Cytology results - Papanicolau scale, Bethesda system, hormonal cytology
Oncological cytology results can be reported on the commonly used five-point Papanicolau scale or on the Bethesda system. In addition, the so-called hormonal cytology, which enables the assessment of the course of the menstrual cycle and the action of sex hormones, which are especially important when trying for a child. Pap smear is of great importance for the assessment of a woman's health. Abnormalities indicated by cytology results may require treatment and may be a contraindication to pregnancy.
See the video: "What can Pap smear detect?"
1. Cytology results - Papanicolau scale
In our country, the results of cytology are most often given on the Papanicolau scale. On its basis, it is possible to assess the condition of the cervix and detect possible neoplastic changes at an early stage. The test result belongs to one of five groups:
- group I - the smear shows only normal epithelial cells and a small amount of white blood cells; such a result is an indication for another Pap smear test only in a year's time;
- group II - similarly to group I, the result is considered "unsuspected"; there are large amounts of lymphocytes and histiocytes in the smear; epithelial cells show a pattern typical of inflammation or retrograde changes in older women; a group II result indicates the need for anti-inflammatory treatment or treatment with estrogens (for women with retrograde lesions), after which follow-up is necessary;
- group III - is a positive result, which means that the picture of epithelial cells is suspect; in addition to normal cells, dysplastic cells are detected, which, depending on the number and severity of the lesions, are classified as low, medium or high degree dysplasia; the cause of such an image may be precancerous lesions, severe inflammation or viral infections, for example with human papillomavirus, therefore it is necessary to take an excerpt from the disc of the vaginal part and initiate appropriate treatment; after it, the examination should be performed again;
- group IV - single atypical cells are visible in the smear, indicating malignant lesions limited to the epithelium;
- group V - the test confirms the presence of numerous atypical cells, suggesting an invasive tumor; however, the result does not mean that the tumor is definitively present, but only indicates that it is possible.
The results included in groups IV and V are an indication for further diagnostics, and above all for the histopathological examination of the cervix.
2. Cytology results - Bethesda system
The Papanicolau scale, although the most popular in Poland, is considered by doctors to be insufficient as it does not provide all the necessary information. The Polish Gynecological Society recommends the Bethesda system as a better way of describing the cytology result, the advantage of which over the Papanicolau system is due to the fact that it provides an accurate description of the changes found.
The description includes information on the type of infection, the presence of abnormal cells other than epithelial cells, and whether the material to be assessed was appropriate, and whether the material to be assessed was appropriate, in addition to cells from the vaginal ring, there were cells from the cervical canal.
Possible results of cytology in the Bethesda system:
- normal cytology - this result corresponds to group I of the Papanicolau scale and means that only normal squamous and glandular epithelial cells are present in the smear;
- normal cytology with mild inflammation - apart from normal cells, the smear contains a few cells that indicate inflammation; there is a high probability that it will resolve spontaneously;
- normal cytology with inflammation - this result corresponds to group II of Papanicolau and finds normal cells, cells indicating inflammation and few leukocytes in the smear;
- AGUS / ASCUS - abnormal result - abnormal cells of the glandular or squamous epithelium in the smear, which cannot be clearly classified, in such cases a cytological control is usually recommended in 6 months;
- Bethesda LSIL - abnormal result - presence of single cells that are at risk of developing into tumors; the result corresponds to group III and usually indicates acute inflammation;
- Bethesda HSIL - abnormal result - the smear contains numerous cells with suspected high-grade lesions, indicating the need for histopathological examination.
We can perform cytology in several ways, and the results of the cytology will give us important information (123RF)
3. Cytology results - hormonal cytology
The term cytology covers tests that are not only intended to detect inflammatory or neoplastic changes. Based on the examination of vaginal epithelial cells, the activity of sex hormones can be assessed. This is especially important for women who are trying to get pregnant and for patients undergoing hormonal treatment.
In this case, the smear test informs whether the woman has a normal, two-phase menstrual cycle and whether ovulation has occurred in the given cycle. It also indicates whether the hormone treatment is having the desired effect. A test performed on pregnant women assesses whether the hormones are working properly.
The Pap smear results are very important for couples who plan to enlarge their family. If it turns out that a woman has inflammation or mild lesions, they must be removed before trying for a baby, as treatment may not be possible during pregnancy and the lesions may spread. A poor Pap smear may require the cervix to be shortened or removed, making it difficult for a woman to become pregnant and maintain her.