms help reduce the risk of getting HPV. You are less likely to be infected and to infect partners. However, condoms do not prevent all infections.
  • Use spermicidal gels. They also help protect against HPV.
  • If you feel you are at risk for a sexually transmitted infection, you should visit your health care provider for testing and an examination.

Don’t smoke. The risk of developing cervical cancer increases with the length of time if you smoke and the number of cigarettes smoke per day.

Take these steps to make your Pap test as accurate as possible.

  • Make your appointment for at least five days after your menstrual period stops.
  • For 48 hours before the test: Do not have sex, and do not use douches, tampons, birth control foams or gels, vaginal creams, moisturizers or lubricants, or vaginal medicines.

Pap Test | Cancer.Net

Listen to the Cancer. Net Podcast: Pap Test–What to Expect, adapted from this content.

A Pap test is the most common test used to look for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. It involves gathering a sample of cells from the cervix. The cervix is the part of the uterus that opens to the vagina.

The sample is placed on a glass slide or in a bottle containing a solution to preserve the cells. Then it is sent to a laboratory for a pathologist to examine under a microscope. A pathologist is a doctor who specializes in reading laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A pathologist can identify abnormal cells by looking at the sample.

Abnormal cells can be cancerous, but they are most often treatable, precancerous cellular changes, rather than cervical cancer. Some of the cells collected from the cervix during a Pap test may also be tested for human papillomavirus, also called HPV. Infection with HPV is a risk factor for cervical cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV. Some strains are more strongly linked with certain types of cancer.

Your health care provider may test for HPV at the same time as a Pap test. Or you may need testing for HPV only after Pap test results show abnormal changes to the cervix. HPV testing may also be done separately from a Pap test. Learn more about HPV and cancer.

How often you need to have a Pap test depends on your age, results of previous tests, and other factors. Learn more about cervical cancer screening guidelines.

Who performs my Pap test?

A gynecologist typically performs a Pap test. A gynecologist is a medical doctor who specializes in treating diseases of a woman’s reproductive organs. Sometimes other health care providers perform Pap tests. This may include primary care doctors, physician assistants, or nurse practitioners. If the person performing the test is a man, a female assistant or nurse may also be in the room.

If the results of the Pap test show cervical cancer, your health care provider will refer you to a gynecologist or an oncologist. An oncologist is a doctor who specializes in treating cancer.

How should I prepare for a Pap test?

To ensure that the Pap test results are as accurate as possible, do not have sexual intercourse for 2 to 3 days before the test. Also, to avoid washing away abnormal cells, do not use the following for 2 to 3 days before the test:

The best time to schedule your Pap test is at least 5 days after the end of your menstrual period. A Pap test can be done during your menstrual period, but it is better to schedule the test at another time.

During the Pap test

Your health care provider will perform the Pap test during a pelvic exam in a private room in his or her office. It takes only a few minutes. The test may be uncomfortable, but it is not usually painful. You may experience less discomfort if you empty your bladder before the examination. Also, try taking deep breaths and relaxing your muscles during the procedure.

When you arrive for your Pap test, your health care provider may ask you some basic questions related to the test. These may include:

  • Are you pregnant?

  • Do you use birth control?

  • What medications have you taken recently?

  • Do you smoke?

  • When was your last menstrual period, and how long did it last?

  • Do you have any symptoms, such as itching, redness, or sores?

  • Have you had surgery or other procedures on your reproductive organs?

  • Have you ever had abnormal results from a previous Pap test?

Before the procedure, you may need to change into a hospital gown in a private area or when your health care provider leaves the room. During the procedure, you will lay on your back on the exam table with your heels in the stirrups at the end of the table.

Next, your health care provider performing the exam will gently insert a lubricated plastic or metal instrument into your vagina. This tool, called a speculum, slowly spreads apart the vaginal walls. It may cause some discomfort.

After a visual inspection of your cervix, your health care provider will use a cotton swab or a cervical brush to gently scrape cells from 2 places on the cervix:

  • The ectocervix, which is the part closest to the vagina

  • The endocervix, which is the part next to the body of the uterus. This area is called the transformation zone, and it is the location where cervical cancer typically develops.

You may feel pulling or pressure during the collection of the cells, but it typically does not hurt.

Your health care provider will smear the cells onto a glass microscope slide or put the cells into a container with liquid that preserves the sample. He or she will then send the sample to a pathologist for evaluation.

After a Pap test

You can resume your normal activities right after having a Pap test. You may have a small amount of vaginal bleeding after your Pap test. But tell your health care provider if you experience excessive bleeding.

If the Pap test shows abnormal cells and an HPV test is positive, your health care provider may suggest one or more additional tests. The Pap test is an excellent screening tool, but it is not perfect. Sometimes the results are normal even when abnormal cervical cells are present. This is called a “false negative” test result.

Regular screening is important. Talk with your health care provider about how often you should have a Pap test. Research shows that almost all cervical changes can be found with regular screening and treated before they become cancerous.

Questions to ask your health care team

Before having a Pap test, consider asking the following questions:

  • Who will perform my Pap test?

  • Should I also be tested for HPV?

  • When will I get the test results?

  • Who will explain the results to me?

  • What will happen if the test results are abnormal or unclear?

  • What further tests will be necessary if the test results indicate cancer?

  • After this test, when should I have my next Pap test?

Related Resources

Cancer.Net Podcast: HPV and Cancer

Cancer Screening

More Information

National Cancer Institute: Pap and HPV Testing

Pap test | CTCA

A Pap test, also known as a Pap smear, is a screening tool performed by a medical provider to look for abnormal changes to cells in the cervix, which connects the uterus and the vagina. Left untreated, abnormal cells may develop into cervical cancer and spread to other organs.

The sexually transmitted human papillomavirus (HPV) is the leading cause of cervical cancer. HPV can also cause vaginal, vulvar, penile, anal and oral cancers in both men and women. The pap test and the HPV test are the two screening methods for cervical cancer.

For decades, cervical cancer was the leading cause of cancer deaths in women. Since the American Cancer Society’s (ACS) endorsement of the Pap test in the 1960s, the cervical cancer death rate in the United States has dropped by about 70 percent. Not only can the test find cervical cancer in its early stages, it can also detect changes in the cervix before cancer develops, which helps explain the decline in diagnoses. The ACS estimates that 13,800 new cervical cancer cases will be diagnosed in 2020, and about 4,200 women will die from the disease.

The average age of a cervical cancer diagnosis is 50.

What happens during a Pap test?

Pap tests are performed in the doctor’s office as part of a gynecological exam. An instrument called a speculum is gently placed inside the vagina to expand it so the gynecologist can examine the vagina and cervix. Using a slender brush and spatula, a sample of cervical cells is collected and sent to the lab to check for the presence of abnormal cells. The procedure takes only a few minutes and is painless for most women, though some women may find it uncomfortable. There may be a sensation of pressure when the speculum is inserted in the vagina. The test is often performed along with an HPV test, something known as co-testing, as both procedures examine cells from the cervix.

Pap test results typically come back within a few days. Abnormal cells don’t necessarily mean a woman has cancer. It may be an indication of:

  • Cervical dysplasia, meaning there are abnormal cells that aren’t cancerous (These abnormal cells may go away on their own, or they may develop into cancer if not caught and treated early.)
  • HPV or another infection
  • Inflammation, which may occur if the woman had sexual intercourse or used a diaphragm shortly before the Pap test

If your doctor is concerned about the test results, further testing will be recommended.

How often should a Pap smear be repeated?

Screening guidelines are issued by the U.S. Preventive Services Task Force (USPSTF), a group of independent experts who make screening recommendations for preventive services based on peer-reviewed evidence.

For women who are not at high risk for cervical cancer, the USPTF recommends that:

  • Women between the ages of 21 and 29 have a Pap test alone every three years.
  • Women between the ages of 30 and 65 have a Pap test and an HPV test every five years (known as co-testing), or a Pap test alone every three years.

The USPSTF does not recommend a screening test for:

  • Women older than 65 who have had regular screenings throughout their lifetime and who are not considered high risk for cervical cancer
  • Women younger than 21
  • Women who have had a hysterectomy that included removing the cervix and who do not have a history of a high-grade precancerous lesion or cervical cancer

What should I know about cervical cancer screening?

