Pap Smear

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What is PAP Smear?

PAP Smear is a diagnostic screening test that is done to detect cancer and precancerous conditions of the cervix through microscopic examination of the cells in the transitional zone of the cervix. It is a preliminary test done before more sensitive and accurate tests are done to confirm the diagnosis. The cervix is the lowermost portion of the uterus, cylindrical in shape with an external opening in the vagina and helps in the passage of semen into the uterus.

Alternate names

  • Papanicolaou Test
  • Papanicolaou Test
  • PAP Test
  • Cervical Smear
  • Cervical Screening
  • Smear Test

Is PAP Smear procedure an elective or an emergency procedure?

PAP Smear is an elective procedure.

Indications

PAP Smear is indicated in women over the age of 21 years and is usually done along with a pelvic examination for the following:

  • Diagnosis and detection of cancerous conditions affecting the cervix
  • Diagnosis and detection of precancerous conditions affecting the cervix

Contraindications & Risk factors

There are no absolute contraindications for performing a PAP Smear other than the following:

  • Presence of active cervicitis; treatment is needed before a PAP Smear is done
  • During menstruation

Investigations before the procedure

There are no other investigations required before performing a PAP Smear.

Preoperative advice

The following are advised before performing a PAP Smear:

  • Avoiding vaginal intercourse 48 hours before the test
  • Avoiding douching 48 hours before the test
  • Avoiding medicinal or contraceptive vaginal creams 48 hours before the test
  • Avoiding the use of tampons 48 hours before the test

Intraoperative details

Anaesthesia: No anaesthesia is required for a PAP Smear.

Duration: A PAP Smear takes a few minutes to perform.

Details of the procedure

The individual is asked to lie down on their back on the examination table with their feet in foot stirrups and the tail bone at the edge of the table. A metal or a plastic speculum is placed in the vagina to first examine the cervix, and a cervical broom or spatula is placed on the cervix and rotated in one direction to obtain the cells from the cervix. Additionally, a cervical brush may also be used in addition to a spatula for obtaining the cells from the cervix. The specimen obtained is transferred to a liquid cytology vial or a glass slide labelled and sent to a laboratory for microscopic examination.

Post-operative advice

The procedure is performed on an outpatient basis and the individual can leave immediately after and resume their normal activities.

Interpretation of test results based on the presence of abnormal cells is done as follows:

  • Epithelial cell abnormalities:
    • Squamous cell abnormalities:
      • Atypical squamous cells: It requires further investigations
      • Low-grade intraepithelial lesions: It requires further investigations
      • High-grade intraepithelial lesions: It requires further investigations
      • Squamous cell carcinoma: It requires further investigations
    • Glandular cell abnormalities:
      • Atypical glandular cells: It requires further investigations
      • Atypical endocervical cells: It requires further investigations
      • Endocervical carcinoma in situ: It requires further investigations
      • Adenocarcinoma: It requires further investigations

Complications

There are rarely any complications associated with a PAP Smear test and may include minor bleeding or infections.

Prognosis

A PAP Smear is an effective screening and diagnostic tool that helps in the early detection of cervical cancer. When combined with other confirmatory diagnostic tests such as colposcopy, it can help to greatly increase the early detection and management of cervical cancer.

When to contact the doctor or hospital?/ Indications for hospitalization if required

PAP Smear is done as an outpatient procedure and no hospitalization is required. Medical attention is warranted in the rare event of heavy bleeding after the test.

Suggested clinical specialist/ Departments to consult for this procedure

  • Gynecology & obstetrics

Additional information

PAP Smear is advised to be done on a regular basis as follows:

  • 21 years: Begin screening
  • 21-29 years: Once every 3 years
  • 30-65 years: Every 5 years in combination with HPV testing
  • 65 years and above: Stop screening if previous negative history
  • After hysterectomy: No screening required if there is no history of precancerous conditions in the past 20 years
  • HPV vaccinated women: To be screened similar to those who are unvaccinated
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