Papanicolaou (Pap) smear
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Indications
- used primarily to detect premalignant lesions of the cervix
- screening for cervical cancer
- every 3 years age 25-65 years (ACS) 21-65 (USPSTF)
- 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]
- performing human papillomavirus DNA on specimens may be useful[8]
- Results reported as cytology report of cervical or vaginal smear
Management
- colposcopy in a any woman with abnormal Pap smear showing high-grade squamous intraepithelial lesion, or microinvasive or invasive cervical cancer
- women 21-24 years of age with Pap smear that shows atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions with reflexive positive HPV DNA: repeat cervical cytology alone in 12 months[9]
- biopsy any grossly visible abnormality of the cervix
More general terms
Additional terms
- cytology report of cervical or vaginal smear
- recommendations for performing Papanicolaou (Pap) smear
- screening for cervical cancer
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 405-407
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
- ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/12423847
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: https://www.ncbi.nlm.nih.gov/pubmed/12423848 - ↑ Journal Watch 23(5):42, 2003 http://www.ahrq.gov/clinic/3rduspstf/cervcan/
- ↑ Journal Watch 23(23):181, 2003 Sawaya GF et al, N Engl J Med 349:1501, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/14561792 <Internet> http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr2.htm
- ↑ Journal Watch 24(6):452, 2004 Wright TC Jr et al, Obstet Gynecol 103:304, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14754700
- ↑ 7.0 7.1 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: https://www.ncbi.nlm.nih.gov/pubmed/15213211
- ↑ 8.0 8.1 Kinde I et al. Evaluation of DNA from the Papanicolaou test to detect ovarian and endometrial cancers. Sci Transl Med 2013 Jan 9; 5:167ra4
- ↑ 9.0 9.1 Massad LS et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013 Apr; 121:829 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23635684