Regular screenings have been shown to save lives. The screening guidelines do not apply to women who have a history of high-grade precancerous cervical lesions or cervical cancer, in utero exposure to diethylstilbestrol (DES), or a compromised immune system.

What are the risk factors for cervical cancer?

Risk factors for cervical cancer include:

  • Family history that includes a biological mother who took the hormone drug Diethylstilbestrol (DES) to prevent miscarriage
  • Family history of cervical cancer
  • Certain strains of HPV
  • Sexual intercourse before the age of 18
  • Multiple sexual partners
  • A partner who has an HPV infection or who has had many sexual partners
  • History of smoking
  • A weakened immune system
  • Long-term use of birth control pills
  • Medical history that includes having had three or more full-term pregnancies
  • A full-term pregnancy before the age of 20
  • A diet low in fruits and vegetables

What Comes after an Abnormal Pap Smear?: Physicians for Women

The Pap smear was developed in 1928 by George Papanicolaou and has become one of the fastest, easiest, and most effective ways to detect cervical cancer early on. It’s now a routine test done for most 21–65-year-old women every three years, and it saves many lives. 

At Physicians for Women in Madison, Wisconsin, our team of reproductive health specialists are committed to early detection practices to reduce your health risks and keep you going strong. Pap smears are done every three years at the time of your yearly gynecological exam, and if you have an abnormal result, we’ll immediately follow up with you.

What a Pap smear checks for

The Pap smear checks for abnormal cervical cells, which are usually caused by human papillomavirus (HPV). Abnormal changes in the cervical tissue can lead to the development of cancer cells. A Pap smear every three years can detect changes in cervical tissue in the early stages, and when detected early, cervical cancer is highly treatable. 

In fact, regular Pap smears combined with HPV vaccination can prevent an estimated 93% of cancer cases. Sadly, only around 69% of women, though, stay up to date on their Pap smears. How long has it been since you’ve gotten a Pap? If the answer is “more than three years,” it’s time to call our office and schedule an exam.

At Physicians for Women, we use the ThinPrep Pap Test, which is the most effective and widely used test available and has been proven to increase early detection of precancerous cells.  

Most abnormal Pap smear results are nothing to worry about

Most women will have at least one abnormal Pap smear result in their lifetime, with an overall average of 5% of all Pap tests coming back as “abnormal.” In most cases, the abnormal result is nothing to worry about, but it’s important to follow up to make sure. 

If your Pap smear comes back with signs of changes to your cervical tissue, we’ll notify you and help you navigate the next steps.

HPV testing

If you are age 21 to 29, and you have an abnormal Pap result, your doctor will call you in for an HPV screening, which looks for signs of high-risk HPV that could cause cancer. This test is extremely accurate and can typically tell us whether or not you are at high risk for cervical cancer. If you are age 30 to 65, we co-test, which means we perform an HPV test at the same time as your Pap smear.

If your HPV test comes back negative, we’ll note the abnormal Pap smear in your file and may add a Pap to your next annual well woman exam instead of the usual three year interval between Pap smears, so we can track your results. If the HPV test comes back positive, we’ll discuss what types of HPV infections we found. 

Treatment for abnormal cells

An abnormal Pap result combined with a positive HPV test usually doesn’t mean you have cancer, only that cancer is a potential future threat. 

We may do a follow-up colposcopy (inspection of the cervix) to check and see if your cellular abnormalities are resolving on their own, as many women can clear HPV without outside interference. If the abnormalities have progressed, your doctor may perform LEEP (loop electrosurgical excision procedure) to remove affected tissue. This treatment can be done in our office.  

Bottom line? If you have an abnormal Pap smear, don’t panic. Your odds are good that it’s going to be fine, and your body will resolve the issue on its own. And we’ll be there to help you every step of the way. 

Want more information about Pap smears, HPV, or cancer prevention? Contact our office at 608-218-4825, or book an appointment online.

Why Annual Pap Smears Are History – But Routine Ob-Gyn Visits Are Not

In the recent past, women were advised to visit their ob-gyn every year for a Pap test, as well as a pelvic exam and breast exam. The Pap test, also called a Pap smear, is a screening test for cervical cancer.

Fast forward to today, and our advice has changed. Women should still visit their ob-gyn each year, and I’ll outline why that’s so important below. But we no longer advise women to have an annual Pap test. A big reason for the change: We now better understand the way cervical cancer develops over time—we know it takes many years to develop—so we’ve expanded the time between screenings.

We also now have two screening options to detect cervical cancer, the Pap test and the HPV test. (HPV stands for human papillomavirus—a virus that can cause cervical cancer.) With both tests, cells are taken from the cervix and tested. The Pap test looks for abnormal cells that may develop into cancerous cells over time. The HPV test looks for the strains of HPV that are most likely to cause cancer.

Here’s a quick summary of ACOG guidelines for cervical cancer screening (read this FAQ for the full details):

  • Women age 21 to 29 should have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.

  • Women age 30 to 65 have three options for testing. They can have both a Pap test and an HPV test every 5 years. They can have a Pap test alone every 3 years. Or they can have HPV testing alone every 5 years.

  • After age 65, you can stop having cervical cancer screenings if you have never had abnormal cervical cells or cervical cancer, and you’ve had two or three negative screening tests in a row, depending on the type of test.

Exceptions to the guidelines

You may need more frequent screenings if you

  • have a history of cervical cancer

  • are HIV positive

  • have a weakened immune system,

  • were exposed before birth to diethylstilbestrol (DES, a hormone given to pregnant women between 1940 and 1971)

If you have had a hysterectomy, you still may need screening. And if you’ve had the HPV vaccine, you should still follow the guidelines. The vaccine doesn’t protect you against every type of HPV.

Doctor’s notes

Most women are exposed to HPV in the course of normal sexual activity if they’ve had more than one sexual partner. The reason we don’t do Pap tests before age 21 is because the likelihood of someone that young getting cervical cancer is very low. After age 65, the likelihood of having an abnormal Pap test also is low.

Why you should see your ob-gyn every year

Whether or not you are due for cervical cancer screening, you should still see your ob-gyn at least once a year. Your routine visit is a good time for you and your ob-gyn to share information and talk about your wishes for your health care.

During your visit, you and your ob-gyn can talk about any number of common concerns, such as problems with sex or birth control, pelvic pain, or abnormal bleeding.

You also can talk together about whether you need a breast exam or pelvic exam. Plus, you can discuss testing for STIs (sexually transmitted infections), getting the vaccines you need, having your blood pressure checked, and other general medical issues.

The routine visit to your ob-gyn is crucial for your overall health, and cervical cancer screening is just one small—but important—part of that.

Last updated: April 2021

Last reviewed: April 2021

Copyright 2021 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

90,000 Pap smear recommendations: Changes in cervical cancer screening

Author: Female staff

During your annual check-up, you may be asked to have a Pap test. Doctors do tests every couple of years to make sure you don’t have cervical cancer. A Pap test collects tissue from the cervix and checks for any abnormalities. Early detection of cervical cancer leads to better results.In the past, the recommendation for getting a Pap smear was to get one every five years along with an HPV test. However, these rules have changed recently.

Changes to recommendations for taking a Pap smear

A recent change in the recommended screening for cervical cancer has been controversial. Many healthcare organizations, health advocates and healthcare providers disagree with the change. In September 2017, the US Preventive Services Task Force issued a draft recommendation that states:

USPSTF recommends screening only every 3 years by cervical cytology [Pap smear] or every 5 years only with testing for high-risk human papillomavirus (hrHPV) in women aged 30 to 65 years.

In addition, the recommendation to use only one of the two screening methods is a change from the previous recommendations of the Task Force. In addition, in 2012, the USPSTF recommended that women between the ages of 30 and 64 have HPV and Pap tests every five years. However, many major medical organizations still recommend both tests. These include the American Cancer Society, the American College of Physicians, and the American Congress of Obstetricians and Gynecologists.

