PAP-test: Possibilities and Limitations

Olha Burka, Tetyana Naritnik
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Abstract

Cervical cancer (CC) progresses slowly, and the cytological screening increases the likelihood of early detection of precancerous lesions. Cytology of the cervix is one of the primary methods of effective CC diagnosis, which, thanks to early detection and timely treatment, leads to a stable decrease in morbidity and mortality from invasive CC. The results of many studies have shown that the specificity of the conventional Pap smear test is approximately 80–100%, its sensitivity ranges from 30% to 80%, and the rate of inadequacy of this method is from 5% to 25%. With traditional smear preparation, only a small percentage of collected cells end up on the slide, while abnormal cells may be discarded and not analyzed. When viewing the slide, cells that have dried and clumped together may interfere with the visualization of atypical cells. To overcome these limitations, in 1996, as an alternative to the traditional Pap test, liquid cytology was presented – the technology of preparing slides on which the cells are placed in a single layer. This technology outperformed the conventional Pap test with improved fixation, reduced obscuring factors, and standardized cell transfer. In liquid cytology samples are collected by fully immersing the cytobrush in a vial containing a preservative liquid, whereby the cells are preserved and fixed simultaneously, unlike conventional smears where the sample is applied to a glass slide and fixed separately. Today, two main methods of preparation based on liquid cytology are known: ThinPrep and SurePath. The results of cytology are described according to the Bethesda system. The Bethesda classification is widely accepted because it corresponds to the clinical presentation, reproduces the nature of the lesions, and is therefore treatmentoriented with a desirable follow-up procedure. The indisputable advantage of the Pap test by liquid cytology is the ability to perform both cytological and molecular studies, in particular HPV, in one sample. This capability facilitated the implementation of a two-step strategy when HPV testing is used as a triage test for ASC-US or low-grade squamous intraepithelial lesion cytology, or when cytology is used to triage HPV-positive women.
PAP 测试:可能性与局限性
宫颈癌(CC)进展缓慢,细胞学筛查增加了早期发现癌前病变的可能性。宫颈细胞学检查是有效诊断宫颈癌的主要方法之一,通过早期发现和及时治疗,可使浸润性宫颈癌的发病率和死亡率稳定下降。许多研究结果表明,传统巴氏涂片检查的特异性约为 80%-100%,灵敏度为 30%-80%,而这种方法的不合格率为 5%-25%。为了克服这些局限性,1996 年,作为传统巴氏涂片检查的替代方法,液体细胞学技术问世了。这项技术改进了固定方法,减少了遮盖因素,并实现了细胞转移的标准化,因而优于传统的巴氏试验。在液体细胞学检查中,采集样本时要将细胞刷完全浸入装有防腐液的小瓶中,这样细胞就能同时得到保存和固定,而不像传统涂片检查那样,样本要涂抹在玻璃载玻片上,然后再分别固定。如今,基于液体细胞学的制备方法主要有两种:ThinPrep 和 SurePath。贝塞斯达分类法被广泛接受,因为它符合临床表现,再现了病变的性质,因此是以治疗为导向的,具有理想的随访程序。采用液态细胞学方法进行巴氏试验的无可争议的优点是能够在一份样本中同时进行细胞学和分子研究,特别是 HPV。当HPV检测被用作ASC-US或低级别鳞状上皮内病变细胞学分流检测时,或当细胞学被用于分流HPV阳性妇女时,这种能力有助于实施两步策略。
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