Papanicolaou Smear

From Anvita Health Wiki

Contents 1 Indications 2 Procedure 3 Management 4 More General Terms 5 Additional Terms 6 References

Indications

• used primarily to detect premalignant lesions of the cervix
• screening for cervical cancer (also see recommendations for performing Pap smears)
• any woman with postcoital bleeding
• unnecessary in women who have had hysterectomy, provided no cervical tissue remains [7]
• not indicated in women > 60 years of age who have previously had normal smears

Procedure

• perform prior to cultures for gonococcus & Chlamydia
• specimens taken from the squamocolumnar junction of the cervix
• small amounts of lubricant do NOT affect Pap smear results [3]

Management

• colposcopy in a any woman with abnormal Pap smear showing high-grade squamous intraepithelial lesion, or microinvasive or invasive cervical cancer
• biopsy any grossly visible abnormality of the cervix

More General Terms

• cytology

Additional Terms

• recommendations for performing Papanicolaou (Pap) smear
• screening for cervical cancer

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 405-407
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
3. Journal Watch 23(1):10, 2003
   - Harer WB, Valenzuela G Jr, Lebo D. Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears. Obstet Gynecol. 2002 Nov;100(5 Pt 1):887-8. PMID: &dopt=Abstract
   - Amies AM, Miller L, Lee SK, Koutsky L. The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis. Obstet Gynecol. 2002 Nov;100(5 Pt 1):889-92. PMID: [1]
4. Journal Watch 23(5):42, 2003 [2]
5. Journal Watch 23(23):181, 2003 Sawaya GF et al, N Engl J Med 349:1501, 2003 <PubMed> PMID: [3] <Internet> [4] [5]
6. Journal Watch 24(6):452, 2004 Wright TC Jr et al, Obstet Gynecol 103:304, 2004 PMID: [6]
7. Journal Watch 24(15):117-118, 2004 Sirovich BE, Welch HG. Cervical cancer screening among women without a cervix. JAMA. 2004 Jun 23;291(24):2990-3. PMID: [7]
8. National Guideline Clearinghouse
   - 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. ngc-guideline: [8]
   - Initial management of abnormal cervical cytology (Pap smear) and HPV testing. (Institute for Clinical Systems Improvement) ngc-guideline: [9]
   - Guidance on the use of liquid-based cytology for cervical screening. (National Institute for Health and Clinical Excellence) ngc-guideline: [10]
   - Management of abnormal cervical cytology and histology. American College of Obstetricians and Gynecologists ngc-guideline: [11]
   - Cervical cytology screening. American College of Obstetricians and Gynecologists ngc-guideline: [12]

Papanicolaou (Pap) smear