PAP smear

Pap test is a surface biopsy screening test to detect precancerous and cancerous condition of the cervix.
* it is included in routine gynaecological examination
* it can also detect some viral infections like herpes
* detects 98% of ca cx and 70% of endometrial ca

Prosedure:
* smear obtained prior to vaginal examination coz fingers may remove desquamated cells and give false neg report.
* Cosco's self-retaining speculum gently introduced without using lubricant
* squamocolumnar junction is scrapd with Ayte's spatula rotating all around -- spread on glass slide -- dipped in equal parts of 95% of alcohol and ether
* three types of cell r found
1) basal cells 2) middle layer squamous cells 3) cells of superficial layer
* malignant cells r hyperchromatic, with increased chromatin content, variable nuclear size, small amt of cytoplasm, increased nucleocytoplasmic ratio.

Pap smear classification:
Pap smear      WHO       Bethesda
  I              normal       normal
  II         inflammatory   inflammatory
                            - HPV, - ASCUS
  III          CIN I           low SIL
  IV        CIN II, III, CIS    high SIL
  V           SCC         SCC

CIN - cervical intraepithelial neoplasia
SIL - squamous intraepithelial lesion
CIS - carcinoma in situ
SCC - squamous cell ca
ASCUS - atypical squamous cell of underemined significance