According to a recent NPR article, simplifying screening for cervical cancer can lead to a missed diagnosis. This is especially true among at-risk groups. Additionally, the article says:

“A proposal to simplify screening for cervical cancer could result in some cancers being left out,” say researchers and patient advocates. And this can be especially true for minority women. According to the Centers for Disease Control and Prevention, Latin and black women already have the highest incidence of cervical cancer in the United States, and more than half of women with the disease did not get screened within five years of being diagnosed. “

Our recommendations for screening for cervical cancer

At Women’s Care, we follow current guidelines for cervical cancer screening for women at low risk. Depending on your risk factors, your doctor may recommend more frequent examinations. In addition, women who have an abnormal cervical cancer screening result, have a history of cervical cancer, HIV, or a weakened immune system may need additional screening.

If you:

Under 21 You don’t need screening
Age 21 to 29 Pap smear every 3 years with possible HPV depending on specific Pap test results.
Age 30-64 Pap smear and HPV (joint testing) every 3–5 years; or only a Pap smear every 3 years.
Over 65 years of age or after hysterectomy You no longer need screening if all of your recent Pap tests were normal.

For advice on the type and frequency of cervical cancer screenings that are best for your age, consult your obstetrician / gynecologist. Find a doctor now in Women’s Care.

90,000 Georgios Papanikolaou – love, war, smear for cytology

There are many touching love stories in the world.EVACLINIC knows one more. The story is associated with the origin of the Pap smear, aka “smear for cytology.”

The young scientist Georgios was in love with Andromache, whose father was a colonel in the Greek army. The future father-in-law did not want to give his daughter to a scientist engaged in biology and genetics. He believed that this was an unequal marriage and that Georgios’ hobbies would not feed the family. The colonel agreed that Papanicolau was taken on a ten-month sea expedition to the prince of Monaco, who was called “an amateur oceanologist.”The lovers were separated for a short time.

The journey was good for Georgios. He scrupulously studied the genetics of the inhabitants of the sea and improved the knowledge gained earlier at the Universities of Athens and Munich. Research was interrupted by the First Balkan War, in which Papanikolaou worked as a military doctor. During the hostilities, there was a threat of war with Bulgaria, and Georgios did not want to fight with his brothers on the ground. In 1913, he, along with his comrades and wife Andromache, went by ship to New York.

Getting off the ship with a few dollars in their pockets, the couple began to settle down. Due to the difficult pronunciation of Greek names, Andromache became Mary, and Georgios asked to be called “Doctor Pap”. Without knowing the language and with a Greek diploma, Papanikolaou could not work as a doctor, so together with his wife they began to earn money in a clothing store. In the evenings Georgios played the violin in the restaurant.

Knowing about Georgios’ hobbies in genetics and medical education, his comrades found him a job as a science journalist in the only Greek magazine in America, Atlantis.Developing the column, Papanikolaou arranged to interview scientist Thomas Morgan. During this conversation, Morgan found out that before him was Georgios, who published entertaining articles on genes and biology, and recommended him to the pathology laboratory at the Cornell University Hospital Hospital.

In this laboratory, Georgios was tasked with studying the effects of alcohol on guinea pigs. To study it, only chromosomes were needed and, first of all, he studied guinea pigs in which ovulation occurred.Not having the required number of rodents to study, Papanicolaou came up with the idea that on different days of the cycle, the composition of the epithelial cells of the vagina and uterus is different. To prove this, he began taking swabs from pigs using a nasal speculum (an otolaryngologist’s instrument) and examining the cells taken under a microscope to pinpoint the day of ovulation.

It dawned on Georgios. If determining the day of ovulation in this way is possible in guinea pigs, then in women it is possible to track endocrine changes in the vagina and uterus in a similar way.The only thing that stopped the study was that pigs and women had different structures of the genitals. It was necessary to develop a new instrument, a new brush for collecting cells. Papanikolaou created such a probe and began to work with it, using it on his wife Andromache, because there were no other laboratory assistants. Soon, the wife of Georgios left the store to his laboratory and became his assistant. By 1923, the safe and painless cell research method was ready to be used in clinical research in women.

Since many tests were taken in the laboratory where Georgios worked, he added his flora to the usual smear and soon received hundreds of cells for study. Among this amount of material, Papanicolaou accidentally discovered one cancer cell, she had not yet had time to penetrate deeply into the epithelium and tissue. According to the collected anamnesis, it turned out that the woman, in whose smear a “bad” cell was found, had no symptoms of cervical cancer. This meant that at this stage, the cancer could be stopped without surgery.Considering that cervical cancer in those days was the main malignant tumor among women, it was most often detected at a late stage, when even surgery would not save a woman’s life.

After collecting data on the research obtained, Georgios in 1928 made a presentation at a scientific conference on the early detection of cancer of the female genital organs. Considering that the conference at which he spoke turned out to be mediocre, the report did not evoke a response from the public.Only one gynecologist noticed Papanikolaou, but did not recognize the significance of his discovery for gynecology only because he believed in biopsy as a guaranteed method for detecting cancer cells. The leader of Georgios was of the same opinion. So he scrapped Papanicolaou’s research and returned to studying the effects of alcohol on guinea pigs. Georgios secretly continued to refine his studies and waited for the leader to retire. I waited until 1939.

With the arrival of the new leadership, Georgios’ research activities to detect cancer cells using a simple smear began to develop rapidly.He was allocated a staff of gynecologists. The media urged women in New York to have a Pap test. As it turned out, this smear in 95% of cases detected cancer cells at an early stage. Thanks to this method, the mortality rate of women at that time decreased by 70%. For simplicity, the name of the smear has been abbreviated to “Pap Test”. Nowadays it is called “smear for cytology”, “oncocytological smear”.

Nowadays, millions of women regularly take a Pap test. As a result of the discovery of this method, less than one woman in 100,000 people dies from cervical cancer.At EVACLINIC, the fourth woman takes this smear to be sure that everything is in order!

P.S. Love in this story is intertwined with science and the Papanicolaus showed how important it is to support each other and believe in the best!

Smear for oncocytology of the cervix in St. Petersburg, Vyborgsky district

What is a smear for oncocytology?

A smear for oncocytology is a microscopic analysis of cellular material taken from the cervix.In connection with the constant increase in the number of oncological diseases, the most important role is assigned to research, which makes it possible to detect the disease at the earliest stages.

Among oncological diseases in women, the most common diagnosis is cervical cancer. Analysis of a smear for cervical oncocytology answers many questions, but its main task is to identify possible cancer cells or to recognize precancerous processes , i.e. phenomena that can cause cervical cancer.

Also, this study helps to recognize many viral and inflammatory processes , such as human papillomavirus infection, dysplasia, etc., already at the initial stage. The overwhelming majority of these diseases are successfully treated if they are detected in a timely manner.

Who is the study shown to?

1. Conducting a smear for oncocytology of the cervix is ​​recommended for everyone who has: cervical erosion, menstrual irregularities, oncogenic papillomavirus. In these cases, the analysis should be carried out every six months.

2. Also, the analysis is mandatory should be passed when registering a pregnant woman. Due to the high hormone levels during pregnancy, which can accelerate the development of precancerous conditions, the doctor at our clinic will most likely recommend retesting in the second and third trimester.

3. Doctors recommend regular annual examinations for women:

  • with multiple sexual partners
  • after prolonged use of contraceptives
  • with chronic infections (herpes, chlamydia)
  • with chronic inflammation of the pelvic organs
  • with early onset life
  • in the case of multiple births.

Our clinic recommends doing an analysis for oncocytology as part of the annual preventive examination by a gynecologist.

How is a smear taken for oncocytology?

Preparation

The study can be carried out on any day, except for the period of menstruation.

If inflammatory processes are accompanied by bloody discharge, then the analysis should be postponed, as it may give unreliable results.

Contraindications to the analysis for oncocytology are colpitis and cervicitis, because the changes in cells they cause can be recognized as a precancerous process.

Within two days before the examination, we recommend not to have sexual intercourse, do not use tampons, vaginal creams, douching, as all these factors can greatly affect the reliability of the results.

Analysis

The analysis itself is carried out in the gynecological office and takes a few seconds. The sampling of the epithelium of the cervix and its canal is carried out using a soft special brush (spatula) with a light, slightly perceptible touch.The obtained epithelium samples are placed on a glass slide and sent to the laboratory of our clinic in St. Petersburg.

Oncocytology smear results

Final test results are usually ready in 10-12 days. The process evaluates the shape, size, structure and composition of the harvested epithelial tissue. There are two research methods: Leishman and Papanikolaou (Pap test).

