What is the primary purpose for doing a Pap smear? What are the indications for doing a Pap smear? Primary purpose of doing a Pap smear is to identify changes that place patients at risk for cervical cancer. Indications for Pap Smear (know these): (1) women at the onset of sexual activity or 18+ years old, (2) at least annually for 3 consecutive years to establish baseline, (3) after hysterectomy for benign disease, (4) history of hormone DES (diethyl stilbestro) exposure which can lead to clear-cell vaginal cancer and trouble getting pregnant, (5) following treatment of cervical pre-invasive disease or cancer, (6) pre-natal screening. *Up to 25% of Pap smears can have a false negative.*
What is the most critical area to sample when collecting a Pap smear?
--the transformation zone (squamous-columnar junction), where most abn cell changes occur
Correlate Pap smear cytological abnormalities w/ biopsy-obtained histopathological abnormalities using the WHO and Bethesda systems.
Comparison of WHO and Bethesda:
WHO Histopathologic Terms Bethesda Cytology Terms
CIN 1/ Mild Dysplasia LSIL [lower 1/3rd cervical epithelium]
CIN 2/ Moderate Dysplasia HSIL [middle 1/3rdepithelium]
CIN 3 / Severe Dysplasia HSIL [>2/3rd epithelium]
CIN 3 / Carcinoma in Situ HSIL [full thickness]
What organisms may/may not be detected on a Pap smear?
--The Hybrid Capture II assay is a specialized Human Papilloma Virus test that can provide qualitative detection of 18 (of the 100) types of HPV. This test can differentiate between low-risk HPV types and high/intermediate HPV risk types. However, it cannot determine the specific HPV type present. ?? AND WHY NOT? IT CAN TELL HIGH FROM LOW RISK BUT NO MORE? WHAT IF YOU PAY ANOTHER $1000, THEN CAN IT TELL?? please pardon my cynicism...onward:
--The “wave of the future” is PCR, polymerase chain detection, which can perform HPV DNA testing for high-risk HPV types. This will enable identification of individual HPV strains.
HPV Strain Linked to
6/11/42/43/44 Low risk
6 &11 benign lesions -> condylomata accuminata & mild dysplasia
16 & 18 most commonly associated with CIN & CIS
What is the optimal time for collecting a Pap smear?
--The optimal time to collect a Pap smear is the week following cessation of menses, in the Proliferative phase, i.e. 2 weeks after the start of the menses, day 14.
What strain(s) is the new HPV vaccine effective against?
HPV 6, 11, 16 & 18
What strain is most implicated in cervical cancer?
HPV 16 (implicated in 50% of cervical CA cases)
And just a reminder, here's what HPV can do to you if your immune system cannot fight against it: