Cervical cytology

Specimen:

Conventional on slide fixed ecto- and endo- cervical smears; liquid based cytology sample.

Vaginal vault smears are required following hysterectomy if there is a history of dysplasia or malignancy

Application:

Investigation of abnormal vaginal bleeding.

In screening asymptomatic women current guidelines are that routine screening should be carried out every two years for women who have no symptoms or history suggestive of cervical disease.

All sexually active women should commence screening within two years of first sexual intercourse and screening may be ceased over age 70 for women who have had two normal smears within the previous five years (see country specific guidelines).

Vaginal vault smears are required indefinitely following hysterectomy if there was a previous history of dysplasia or malignancy.

Women who have never had coitus do not need routine smears.

Interpretation:

Cytology can detect and define the nature of pre-malignant and malignant cervical disease: cervical dysplasia and carcinoma in situ of the squamous epithelium (cervical intra-epithelial neoplasia);
invasive squamous carcinoma; and
in situ and invasive adenocarcinoma.

Specific infections can occasionally be identified on a smear including bacterial, fungal, parasitic (Trichomonas vaginalis), viral (HSV and HPV) and chlamydial (Chlamydia trachomatis) infections.

HPV typing.

Reference:

Gray W and Kocjan G eds. Diagnostic Cytopathology.  3rd ed. Churchill Livingstone 2010.

Solomon D, Nayer R. The Bethesda system for reporting cervical cytology. Springer. 2nd Ed. 2004.