As a result of oncocytological analysis, the result of the research is indicated: “positive” or “negative”.A negative result means the absence of any atypical cells in the collected biomaterial. This result indicates the health of the cervix. A positive finding indicates that unusual cells were found on the surface of the cervix or in its canal.

Let’s see what diseases the received test results can talk about:

  • Inflammation . They are manifested by a large number of leukocytes and cells of infectious agents (fungi, Trichomonas, etc.)NS.). Abnormal cells recover after anti-inflammatory therapy.
  • Human papillomavirus infection . Often found only in oncocytology. With this disease, the cells on the cervix become smaller and change their structure. By the presence of these cells, the doctor can diagnose HPV.
  • Dysplasia of varying severity . The diagnosis is made if atypical cells are found in the selected biomaterial.
  • Cancer.The diagnosis is made if atypical cancer cells are found. Requires colposcopy (examination of the walls of the vagina and cervix under a microscope) and other additional examinations.

Oncocytological study is an analysis that allows you to establish the final diagnosis with a high degree of confidence and, if necessary, start treatment on time.

See also: Diagnosis of infertility, Treatment of infertility, Visiting a gynecologist, Diagnosis and treatment of STIs, Gynecological smear.

Cytological method in the diagnosis of tumors and tumor-like processes

Cytopathology, clinical or diagnostic cytology, studies the cellular composition of pathological processes. As a separate medical specialty, it was officially recognized in 1941 after the works of G. Papanikolaou and N. Trout. To the credit of our country, the development of a cytological diagnostic method began in 1938 in the clinical diagnostic laboratory of the Moscow Research Oncological Institute named after N.I.P.A. Herzen. In 1941, Professor N.N. Shiller-Volkova at the session of the Institute reported on the first results on the study of vaginal discharge, sputum and punctate. Three main stages can be distinguished in the development of cytology: exfoliative, mainly gynecological cytopathology; aspiration cytology, the rapid flowering of which begins in the 80s and is associated with the introduction of ultrasound diagnostics, and the current stage of development is determined by the use of immunocytochemical and molecular research methods, as well as automated screening in gynecological cytology.

The cytological method is technically simple, fast, relatively cheap, and less traumatic. However, the “ease” of the cytological method is deceptive, since the cytological examination must end with the formulation of a conclusion, on the basis of which the treatment tactics are developed.

According to the method of obtaining the material, cytology can be divided into preoperative (exfoliative, abrasive, aspiration) and intraoperative. Exfoliative cytology includes the examination of vaginal smears, sputum, urine, pleural, peritoneal, pericardial, cerebrospinal, synovial fluid, etc.e. This section of cytology is distinguished by the simplicity of the technique for obtaining a large number of various types of cells, including the inflammatory series. Cellular material may not be well preserved. To obtain informative material, pus-like masses, crusts, necrotic plaque are removed from the surface of the pathological focus. If the resulting material is a liquid, then sodium citrate is added to it so that the liquid does not curdle.

Abrasive cytology obtains material from a specific area of ​​internal organs, including the study of subepithelial lesions using fiberoptic instruments.With such a sampling of the material, the cells are well preserved, and the preparations are easy to interpret. The material is obtained from the cervix, vagina, endometrium, respiratory, gastrointestinal, urogenital tract.

Fine needle biopsies are now available from virtually any organ. The method is constantly being improved and gives optimal results, which makes it highly effective and economical in terms of diagnostics.

The material taken for cytological examination is placed on the edge of a glass slide and with another slide or cover glass, evenly, without pressing hard, spread in a thin layer over the entire surface of the preparation.

In recent years, in addition to routine cytological smears, a liquid system has been used to obtain high-quality monolayer cytological preparations: punctures are introduced into a special accumulation medium, after which they are centrifuged at 1000 revolutions for 5 minutes at an average acceleration in a centrifuge (Sutospin-3, Sutospin-4) … The use of the liquid cytology technique has a number of advantages: it ensures the preservation of cell structures, reduces the background, the cells are concentrated in one place – the “window”, which reduces the time for viewing the preparation and significantly saves expensive sera during immunocytochemical studies.To create an archive and the possibility of subsequent study of the material, the Cell-block technique is used, in which preparations are obtained that occupy an intermediate position between cytological and histological ones.

Wet fixation of the drug in alcohol immediately after taking smears is used for Papanicolaou staining. In other cases, the smears are dried in air and then fixed in the laboratory. The most common method of fixation is in equal volumes of alcohol and ether (Nikiforov’s mixture).For immunocytochemical studies, fixation with acetone is used. When staining smears, panchromic staining with azure-eosin is used according to the Romanovsky-Giemsa method in various modifications (Leishman, Pappenheim), as well as staining with hematoxylin and eosin, especially when examining gynecological material, Papanicolaou stain is used. It is possible with routine research or special staining to identify bacterial flora, including Koch’s bacillus, leprosy, Helicobacter, Trichomonas, etc.

Cytological diagnostics is based on the following principles:

  • Difference in cellular composition in health and disease.
  • Evaluation of not one single cell, but a set of cells, great importance is attached to the background of the preparation.
  • The cytologist must have a pathological basis.
  • Each study ends with a statement of opinion.

Criteria for the cytological diagnosis of malignant neoplasms are composed of an assessment of the cell, nucleus and nucleolus.

Cage:

– increased in size, sometimes gigantic, rarely the size is close to normal, which complicates cytological diagnosis, for example, in colloid, tubular cancer, mastitis-like variant of lobular breast cancer, follicular thyroid cancer, carcinoid, renal clear cell carcinoma, highly differentiated cell carcinomas

– change in the shape and polymorphism of cellular elements;

– violation of the ratio of the nucleus and cytoplasm towards an increase in the proportion of the nucleus;

– dissociation of the degree of maturity of the nucleus and cytoplasm, for example, a young nucleus in the keratinized cytoplasm in highly differentiated squamous cell carcinoma.

Core:

– an increase in size, polymorphism, tuberosity, an uneven pattern of chromatin, the most constant sign is uneven contours, hyperchromia, figures of cell division in cytological preparations are relatively rare.

Nucleolus:

– the number of nucleoli is greater than in a normal cell, the nucleoli are enlarged in size, irregular in shape.

Despite the presence of criteria for malignancy in the vast majority of cells, in some cancer cells these criteria may be absent or not fully expressed.It is necessary to pay attention to the peculiarities of the mutual arrangement of cells, the nature of intercellular connections. The conclusion is formulated on the basis of a set of signs with a sufficient amount of cellular material. Attempting to evaluate a smear on an inadequately taken material is the most common cause of erroneous conclusions.

The main tasks of cytological diagnostics are as follows:

  1. Formulation of the conclusion before treatment.
  2. Intraoperative urgent diagnostics.
  3. Monitoring the effectiveness of treatment.
  4. Assessment of the most important factors in the prognosis of the course of the disease.

Cytological report before treatment includes:

  • determination of the histogenesis of neoplasms;
  • determination of the degree of differentiation of the tumor process;
  • Clarification of the extent of the tumor;
  • study of background changes;
  • determination of some forecast factors;
  • the possibility of studying the bacterial flora.

The modern cytological conclusion not only states the presence of cancer, but also indicates the histological type of the tumor and the degree of differentiation according to the generally accepted international classifications (ICD-O and WHO).

The criteria for the reliability of the cytological method are the results of comparison with the planned histological examination. The greatest percentage of coincidences of the cytological conclusion with the final histological conclusion is observed in the study of formations of the skin, mammary, thyroid gland, with metastatic lesions of the lymph nodes.The results of the study of hyperplastic processes in the endometrium are unsatisfactory (reliability 30–50%) and force us to look for ways to improve diagnostics. The reliability of cytological diagnosis of cervical pathology is 75–90%. 3–24% of studies, depending on the location and method of obtaining the material, turn out to be unsuccessful due to inadequately obtained, uninformative material.

Table 1 . Reliability of cytological studies of
tumors of various localizations.

