Name of the Procedure:

Cytopathology, cervical or vaginal (Pap smear), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision.

Summary

A Pap smear is a medical test in which cells from the cervix or vagina are collected and preserved in a special fluid. These cells are then prepared using automated thin layer technology for microscopic examination. The screening and rescreening of the cells are done manually under physician supervision to check for any abnormalities, such as precancerous conditions or cancer.

Purpose

A Pap smear is primarily used to:

• Detect abnormal cells in the cervix or vagina that could indicate precancerous conditions or cervical cancer.
• Identify infections or inflammation.
• Verify the health of the cervical and vaginal cells.

Indications

• Women aged 21 and above.
• Routine screening for cervical cancer.
• Follow-up of previous abnormal Pap smear results.
• Women with risk factors for cervical cancer (e.g., human papillomavirus (HPV) infection, smoking).

Preparation

• Avoid intercourse, douching, or using vaginal medications for 24-48 hours before the test.
• Schedule the test when not menstruating, ideally mid-cycle.
• No specific fasting or medication adjustments required.

Procedure Description

1. The patient lies on an examination table and places her feet in stirrups.
2. A healthcare provider inserts a speculum into the vagina to widen it for easy access to the cervix.
3. A small brush or spatula is used to gently collect cells from the cervix or vaginal walls.
4. The collected cells are placed in a vial with preservative fluid.
5. The vial is sent to a laboratory where the cells are processed into a thin layer on slides using automated technology.
6. The slides are manually screened and rescreened under a microscope by a cytotechnologist and supervised by a physician.

Duration

The procedure typically takes about 10-20 minutes.

Setting

Performed in an outpatient setting, such as a doctor's office, clinic, or hospital outpatient department.

Personnel

• Gynecologist or trained healthcare provider (e.g., nurse practitioner, physician assistant) for cell collection.
• Cytotechnologists and pathologists for screening and analysis.

Risks and Complications

Common risks:

• Mild discomfort or spotting after cell collection. Rare risks:
• Infection or significant bleeding (very uncommon).

Benefits

• Early detection of cervical cancer or precancerous conditions.
• Early treatment and intervention can significantly improve outcomes.
• Routine screening can lead to better overall cervical health.

Recovery

• Usually, there’s no downtime required.
• Patients can resume normal activities immediately following the procedure.
• Follow-up instructions depend on the results of the test; if abnormal, further testing or treatment may be required.

Alternatives

• HPV testing, either alone or combined with a Pap smear.
• Visual inspection with acetic acid (VIA) as a screening method in some settings.
• Each alternative has its pros and cons regarding sensitivity, specificity, availability, and cost.

Patient Experience

• Mild discomfort or pressure during the insertion of the speculum.
• Light spotting or cramping after the procedure may occur.
• Generally painless and quick procedure.
• Pain management and comfort measures are minimal due to the non-invasive nature of the test.