Transcript Historical overview CLIA (1988)

‫بسم هللا الرحمن الرحيم‬
Gynecologic Cytopathology
Conventional Pap Smear

Historical overview

Cervical cytology practice guidelines

Tips for making good pap smear
Historical overview
1845
Donne’s ATLAS (Paris)
Vaginal Cells
1847
Pouchet’s Book (Paris)
Vaginal Cells
1912
Schottlaender & Kermauner
1928
Schiller
1925
Hinselmann
Colposcope
1928
George N.Papanicolaou
Observe &
1928
Aureli Babes & C.Daniel
Report of cancer
cell in CVS
CIS
Donne’s Atlas, Paris, 1845
Historical overview
1941(article) George N.Papanicolaou
1943(book)
& Herbert Traut
The value of vaginal smear in the discovery of occult cancer
of cervix and endometrium
Historical overview
1947
Ayre
Cervical scraper
1986
Boon et al
Endocervical brush
Period of critique (1970-1985)
CLIA (Clinical Laboratory Improvement Act)
Historical overview
CLIA (1988)
1) Targets of population screening
2) Nonrepresentative or inadequate smear (F.N.)
3) The techniques of fixation, staining, microscopic
screening and interpretation are not adequate
Three separate situations
2 FN
1 FP
4) Reported results are not appropriately understood and
the clinical follow-up is inadequate
Cervical Cytology Practice Guidelines
Specimen collection and submission
Cervical cytology practice guidelines
Patient preparation
1) Two weeks (10-18 days) after LMP
2) Not douche 48h prior to the test
3) Not use tampons, birth control foam, jellies or other
vaginal cream of medications for 48h prior to the test
4) Refrain from intercourse 48h prior to the test
Cervical cytology practice guidelines
Sampling principles
 Sampling techniques
 Smear preparation
 Smear labeling and test requisition
Cervical cytology practice guidelines
Sampling techniques
 Exfoliative cytology and abrasive cytology
 Vaginal smear and cervical smear
Cervical cytology practice guidelines
Smear preparation
 Fixation and fixatives
Common fixatives for cervical smears
Cervical cytology practice guidelines
Test Requisition
The minimal clinical data:
 Age
 Date of LMP or onset of menopause
 Past or Current history of any abnormalities or treatment
 Pregnancy status
Cervical cytology practice guidelines
Important factors in assessing the results :
 Patient preparation
 Sampling
 Fixation
 Staining
 Interpretation
 Reporting
 Quality control and Quality assurance
Cervical cytology practice guidelines
Definition of an adequate smear:
 Cells of all epithelial surfaces
 Sufficient number of cells
 Two of the three component (EC, MC, EM)
Tips for making good pap smear
Problem: Air-drying
Solution: Spray-fix the smear immediately
Problem: Blood, mucus and pus
Solution: Remove excess mucus,
Spatula first, Then the brush
Problem: Traumatized cells
Solution: Spatula, Rotate no more than 360
Brush, Rotate only 90 to 180
Tips for making good pap smear
Problem: Incomplete clinical information
Solution: Fill out the requisition completely
Problem: Dueling laboratories
Solution: The abnormal pap and follow-up biopsy MUST be
examined simultaneously by the same pathologist