Localization % coincidence of cytological and histological diagnosis % agreement according to the literature % of failed punctures
Lung 95.5-97 79-98 2.9-3.0
Mammary gland 95.8-97.4 90-96 2.6-8.3
Lymph nodes 98.4-98.7 90 1.6-10.7
Leather 91.2-92.7 90-98 2.4-12.5
Soft tissue
(no indication
histological
tumor type)
90.2-93.8 65-93.4 5-12.3
Gastrointestinal tract 92.3-97.5 73-93.6 2.5-4.4
Thyroid 85.5-93.2 57-94 1.6-4.2
Cervix 89.5-93.2 65-90 3.5-4.5
Endometrium 78.9-84.8 30-90 3.8-15.4
Kidney 86.2-89.3 76.4-91.3 7.1-11.5
Exudates 95.7-100 1.2-2.7

A confident cytological conclusion on the presence of a malignant neoplasm, which coincides with clinical symptoms and data from other diagnostic studies, is regarded as a morphological confirmation of the diagnosis of a malignant tumor.This places high demands on the cytological method and forces one to look for ways to prevent possible errors. By the nature of the errors, cytologists can be divided into two large groups: false negative and false positive. False negative conclusions prevail and lead to underdiagnosis of the tumor process, most often due to the small amount of informative material in the punctate. There are also objective difficulties in assessing changes, often associated with high tumor differentiation, for example, it is almost impossible to diagnose follicular thyroid cancer with minimal invasion, it is difficult to diagnose a tubular, mastitis-like form of lobular breast cancer.

The overdiagnosis of tumors in our material for many years does not exceed 1%, however, it can cause unnecessary and sometimes crippling treatment. True overdiagnosis, that is, a false cytological conclusion about the presence of a tumor, is explained by several of the most typical reasons.

Severe proliferation of cellular elements is the most common cause of cancer overdiagnosis. For example, the proliferation of the epithelium of the ducts and lobules of the mammary gland in fibroadenoma and proliferating adenosis, especially with enlargement of the nuclei, most often leads to overdiagnosis of breast cancer.The analysis of the nuclear characteristics of tumor cells helps in correct diagnosis: the presence of even contours of the nucleus and an even distribution of chromatin.

Reactive changes in the epithelium are also a common cause of inadequate cytological diagnosis. The most serious errors occur in kidney angiomyolipoma, in which reactive changes in the renal epithelium with enlargement and polymorphism of the nuclei lead to an erroneous diagnosis of highly differentiated renal cell clear cell carcinoma.The detection of vascular structures and spindle-shaped cells expressing vimentin, desmin, HMB-45 helps diagnose angiomyolipoma.

Chronic autoimmune thyroiditis of the Hashimoto type is accompanied by the formation of papillary-like structures, the assessment of which must be approached with caution and remember that during this process reactive changes in the epithelium can be mistaken for papillary thyroid cancer. Chronic dermatitis and ulcers are characterized by atypical reactive growths of stratified squamous epithelium, which often present insurmountable difficulties in differential diagnosis with highly differentiated squamous cell carcinoma.Expressed dystrophic changes in cells are also one of the reasons for erroneous cytological diagnosis. For example, severe fatty degeneration of hepatocytes can lead to overdiagnosis of metastasis of renal cell clear cell carcinoma, especially in the case of an already existing diagnosis of renal cancer.

Differential diagnosis of various degrees of dysplastic changes in the epithelium and intraepithelial cancer is a major problem in cytology. The presence in severe dysplasia of polymorphic large cells with large irregularly rounded nuclei, sometimes with enlarged nucleoli, binucleated cells with a heavy chromatin pattern may be incorrectly regarded as cancer.With dysplastic changes in the squamous epithelium, it is necessary to take into account that most cells are similar to the cells of the deep layers, large atypical cells are in close connection with cells without signs of atypia, there are stromal cells. To objectify the differential diagnosis of various degrees of dysplasia and intraepithelial cancer, it is desirable to conduct morphometry of cells and nuclei, which can significantly reduce the percentage of erroneous conclusions.

Often, the cause of overdiagnosis of metastatic lesions in the lymph nodes are complexes of enlarged endothelial cells and histiocytes, which form epithelium-like structures, as well as the presence of macrophages containing brown pigment.In case of difficulties in diagnosis, an immunocytochemical study with a small set of antibodies (factor VIII, cytokeratins, EMA, HMB-45) helps, which allows to confirm or reject the presence of metastases of cancer or melanoma.

In order to avoid errors in morphological diagnostics, it is of great importance to clearly indicate the nature of the treatment performed. For example, taking the fairly common antibiotic tetracycline leads to the accumulation of brown pigment in the cells of the thyroid gland and an erroneous diagnosis of melanoma metastasis.Reception of mercazolil in goiter is accompanied by a sharp polymorphism of the follicular epithelium, which is the cause of cytological and even histological overdiagnosis of follicular cancer. Radiation therapy causes pronounced changes not only in tumor cells, but also in normal epithelium: enlargement, cell polymorphism, pathological keratinization, which is the cause of cancer overdiagnosis.

There are also objective diagnostic problems, for example, in the differential diagnosis between highly differentiated endometrioid adenocarcinoma and atypical endometrial hyperplasia, seborrheic (basal cell) keratoma and basal cell carcinoma, infectious mononucleosis and Hodgkin’s disease, where a fairly high percentage of erroneous conclusions and Hodgkin’s disease are required. diagnostics.

Knowledge of the clinical picture, the nature of the treatment, the use of modern methods of morphological diagnostics using immunocytochemistry and morphometry helps to reduce cases of overdiagnosis to zero.

Along with true cytological overdiagnosis, there is false overdiagnosis, when a cytologist gives a confident conclusion about a malignant process, but a histological examination of a tumor is not detected, that is, in fact, histological underdiagnosis takes place.Revision of cytological preparations by several highly qualified specialists, repeated taking of a biopsy, and the clinical course of the disease further confirm the results of a cytological study. Most of all, false cytological overdiagnosis relates to the study of biopsy material from the bronchi and larynx, as well as to the study of lymph nodes, when the cytological study revealed single complexes of anaplastic cells, undoubtedly belonging to cancer.When preparing histological preparations, these complexes are lost in the finished histological preparations. The real loss of a few tumor cells during the preparation of histological preparations prevents the clinician from ignoring the cytological examination data and leads to the “gold” standard – a joint cytological and histological examination of the biopsy specimen.

Intraoperative cytological diagnostics is one of the main directions of the cytological research method.During the operation, using the cytological method, the nature of the pathological process, the degree of prevalence with the identification of metastases to the lymph nodes, liver and other organs is clarified, the radicality of the operation performed is monitored with the study of the edges of the resection. The role of cytology increases in the development of indications for extended lymphadenectomy and in the determination of the so-called “sentinel”, or “sentinel”, lymph nodes, of which there may be six, and the use of a histological method is impossible due to the duration of the study.According to leading clinics, the error of urgent histological examination of sentinel lymph nodes is 25%, so they recommend using intraoperative cytological examination of prints from the surface of the cut lymph node. According to our data, the reliability of an urgent cytological study to identify metastatic lesions of the lymph nodes is 97-99%.

It should be noted that there may be contraindications for urgent morphological examination.Urgent intraoperative morphological examination is not recommended if intraepithelial cancer with a limited lesion is suspected due to the fact that there will be no material left for a planned histological examination. Cytological criteria for intraepithelial cancer are only being developed, and the cytologist can make a conclusion about the cancer without indicating that it is Carcinoma in situ. With intraductal papillomas of a small size, it is better not to perform an urgent histological examination, and a cytological examination will reliably help to establish the nature of the process.

In urgent morphological diagnostics, macroscopic examination of the operating material is essential. An experienced morphologist can already make a diagnosis by visual examination, but microscopic examination is necessary to confirm the diagnosis. For example, a tumor node of a classic stellate shape can be in three completely different processes: in cancer, sclerosing adenosis with the Semba center and lipogranuloma. And only microscopic examination allows the correct diagnosis.

The cytological method allows in dynamics, without traumatizing the patient, to study therapeutic pathomorphosis during chemoradiation and photodynamic therapy.

XX century is called the century of cytopathology in medical circles. Assessing the capabilities of the cytological method, we can say that there are still opportunities for its development in combination with other disciplines and methods.

Immunocytochemical research is often decisive in the differential diagnosis of neoplasms, when, during routine research, insurmountable difficulties arise for establishing the histogenesis of individual tumors, determining the source of metastasis, and interpreting multiple primary lesions.

