What it is and why you should do it
PAP TEST AND THIN PREP (LIQUID-PHASE PAP TEST)
The Pap test or Papanicolaou test It is a gynecological screening test that allows for the early identification of alterations in the cells of the cervix before they progress to more serious forms. It's a simple cell sample taken during a visit, quick and well-tolerated, which has significantly changed the prevention of cervical cancer. Through the Pap test, it's possible to identify precancerous lesions or very small tumors, often asymptomatic, and plan targeted checkups and treatments based on each woman's clinical profile.
The main function of the Pap test is to identify women at greater risk of developing cervical cancer over time. The test allows you to: highlight so-called pre-cancerous lesions, such as dysplasias and CIN, which represent cellular alterations still in the initial phase. Early diagnosis allows for intervention with targeted outpatient therapies, preserving the functionality of the uterus and considerably reducing the possibility that the lesion will evolve into invasive carcinoma.
In addition to cancer prevention, Pap tests offer useful information on hormonal balance and can indicate the presence of genital infections, including human papillomavirus (HPV). Certain changes in the sample may indicate the presence of bacteria, fungi, or parasites, and may direct the gynecologist to further investigations or specific treatments. Regular Pap tests are therefore a key aspect of the health care system. global prevention tool for gynecological health.
Pap test
when and how often to do it
The main indications recommend starting the Pap test starting at age 25 or from the beginning of sexual activity and repeat it regularly up to 65 years oldIn many situations a solution is proposed frequency between one and three years, which should be adjusted based on individual risk factors, previous results, and the presence or absence of HPV infection. Even after vaccination against human papillomavirus, it is recommended to continue screening, as the vaccine does not cover all possible viral types and is not a substitute for periodic checkups.
The Pap test can be performed at almost any stage of the menstrual cycle, except during periods of bleeding, when the presence of blood may make the sample difficult to read. In the 24–48 hours preceding the test, it is generally recommended to avoid sexual intercourse, vaginal douching, suppositories, or topical products that could alter the results. The use of hormonal contraceptives or the presence of an intrauterine device (IUD) are not contraindications to the test, which can also be performed during pregnancy, preferably within the eighth month.
non-invasive and painless
How is the Pap test performed?
The Pap test is performed by the gynecologist in the office, during a routine gynecological examination. The patient lies on the bed in the gynecological position and the doctor gently inserts the test tube into the vagina. speculum, a small retractor that allows visualization of the cervix. Cells are then collected from the cervix and cervical canal using a soft brush; the sampling takes a few seconds and may cause only mild discomfort, which is generally well tolerated.
Depending on the method used, the sample can be processed as a conventional Pap test, with the cells smeared and fixed on a slide, or as a liquid-based Pap test (Thin Prep), in which the cells are immersed in a specific liquid and then spread into a thin, more uniform layer. In both cases, the preparation is stained and examined under a microscope by a pathologist. After the test, the patient can resume normal daily activities; sometimes, small amounts of bleeding may occur, usually small.
minor
and transitory.
the results
Pap test, HPV test and classification of results
In more recent prevention programs, the Pap test may be combined with HPV DNA testing, especially in age groups where persistent infection represents a significant risk factor. The combination of Pap and HPV testing allows for more accurate identification of women requiring more frequent checkups or further investigations, such as colposcopy with possible targeted biopsy.
Interpretation of results is based on standardized classification systems, such as the Bethesda System, which describes the presence or absence of intraepithelial lesions and distinguishes between low- and high-grade abnormalities. If the result is negative, no suspicious lesions are identified; if abnormalities are present, the gynecologist decides whether to schedule a repeat Pap test soon afterward, request an HPV test, or recommend further investigations. The goal is to build a personalized follow-up path, appropriate to individual risk.
- Negative: no evidence of intraepithelial or neoplastic lesion;
- LSIL: low-grade squamous intraepithelial lesion, including HPV/mild dysplasia, CIN1;
- HSIL: high-grade squamous intraepithelial lesion, including moderate and severe dysplasia, carcinoma in situ / CIN2, CIN3;
- AIS: glandular cells suspicious for in-situ adenocarcinoma of the cervix;
- Carcinoma:squamous cell carcinoma cells;
- ASC-US:atypical squamous cells, not further classifiable;
- ASC-H:atypical squamous cells, HSIL not excluded;
- AGC:atypical glandular cells, specifying whether endometrial, endocervical, glandular, or otherwise unspecified;
- Adenocarcinoma:Endocervical, endometrial, extrauterine, or unspecified adenocarcinoma;
- CTM:Malignant tumor cells not otherwise specified.
Effectiveness and limitations of Pap test screening
The Pap test is considered a effective method for the prevention of invasive cervical cancer, thanks to its ability to identify cellular alterations many years before they develop. However, the test's sensitivity is not absolute, and false negatives, i.e., cases in which a lesion is not detected, are possible. This may be due to suboptimal sampling or the presence of inflammation masking the altered cells.
The progression towards the more advanced forms is however slow and the periodic repetition of the Pap test In most cases, it allows the lesion to be detected during subsequent checks. For this reason, it is important consider screening as a continuous process over time and not as a single, isolated test. Integrating the Pap test with an appropriate lifestyle, HPV vaccination, and regular check-ups with your gynecologist helps maintain a high level of prevention and protect gynecological health throughout all stages of life.
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