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Papanicolaou (Pap) smear

Indications: 1) used primarily to detect premalignant lesions of the cervix 2) screening for cervical cancer - every 3 years age 25-65 years (ACS) 21-65 (USPSTF) - see recommendations for performing Pap smears 3) any woman with postcoital bleeding 4) unnecessary in women who have had hysterectomy, provided no cervical tissue remains [7] 5) not indicated in women > 60 years of age who have previously had normal smears Procedure: 1) perform prior to cultures for gonococcus & Chlamydia 2) specimens taken from the squamocolumnar junction of the cervix 3) small amounts of lubricant do NOT affect Pap smear results [3] 4) performing human papillomavirus DNA on specimens may be useful [8] 5) Results reported as cytology report of cervical or vaginal smear Management: 1) colposcopy in a any woman with abnormal Pap smear showing high-grade squamous intraepithelial lesion, or microinvasive or invasive cervical cancer 2) women 21-24 years of age with Pap smear that shows atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions with reflexive positive HPV DNA: repeat cervical cytology alone in 12 months [9] 3) biopsy any grossly visible abnormality of the cervix

Related

cytology report of cervical or vaginal smear recommendations for performing Papanicolaou (Pap) smear screening for cervical cancer

General

cytology smear for microscopy

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 405-407
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
  3. Journal Watch 23(1):10, 2003 - Harer WB, Valenzuela G Jr, Lebo D. Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears. Obstet Gynecol. 2002 Nov;100(5 Pt 1):887-8. PMID: 12423847 - Amies AM, Miller L, Lee SK, Koutsky L. The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis. Obstet Gynecol. 2002 Nov;100(5 Pt 1):889-92. PMID: 12423848
  4. Journal Watch 23(5):42, 2003 http://www.ahrq.gov/clinic/3rduspstf/cervcan/
  5. Journal Watch 23(23):181, 2003 Sawaya GF et al, N Engl J Med 349:1501, 2003 PMID: 14561792 http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr2.htm
  6. Journal Watch 24(6):452, 2004 Wright TC Jr et al, Obstet Gynecol 103:304, 2004 PMID: 14754700
  7. Journal Watch 24(15):117-118, 2004 Sirovich BE, Welch HG. Cervical cancer screening among women without a cervix. JAMA. 2004 Jun 23;291(24):2990-3. PMID: 15213211
  8. Kinde I et al. Evaluation of DNA from the Papanicolaou test to detect ovarian and endometrial cancers. Sci Transl Med 2013 Jan 9; 5:167ra4
  9. Massad LS et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013 Apr; 121:829 PMID: 23635684