In recent years, tremendous progress has been made in the clinical use of various biological markers. In contrast to serum markers, cell markers are determined directly in tumor cells by ICC analysis, which is based on the antigen-antibody reaction. These include oncogenes, estrogen and progesterone receptors, molecules that mediate apoptosis, growth factor receptors, etc. All these indicators allow a more detailed study of the molecular biological characteristics of tumor cells associated with the degree of differentiation, the ability to invasion and metastasis, sensitivity to chemotherapy, and, therefore, with the characteristics of the course and prognosis of the disease in each case.

There are no specific markers for the differential diagnosis of malignant and benign neoplastic processes, but scientific research is currently underway to solve this problem. Thus, uniform staining of the germinal centers of lymphoid follicles using bcl-2 antibodies indicates follicular lymphosarcoma, while a negative reaction indicates a benign hyperplastic process; the reaction with HBME-1 antibodies in the ICC study of thyroid tumors is often positive in malignant neoplasms and practically absent in benign neoplasms; in differential diagnosis, galectin-3 is widely used, expressed by thyroid carcinomas from A-cells (papillary, follicular) with no expression in follicular adenomas, goiter and normal thyroid tissue.

To establish histogenesis and differential diagnosis of tumors, the schemes of C.R. Taylor and R.J. Cote (1994). The variety of monoclonal antibodies used in immunocytochemical studies of fine-needle punctates, in each specific case, makes it possible to answer the question of whether this tumor is of epithelial origin or is a sarcoma, melanoma, or lymphoma. Immunocytochemistry is widely used for immunophenotyping of malignant lymphomas, without which, according to modern canons, it is impossible to start treatment.

Immunocytochemistry assists in determining the source of metastasis with an undetected primary focus. Unfortunately, there are not so many organ-specific markers. These include prostate specific antigen (PSA), which allows to identify metastases of prostate cancer in more than 95% of cases; thyroglobulin, expressed in 92–98% of follicular and papillary thyroid cancers, and calcitonin, expressed in 80% of medullary thyroid cancers -C-cell cancers.

Steroid hormone receptors were one of the first indicators that entered the practice of treating patients with breast cancer (BC) and belonged to the category of cell markers. Steroid hormone receptors are proteins that specifically and selectively bind the corresponding steroids after they enter the cell.

According to WHO (2003), the expression of estrogen receptors (ER +) and progesterone (RP +) in invasive ductal cancers is 70-80%; Invasive lobular carcinoma expresses ER in 70-95%, in 60-70% – ER, 100% expression of ER is noted in invasive cribrous, mucinous breast tumors.Edocrine therapy is most effective in patients with primary tumors with high steroid receptor levels. In metastatic lesions, the degree of response to endocrine therapy also depends on the presence of ER and RP in the tumor: its effectiveness is about 10-15% for hormone-negative tumors, 27% for tumors with ER + and RP-, 46% with ER- and RP + status and 75% for tumors containing ER + and RP +. Receptor-positive breast tumors have a higher differentiation and a better prognosis.

It should be noted that hormone receptors in benign breast masses are still poorly understood. An increase in the number of ER + cells in normal breast tissue with increasing age was noted, as well as in sclerosing adenosis, papillomas, fibroadenomas and leaf-shaped tumors. Coexpression of ER + / Ki-67 + with varying degrees of severity and ratio was mostly detected in pathology associated with the risk of developing breast cancer.

Estrogen receptors are expressed in cancer cells of the endometrium, ovary, cervix, thyroid, intestine, neuroendocrine tumors, including carcinoids.

Immunocytochemical study allows to establish the most important factors of tumor prognosis at the preoperative stage and to adjust the treatment regimens. The proliferative activity of many neoplasms is assessed using Ki-67 antibodies in malignant lymphomas, tumors of the mammary, prostate, pancreas, lungs, pituitary gland, and colon. A relationship was found between the values ​​of the proliferation index and the degree of histological differentiation of the tumor and the clinical prognosis in endometrial, ovarian, lung, breast, bladder, lymphomas, and tumors of the nervous system.

Overexpression of the oncoprotein C-erbB-2 (HER2 / neu), which is a type 2 epidermal growth factor receptor that gives cells the property of unlimited division, is a risk factor for disease recurrence for a number of tumors: breast, colon, lung cancer, etc. Expression of the oncoprotein C-erbB-2 during IHC study is found in 15–40% of breast cancer. The detection of oncoprotein C-erbB-2, according to some authors, is associated with a high degree of tumor malignancy, the absence of ER and RP, high mitotic activity, resistance to chemotherapy and requires the appointment of Herceptin.

The presence of lymph node metastases in tumor lesions is the main discriminatory prognostic sign. With the help of immunocytochemical studies, it is possible to identify single circulating keratin-positive breast cancer cells in the bone marrow and peripheral blood. The use of ICC research increases the detection rate of micrometastases in the lymph nodes by 3.2-24%.

Immunocytochemical reactions are assessed both qualitatively when specifying tumor histogenesis, the presence of metastasis in a lymph node or other organ, immunophenotyping of lymphomas, and quantitatively – when assessing proliferative activity, expression of hormone receptors in a tumor, oncoprotein C-erbB-2, etc.e. Immunocytochemical reaction can be nuclear, cytoplasmic and membrane. The nuclear reaction is manifested by intense staining of the nucleus and occurs in the determination of ER and RP, Ki-67, PCNA, p53, etc. The cytoplasmic reaction is characterized by diffuse staining of the cytoplasm or the deposition of granules in the form of rough spots and grains. Cytoplasmic staining is given by chromogranin, synaptophysin, protein S-100, vimentin, desmin, thyroglobulin, calcitonin, cytokeratins, bcl-2, etc. Evaluation of this reaction requires great care and control, since the background staining of the cytoplasm of cells can be mistaken for a true reaction.Membrane staining is observed during the reaction with the oncoprotein C-erbB-2 and EMA (epithelial membrane antigen). Staining in such cases only of the cytoplasm should not be counted as antigen expression. The marker of large cell anaplastic lymphoma CD-30 can be expressed both in the cytoplasm and on the cell membrane.

To quantify the expression of the Mc marker. Carthy and co-authors developed the Histo score (H.S.) system. The counting system includes the intensity of immunocytochemical staining, assessed on a 4-point scale, and the proportion of stained cells and is the sum of the products of percent reflecting the proportion of cells with different staining intensities per point corresponding to the intensity of the reaction.Color intensity in points: 0 – no coloration, 1 – weak coloration, 2 – moderate coloration, 3 – strong, 4 – very strong coloration. Calculation formula:

Histochemical score = ∑ P (i) × i (histochemical score),

where i is the intensity of staining, expressed in points from 0 – 4,
P (i) is the percentage of cells stained with different intensities.

The maximum number of Histo scores, respectively, should be 400. The count is carried out in three cohorts of 100 tumor cells in different fields of view (objective x 40).

In practical work, it is permissible to use a semi-quantitative assessment. The reaction is considered negative in the absence or expression of antigen less than 5% –10% of tumor cells, weakly positive – from 5% –10% to 24% of cells, moderately positive – in 25% –75%, pronounced – in more than 75% of cells. When assessing the enzyme immunoassay, the intensity and completeness of the staining of the cytolemma of cells in the center of the tumor focus are taken into account. So, a bright, membrane, continuous along the cell contour, the reaction denotes a pronounced expression of the C-erbB-2 (+++) protein, which in 95% of cases is confirmed by the amplification of the C-erbB-2 gene, detected by FISH (fluorescent in situ hybridization) …

Comparing the data of immunocytochemical studies of various tumors in order to clarify the histogenetic affiliation and the results of postoperative morphological conclusions, the following results were obtained: 89% coincidences in the analysis of thyroid tumors, 83% in the clarification of the histogenesis of the primary tumor and metastases in the lymph nodes, 89% – in soft tumors tissues and skin and 100% – in the study of biological fluids. When determining the hormonal status of breast cancer, the percentage of coincidence of ICC and IHC studies is 88.3%, in the study of proliferative activity – 83%, in the determination of oncoprotein C-erbB-2 – 93.2%.

