Cytologic Test for Cancer (Pap Smear) - Diagnostic Evaluation of Female Physiologic Processes

Diagnostic Evaluation

CYTOLOGIC TEST FOR CANCER (PAP SMEAR)

The Pap smear is performed to detect cervical cancer. Before 1940, cervical cancer was the most common cause of cancer death in women. Dr. George Papanicolaou discovered the value of ex-amining exfoliated cells for malignancy in the 1930s. Due to the effectiveness of the Pap smear as a screening method, cervical can-cer is now less common than breast or ovarian cancer.

Cervical secretions are gently removed from the cervical os (Fig. 46-6), transferred to a glass slide, and fixed immediately by spraying with a fixative. A Thin-prep Pap specimen is immersed in a solution rather than being placed on a slide. This method al-lows for human papillomavirus (HPV) testing if the Pap smear result is abnormal.

The patient should be instructed not to douche before this ex-amination to avoid washing away cellular material. The Pap smear should be performed when the patient is not menstruating because blood usually interferes with interpretation. The proper technique for obtaining a cervical specimen for cytologic study is described in Chart 46-6. False-negative Pap smear results may occur, as may false positives.

The Bethesda Classification system (Chart 46-7) has been de-veloped to promote consistency in reporting Pap smear results and to assist in standardizing management guidelines (Solomon, Davey, Kurman et al., 2001). Terminology includes the follow-ing categories:

·        Low-grade squamous intraepithelial lesion (LSIL), which is equivalent to cervical intraepithelial neoplasia (CIN 1) and to mild changes related to exposure to HPV

·      High-grade squamous intraepithelial lesions (HSIL), which equates to moderate and severe dysplasia, carcinoma in situ (CIS), and CIN 2 and CIN 3

These terms seen on Pap smear findings encompass the pre-cursors to invasive carcinoma of the cervix.

Pap smears that reveal mild inflammation or atypical squamous cells are usually repeated in 3 to 6 months, with findings often re-turning to normal. Patients are apprehensive because many women incorrectly assume that an abnormal Pap smear means cancer. If a specific infection is causing inflammation, it is treated appropri-ately, and the Pap smear is repeated. If the repeat Pap smear reveals atypical squamous cells, then a colposcopy is appropriate.

Thin-prep Pap specimens that show atypical cells can also be used to determine the presence of HPV DNA. If HPV DNA is present, it is more likely that HSIL is present.

If the Pap smear results are abnormal, prompt notification, evaluation, and treatment are crucial. Notification of patients is often done by nurses in women’s health care. Pap smear follow-up is crucial as it can prevent cervical cancer. Many women do not adhere to recommendations—particularly young women, those of low socioeconomic status, minorities, women who have difficulty coping with the diagnosis, and those without social sup-port. Fear, lack of understanding, and childcare responsibilities have all been identified by women as reasons for poor follow-up. Women with a history of abuse, obese women, and women who had a negative gynecologic experience may also find returning for follow-up difficult (Wee, McCarthy, Davis & Phillips, 2000). Interventions are tailored to meet the needs of the particular group. Intensive telephone counseling, tracking systems, brochures, videos, and financial incentives have all been used to encourage follow-up. Nurses can provide clear explanations and emotional support along with a carefully designed follow-up protocol designed to meet the needs of their specific patient population (DeRemer Abercrombie, 2001).