Pap smear in cytology

Preventive examinations by health groups

The frequency and scope of cytological screening directly depend on the woman's age and her belonging to a specific health group.

Health Group I (virtually healthy patients) A standard preventive approach with a clear age-based division is applied here:

• 21–29 years: cytology (cervical smear evaluation) is the baseline method. It must be performed at least every 3 years.
• Ages 30–65: the screening strategy changes. At this age, the priority is cotesting—simultaneous performance of the Pap smear and HPV testing. The screening interval is increased to once every 5 years.

Health Group II (presence of risk factors) This category includes women with an increased risk, primarily HPV-positive patients. Such patients are strongly advised to undergo regular PAP testing:

• If the cytology result is normal (NILM), repeat co-testing is scheduled in 1 year.
• If changes at the ASC-US level or more severe lesions are detected, the patient is strictly indicated for colposcopy.

Health Group III (benign diseases) In the presence of confirmed benign cervical diseases, the management and treatment tactics are determined by the relevant clinical guidelines.

Alternative screening option

In addition to the classical cytological approach, an alternative strategy is permitted, where HPV testing serves as the first step rather than the PAP test. The patient's pathway in this case depends on the virus status:

1. HPV-negative result (-): The risk of developing pathology is minimal. The next screening HPV test is scheduled for the patient only in 5 years.
2. HPV-positive result (+): High risk of intraepithelial lesions. In this situation, performing a cytological study (PAP test) to assess cellular changes in the epithelium becomes a mandatory second step.

Cytological conclusions and management algorithm

Standard or liquid-based cytology is used for analysis. In the absence of additional indications, the test is performed once every 3 years. Further actions of the physician are strictly regulated by the obtained report.

1. NILM Report Negative for Intraepithelial Lesion or Malignancy — this is a normal variant. Squamous and glandular epithelial cells show no signs of atypia.

• Tactics: Repeat the cytological examination routinely in 3 years.

2. ASC-US Report Atypical Squamous Cells of Undetermined Significance — detection of atypical squamous cells of undetermined significance.

• Primary tactics: For ASC-US and any more severe lesions, HPV testing is strictly indicated.

The further algorithm for ASC-US depends on the presence of the virus:

• If HPV test is (-): no cause for concern, repeat co-testing is indicated in 3 years.
• If HPV test is (+): the patient is referred for colposcopy.
• If abnormal findings are detected during colposcopy, a cervical biopsy is performed.
• In the absence of abnormal colposcopic findings, repeat co-testing is scheduled in 1 year.

> Clinical Note: For patients with an ASC-US result and a positive HPV test, additional diagnostic triage may be advisable. For this purpose, immunocytochemical (ICC) testing of the collected biological material for the expression of p16/Ki67 biomarkers is performed. This helps to more accurately assess the risk of high-grade dysplasia.

Class and exam questions

What else to study on this topic

• Morphological appearance of cells in ASC-US and more severe dysplasias
• Comparison of conventional and liquid-based cytology
• Colposcopic features of abnormal findings in HPV infection
• Biochemical mechanism of p16 and Ki67 protein overexpression in cells
• Management tactics for patients with LSIL and HSIL results

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.