Pap-Test
The Pap test was developed in 1928 by the Greek physician George Papanicolaou. It is based on an assessment of stained cell smears from the cervix of the woman and serves the early detection of cervical cancer.
Using a cotton swab (preferably with a specially designed spatula, the so-called Szalay spatula that corresponds to the specific shape of the cervix, or a small brush ) are taken from the cervix ( spatula for portio and brush for cervical ) cells and plated on a slide. After fixation with 96 % alcohol by hematoxylin staining is done by Harris and Orange G, and according to an ascending series of alcohols using a special staining solution ( various modifications ).
In the stained smear can now evaluate the microscopic morphology of the cells. It can draw conclusions on hormonal status and cycle phase (differentiation of the vaginal plate and the zervikoendometrialen epithelium ), inflammation ( granulocytes ) and precancerous lesions and cervical cancers can be detected. Further evidence of infection can be found, for example, milk glass cores with herpes, koilocytes with strongly pronounced ( florid ) HPV infection, paranuclear vacuoles with multiple small, reddish inclusion bodies in Chlamydia, Clue cells ( squamous Intermediärzelltyp from that of densely packed short be covered basophilic rods) with Gardnerella vaginalis and yeast cells of Candida.
Cytology
The cells of the outer cervix consist of several layer, unverhorntem squamous epithelium. They can be due to its appearance of the cells of the cervical canal, which is covered with columnar epithelium, delimit. The squamous cells can in turn be broken down. Cells of the top layer of cells are referred to as superficial. These are 45 to 60 microns in size. Your cytoplasm shows colored pink. The cell itself is of polygonal shape. The core is usually from 5 to 7 microns in comparison to the surface of the plasma cell is very small. The chromatin in the nucleus is tightly packed. It follows a deep blue coloration of the cell nuclei. The superficial set in the first phase of the cycle the main part visible in the smear cells, as in proliferating this stage under the influence of estrogen, the squamous epithelium.
Deeper squamous cells are referred to as small and large intermediate cells. The large intermediate cells have as superficial a polygonal shape. They have the same size as the superficial cells. However, their cytoplasm is rich in glycogen, which is why it is colored pale blue green ( cyanophil ). The cores are up to 10 microns in size. Your chromatin is more loosely packed than the core content of the superficial cells. The large intermediate cells make in the second half of the cycle by the influence of progesterone, the majority of the visible cells. As a small superficial cells are referred to as cells with delicate blue - green plasma. However, they are smaller and have a larger core. The cells are roundish in shape. You can of prolonged ingestion of a contraceptive occur during menopause and hormonal disorders increased. In addition, the core contains a small cell having a large core and little cytoplasm, which belong to squamous epithelium. These, so-called parabasal cells are not sufficiently assessed by light microscopy. However, they are the stem cells of the squamous epithelium, from which derive superficial and intermediate cells.
The columnar epithelium of the endocervix page can be divided in a Pap smear in the two cell groups. The much more common mature epithelial, with small nuclei, blue plasma and sometimes fimbriae show depending on the cut structures that are reminiscent of honeycomb or palisades. The cells are mechanically very fragile and can be destroyed under the smear collection and processing of the material. Your cell debris are visible under the microscope. The stem cells of the Zylinderepithes are called reserve cells. You are the light microscope is difficult to assess. Some of the stem cells are pluripotent. Stem cells of the cylindrical epithelium represent the starting point for the physiological metaplasia at the Zervixaußenseite. They are also the starting point for cervical cancer.
The findings are classified in particular regarding the cervical cancer diagnosis in " groups " after the Munich nomenclature II:
As with any medical test, there are false positive and false negative test results here. A study on the validity of the Pap smear showed a sensitivity (the ability to recognize patients as sick ) of only about 51 % and a specificity (the ability to recognize healthy as healthy) of about 98 %. It is therefore recommended to make the Pap test carried out 1-2 times a year. Only through frequent repetition results in the security of this test. At an annual decrease as the sensitivity increases after 3 years to around 90%.
The cytology is a technical development in the preparation of the extracted cells in the context of the Pap test.