88164 Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision

Name of the Procedure:

Cytopathology, slides, cervical or vaginal (The Bethesda System); manual screening under physician supervision

Summary

Cytopathology involves examining cells from the cervix or vagina collected during a Pap smear to detect precancerous changes, cancer, and other cellular abnormalities. It utilizes the Bethesda System for standardized reporting.

Purpose

Cytopathology screens for cervical cancer, precancerous lesions, human papillomavirus (HPV) infections, and other cellular abnormalities in the cervix or vagina. The main goal is early detection and intervention to prevent the progression of diseases.

Indications

• Abnormal vaginal bleeding
• Pelvic pain
• History of HPV infection
• Previous abnormal Pap smear results
• Routine screening as part of gynecological health

Preparation

• Avoid intercourse, douching, or using vaginal medicines for at least 48 hours before the test.
• Schedule the test at least five days after the end of menstrual bleeding.
• No specific fasting or medication adjustments required.

Procedure Description

1. The patient lies on an exam table with feet in stirrups.
2. A speculum is inserted into the vagina to hold it open for cervix visualization.
3. A small brush and spatula are used to gently collect cells from the cervix.
4. The collected cells are smeared onto slides or placed into a liquid medium.
5. Slides are stained and examined under a microscope by a cytotechnologist or pathologist using the Bethesda System for classification.
6. Results are reviewed and supervised by a physician.

Duration

The cell collection takes about 5–10 minutes. Slide preparation and examination can take a few days, depending on the lab.

Setting

Performed in an outpatient clinic, gynecologist's office, or healthcare facility with cytopathology services.

Personnel

• Gynecologist or trained healthcare provider for cell collection
• Cytotechnologist or pathologist for slide examination
• Supervising physician for diagnosis confirmation

Risks and Complications

• Mild discomfort or spotting post-procedure
• Rare risk of infection
• False-positive or false-negative results

Benefits

• Early detection of cervical cancer and precancerous conditions
• Allows timely intervention and treatment
• Can detect non-cancerous conditions like infections

Recovery

• Post-procedure, normal activities can be resumed immediately.
• Follow any specific instructions given by your healthcare provider.
• Await results, typically available within a week, and attend any follow-up appointments if needed.

Alternatives

• HPV DNA testing: specifically screens for high-risk HPV strains.
• Visual Inspection with Acetic Acid (VIA): used in low-resource settings.
• Routine pelvic exams: may detect abnormalities but less specific than cytopathology.

Pros of Cytopathology

• Standardized reporting (Bethesda System)
• High accuracy for detecting precancers and cancers

Cons of Alternatives

• May not be as specific or sensitive as cytopathology
• HPV testing alone doesn't detect cellular abnormalities

Patient Experience

During the procedure, you might feel mild discomfort similar to a pelvic exam. Post-procedure, some light spotting or cramping may occur. Pain management is usually not necessary, but if you have concerns, communicate with your healthcare provider for reassurance and advice.