Name of the Procedure:

Screening Cytopathology (Cervical or Vaginal)
Common Names: Pap Test, Pap Smear
Technical/Medical Terms: Cervical Cytology, Vaginal Cytology, G0143

Summary

A Pap test is a screening method used to detect precancerous or cancerous cells in the cervix or vagina. The cells are collected using a special brush and placed in a preservative fluid, followed by automated thin layer preparation, and manually screened by a cytotechnologist under a physician's supervision.

Purpose

The Pap test aims to detect human papillomavirus (HPV)-related changes, precancerous conditions, or cervical cancer early. Detecting abnormalities prompt early intervention, which is vital for successful treatment and preventing progression to more severe disease.

Indications

• Routine screening for cervical cancer in women ages 21-65
• Monitoring for women with a history of cervical dysplasia or HPV
• Symptoms like unusual vaginal bleeding or discharge
• Part of a gynecological examination

Preparation

• Generally, no fasting required.
• Avoid vaginal intercourse, douching, or using vaginal medications for 24-48 hours before the test.

• Schedule the test when not menstruating, if possible.

  Procedure Description

  1. The patient lies on an examination table with feet placed in stirrups.
  2. A speculum is gently inserted to widen the vaginal canal.
  3. A special brush or spatula collects cells from the cervix.
  4. Collected cells are placed in a preservative fluid.
  5. Cells are processed using automated thin layer preparation technology.
  6. A cytotechnologist examines the cells under a microscope manually, followed by a physician's review.

  Tools/Equipment: Speculum, cytology brush/spatula, preservative fluid, microscope, automated thin layer preparation machine.

Anesthesia/Sedation: None typically required.

Duration

The actual cell collection takes about 5-10 minutes. Preparing and analyzing the samples can take a few days.

Setting

Typically performed in an outpatient clinic, gynecologist's office, or healthcare center.

Personnel

• Gynecologist or trained healthcare provider (e.g., nurse practitioner)
• Cytotechnologist
• Physician for supervisory review

Risks and Complications

• Mild discomfort or cramping during the procedure
• Spotting or light bleeding afterward
• Rare risk of infection or injury to the cervix

Benefits

• Early detection of precancerous changes or cervical cancer
• High potential for successful treatment if abnormalities are found early
• Peace of mind when results are normal

Recovery

• Resume normal activities immediately.
• Some light spotting or cramping may be experienced.
• Follow-up as recommended based on results (normally every 3 to 5 years for routine screening).

Alternatives

• HPV DNA test: More specific for detecting the presence of high-risk HPV types.
• Visual inspection with acetic acid (VIA): Used in low-resource settings.
• Primary HPV screening: More widely adopted in recent years.

Pros of Pap test:

• Well-established and widely available.

  Cons of Pap test:

• Might miss some high-grade lesions if not combined with HPV testing.

Patient Experience

• During the procedure, patients may feel slight discomfort when the speculum is inserted.
• Post-procedure, minor cramping or light bleeding may occur.
• Most patients can manage mild discomfort with over-the-counter pain relievers if needed.