When comparing the capabilities of ICC research in performing puncture biopsy and IHC research in trepanobiopsy, the advantages of ICC, in our opinion, are undeniable. Puncture biopsy is a simpler procedure, it is not accompanied by such complications as inflammation, bleeding, and allows you to obtain a full-fledged cellular material. In case of unsuccessful puncture and getting into necrosis, the stroma of the tumor, the surrounding tissues, the procedure can be repeated almost painlessly. In addition, there is no loss and masking of antigens during the posting and dewaxing of the material using aggressive chemical reagents.

The use of immunocytochemical studies makes it possible to expand the possibilities of morphological methods and at the preoperative stage to clarify histogenesis, to diagnose multiple primary lesions, the extent of spread, and to evaluate some indicators of prognosis and tumor sensitivity to chemohormone therapy.

At the present stage of development, methods of molecular and gene diagnostics are used in cytology: in situ hybridization, Southern Blotting, Northern Blooting, Western Blotting, DNK Microarray, etc.e) In scientific and practical work, cytologists use flow cytophotometry.

One of the ways to improve the cytological research method is the use of morphometry, which allows you to obtain objective quantitative parameters. For example, when processing on a computer, the most informative morphometric features related to the parameters of the nucleus were identified using the main diagnostic morphometric features: area, perimeter, optical density, polarization coefficient of nuclei, number of nucleoli, their area and perimeter.Objective morphometric signs of various degrees of dysplasia in dyshormonal-hyperplastic processes of the mammary gland and cervix have been developed, which reduced the proportion of subjectivity in determining various degrees of dysplasia.

New methods of microscopy are being developed: phase contrast, fluorescent, confocal, etc. The creation of computer training systems, the development of the teleconsultation method also impose new requirements and, undoubtedly, will contribute to the development and improvement of the cytological diagnostic method.

Volchenko Nadezhda Nikolaevna
Doctor of Medical Sciences, Professor, Head of the Department of Oncocytology
, P.A. Herzen Moscow Oncology Research Institute

Blood test for HPV and cervical cancer, colposcopy price – CMD

Human papillomavirus (HPV) is a DNA virus of the Papillomaviridae family. This family includes common and genetically diverse viruses that infect and damage epithelial cells (skin, mucous membranes of the anogenital region, oral cavity).

More than 130 HPV genotypes are known. According to the clinical classification, they are divided into cutaneous and anogenital types of papillomaviruses. It is the anogenital HPV types that cause damage to the mucous membranes of the vagina and cervix. The most harmless of these diseases is benign genital warts, the most dangerous is cervical cancer.

Human papillomaviruses are transmitted during sexual intercourse. With the onset of sexual activity, the vast majority of women become infected with this virus.It should be borne in mind that the risk of contracting HPV depends both on the number of sexual partners and on the sexual behavior of the only partner (the prevalence of HPV in men is approximately equal to the prevalence among women).

Human papillomavirus infection itself is not a disease. After 6-18 months, in ~ 80% of infected women, the virus leaves the body on its own, without any treatment, without causing disease (spontaneous elimination). And only a small percentage of women with chronic (persistent) infection caused by highly oncogenic HPV genotypes can develop cervical cancer in 10-20 years.It seems that there is enough time for successful diagnosis and treatment, but you should not relax.

Human papillomavirus infection is very insidious, and the precancerous changes associated with it, as a rule, not only do not cause any anxiety and discomfort, but are often not detected during a routine gynecological examination.

Therefore, to detect papillomavirus infection, the HPV test is used by the polymerase chain reaction (PCR) method. The HPV test is a reliable assistant to the doctor: the detection of papillomavirus and the determination of its genotype makes it possible to determine the further tactics of managing and treating a woman.

It should be borne in mind that the identification of HPV of a group of high carcinogenic risk in women is not a basis for the diagnosis of a malignant tumor, but serves as a reason for further examination, more intensive observation and, if necessary, treatment of precancerous changes in the cervical mucosa.

The outcome of HPV infection depends on the genotype of the virus. All papillomaviruses are subdivided into groups according to “harmfulness” or “oncogenicity”. HPV tests by polymerase chain reaction (PCR) can detect all common and clinically significant HPV genotypes.

The group of low carcinogenic risk includes 6, 11 HPV genotypes: they can cause genital warts and mild dysplasias. Analysis for HPV genotypes 6 and 11 is used for differential diagnosis with diseases of non-papillomavirus etiology and in the examination of pregnant women to assess the risk of developing laryngeal papillomatosis in newborns.

The 16th and 18th genotypes of papillomaviruses most often lead to cervical cancer. They, together with types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68, are included in the group of high carcinogenic risk.When conducting analyzes for the human papillomavirus, it is these genotypes that need to be paid special attention. The most important DNA analysis of HPV types 16 and 18, especially if their concentration (“viral load”) is high. And the oncogenic potential of 51 and 56 types is not so great, therefore they are less dangerous, even if they are present in a relatively large amount in the analysis for HPV.

  • Human papillomavirus 16/18, DNA qualitative determination, PCR
  • Human papillomavirus 16/18, DNA quantification, PCR
  • Human papillomavirus of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), total qualitative determination of DNA, PCR 90 120
  • Human papillomavirus of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51, 52.56, 58, 59), qualitative determination of DNA, indicating the type of virus
  • Human papillomavirus of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), total DNA quantification 90 120
  • HPV test extended (with determination of the amount and type of virus)

You can take an HPV test in women by PCR (HPV test) on your own, without a doctor’s referral.If no HPV infection is detected (negative HPV test), then the risk of developing cervical cancer is low. But it should be remembered that with the continuation of an active sex life, the risk of HPV infection remains.

In case of a positive HPV test, detection of HPV of high carcinogenic risk, it is necessary to do an extended study to clarify the genotype of the virus (HPV analysis – typing) and “viral load” (human papillomavirus – quantitative analysis). Then you need to consult a gynecologist for colposcopy – examination of the cervix under magnification using a special device – a colposcope.

All additional tests for human papillomavirus and other studies should be carried out as directed and under the supervision of a physician.

If the lesion of the cervical mucosa is detected at an early stage preceding the cancer, then the treatment is more effective and has practically no side effects. If no pathological changes in the mucous membrane of the cervix are found, then there is no need for treatment: most likely, the body will cope with the virus on its own.

However, after 1 year, it is necessary to undergo repeated HPV testing and, if the virus is still present, to be examined again by a gynecologist.

Analysis for human papillomavirus (HPV) by PCR and cytological studies.

In Russia, the system of compulsory health insurance (MHI) includes a cytological study – “smear for oncocytology”. Are HPV tests necessary then?

The basis of modern screening programs for early detection of oncological pathology of the cervix is ​​a Pap test (Pap test, Pap test).Unfortunately, not all Russian medical institutions use this technique, very often other, less perfect methods of preparing (staining) a cytological smear are used.

In addition, it is important to know that the cytological method is not an analysis for the human papillomavirus. Cytology “does not see” the virus itself, but reveals epithelial cells that have already been changed under its influence, that is, clinical and subclinical forms of HPV infection. The cytological test also has very significant drawbacks – low sensitivity, subjectivity of interpretation and the dependence of the result on the quality of taking a cytological smear.

That is why traditional cytological screening is characterized by a large number of false negative and uncertain results that require repeated studies.

To reduce the possibility of errors, cytological tests were improved – the method of liquid cytology was introduced. Liquid cytology is a new technology for preparing cell samples from the cervix for cytological examination. The advantages of this method are a decrease in the number of inadequate smears, artifacts, the ability to avoid contamination of samples with inflammatory exudate, erythrocytes, which ensures high quality of cytological preparations.Today, it is this method of cytological screening of cervical diseases that is recommended by the WHO (World Health Organization) as the “gold standard” for examining cervical smears.

According to the latest international and domestic recommendations, the combined use of HPV analysis (HPV test by PCR) and cytological examination (PAP test) is the preferred method for early detection of cervical cancer in women over 29 years old.Such screening should be done regularly – once every 3 years.

90,000 An epigenetic test identified early cervical cancer better than standard diagnostics. It focuses on the expression of the EPB41L3 gene, which inhibits cell division – Science

Cervical cancer develops largely due to the human papillomavirus (HPV). HPV leads to dysplasia in the cervix – atypical cells begin to appear on its surface. Dysplasia, in turn, is fraught with the appearance of neoplasms and cancer.

Cervical dysplasia has three stages of development, and doctors conducted a study to test a new technique that was supposed to identify its second and third stages and cancer if it developed.

Testing methods currently available are based on smear examination, which looks for abnormal cells that can become cancerous, and gene analysis, which should show the presence of HPV. The new method, developed by British scientists, works differently: it looks not so much for genes and altered cells, as it detects methylation of gene EPB41L3 , which, as previous studies have shown, is associated with the appearance of a tumor.Methylation, that is, the addition of a methyl group to DNA, stops gene expression.

The functions of the protein that encodes the gene EPB41L3 are still unknown, but the gene itself inhibits cell proliferation, that is, prevents them from dividing. It was found that methylation of the gene EPB41L3 is associated with the activity of cancer cells, which by and large are only engaged in the fact that they are dividing uncontrollably. The new test looks for methylated genes EPB41L3 , thus showing the risk of cancer.

Scientists conducted a randomized study of 15,000 women, who were divided into three groups: those who were tested using a genetic test for HPV, a group in which a new test was tested, and a third, control group, where a Pap smear (Pap smear) was used. the most common test for cervical cancer, invented back in the 40s of the XX century. The participants in the study were tested twice, with an interval of one year.

The results of the study showed that the new test based on methylation is more effective: it revealed third-degree dysplasia in 93% of cases, while the Pap smear only in 61%.

Scientists included in each group the results of eight women who at that time were diagnosed with cervical cancer, and the new test recognized cancer in all eight cases, and the Pap test only in two.

A new technique was needed because one generally accepted type of screening, the Pap test, well detects only the third stage of dysplasia, and another way to identify the risk of future cancer – testing for HPV genes – gives too many positive results – not all cases of HPV infection necessarily lead to cancer.The new test allows you to notice the earliest signals of painful changes in the cells in the cervix. According to the authors of the study, the new test can be put into practice within five years.

Maxim Abdulaev

Human papillomavirus, diagnostics – Clinic Health 365, Yekaterinburg

It is necessary to contact a doctor for diagnostics , since human papillomavirus (HPV) often does not detect itself in any way in both men and women .

Genital warts are flesh-colored and located on the cervix, penis, scrotum, vagina, or anus. They can be small or large, flat or spherical, single or multiple. They can be found both in the groin and thighs or even in the mouth.

Genital warts can be divided into two types in terms of shape and size:

  • Some are visible to the naked eye and located on the surface of the skin, others are small and barely visible 90 120
  • The second type is squamous intraepithelial cell injury and covers the cervix.To see them, video colposcopy is required

Research has shown that certain types of HPV cause genital warts, also known as genital warts. All HPV types are numbered and categorized as “hazardous” and “non-hazardous” depending on whether they cause cancer.

For example, human papillomaviruses 6 and 11, which cause genital warts, are classified as “harmless”. PCV viruses 16, 18, 31, 33 and 35, which develop in the genital area or in the anus, are cancer-causing viruses in both men and women.

If you develop a wart, see your doctor. It is also necessary to undergo diagnostics if:

  • You have any unusual growths, lumps, or other skin changes on the vulva, vagina, anus, or penis
  • You have itching, pain or bleeding in the genital area
  • Your sexual partner has been diagnosed with human papillomavirus.

During the examination, the doctor may use a coloscope, an optical device with a video camera and illuminator, to detect small warts or other abnormalities.The doctor may also apply a vinegar solution, which will stain the affected tissue white. It is not painful and will allow you to better examine the warts or precancerous skin condition.

You may be scheduled to undergo a Pap test, an oncocytological test that looks for early stages of cervical cancer. It can also detect precancerous cells and active HPV.

Papanicolaou test (PAP test) is a simple procedure.In the classic Pap test, the gynecologist uses a special brush and / or spatula to collect cells from the cervix during a pelvic exam and places them on a glass slide, which is then sent to the laboratory. The newer and more accurate ThinPrep Pap test also uses a brush, but the sample is placed in a liquid anticoagulant before being sent to the laboratory.

There are different classifications for abnormal results, but the most common is atypical squamous cells of undetermined significance (ASCUS).

For the detection of HPV, women over 30 years of age can resort to both the Pap test and PCR HPV diagnostics, which uses technology aimed at detecting specific DNA fragments of the human papillomavirus. The use of a Pap test in combination with PCR diagnostics is more effective for women of this age group than a single Pap test.

Both tests help detect a woman’s risk of HPV and prevent cervical cancer in women.Moreover, two new tests for dangerous HPV are approved by the US Department of Health. The first is similar to a DNA test and helps identify 15 dangerous virus species (Cervista HPV HR). The second identifies the two types of HPV that most commonly cause cervical cancer – HPV 16 and 18 (Cervista 16/18).

HPV test (PCR diagnosis of HPV), together with medical history, laboratory tests and other risk factors, helps doctors determine the right treatment if the Pap test is positive.

Recommendations for the PAP test (Papanicolaou, PAP-test)

Here are some guidelines from the American Cancer Society for Pap tests and early detection of cervical cancer:

  • All women should be screened for cervical cancer from age 21 if they have sex. When using the conventional Pap test, the examination is done once a year, and the Pap test by liquid cytology can be used every two years 90 120
  • If by the age of 30 a woman has three consecutive Pap tests negative, follow-up tests can be performed every two to three years.In addition, if an HPV PCR test is additionally carried out, then the Papanicolaou test is sufficient to carry out every three years 90 120
  • If a woman aged 65 to 70 years and older had three or more negative Pap tests in a row, and other tests were also negative, then the next 10 years the test for cervical cancer may not be done. However, women with the risk factors listed below should be screened every year.

The recommendations of the American College of Obstetricians and Gynecologists differ slightly.Experts from this institution believe that screening – a test for cervical cancer should be started at the age of 21, regardless of whether or not there is sexual contact.

Girls under 21 are very rarely at risk of cancer. The American College of Obstetricians and Gynecologists believes that the benefits of cervical cancer screening in this age group do not offset all potential risks, such as unnecessary diagnostic methods and possibly unnecessary treatment.

He also recommends that women aged 21 to 29 conduct a PAP test every two years. An annual survey for women in this age group is not much more effective than a survey conducted every other year. However, an annual check-up is recommended for women of any age at risk of cervical cancer.

Women with a hysterectomy (removal of the uterus and cervix) may not be tested for cervical cancer unless the hysterectomy was done due to cervical cancer or some precancerous factor.If a hysterectomy has been performed to correct cervical cancer, screening – Pap tests should be done annually.

If the uterus was removed, but not the cervix, then screening tests should be continued based on age and preoperative medical history (including Pap test results).

If the doctor notices any changes at the cellular level, he or she may recommend additional methods of examination or treatment, depending on your medical history.For example, repeat the Pap test, HPV PCR test, colposcopy, or order a comprehensive examination or biopsy of an abnormal body area, and refrain from treatment for a while.

Colposcopy is necessary if the Pap test results show more serious abnormalities. Further diagnosis and treatment will depend on the results of the colposcopy. Mild dysplasia of the cervical intraepithelial neoplasia of the first degree (VNShM-1) does not need to be treated, but it is necessary to repeat the Pap tests from six months to a year.But in the case of VNShM-2 and VNShM-3, it is necessary to prescribe treatment to eliminate abnormal cells.

Bisexual and lesbian women should also have regular Pap tests. Surveys show that it is better to go to a private clinic due to the fact that in a regular hospital they feel uncomfortable answering questions about their sexual orientation. While bisexuals and lesbians may think that they do not need preventive diagnostics because they are not at risk, they are also prone to HPV infections and cervical cancer (for example, through male ex-partners, vibrators and other sex toys who have had skin contact with an infected partner).

More detailed information about the human papillomavirus can be obtained from the gynecologists of the Zdorovye 365 clinic in Yekaterinburg.

Related topics:

STD

Inflammatory diseases

Bacterial vaginosis

Menstrual pain

Ovulatory syndrome

Pain in the lower abdomen

Signs of pregnancy

Colposcopy

Miscarriage

Ectopic pregnancy

Premature birth

Hysterosalpingography

Hysteroscopy

Laparoscopy

Gynecological operations

Removal of the uterus

Uterine myoma

Endometriosis

Ovarian cyst

Adenomyosis

Ultrasound of the small pelvis

Ultrasound of mammary glands

Mastopathy

Menopause

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