**5.1. Procedure**

Following appropriate counseling of the patient and obtaining informed consent for the procedure, the patient is put in lithotomy position with the cervix exposed using a bivalve speculum. A soft cotton is used to remove any mucous material from the external cervical Os, while taking care not to contact the cervix, a tenaculum is used to grasp the anterior lip of the cervix.The collecting device which could be a spatula is introduced into the internal Os and rotated in 3600 degree once. The samples collected are smeared on already labeled slide and fixed in 95% alcohol. A four quadrant pap smear of the vaginal walls is advised in patients with history of exposure to diethylstibesterol who are at risk of developing adenosquamous vaginal cancer (Sarina et al 2004)

#### **5.2. Interpretation of results of PAP smear after analysis**

The specimen can be categorized as satisfactory or non-satisfactory according to the Bethesda system of reporting of adequacy of smears collected. A satisfactory PAP specimen is that in which the sample collected has a adequate number of squamous epithelial cell, endocervical and representative amount of the transformation zone cell components while an unsatisfactory smear has paucity of epithelial cells poorly preserved or cellular or inflammatory cell that obscure the film.Epithelial cell abnormalities can be classified as:

Atypical squamous cells of undermined significance, low grade squamous intraepithelial lesions (CIN1) and high grade intra epithelial lesions which include carcinoma in-situ, CIN2

**Figure 1.** Taking a sample of cells

ogy.It is advisable for evidence of cervicitis /vaginitis be treated if present and intercourse should be avoided with 24-48hours of the procedure in addition to avoidance of vaginal douching or application of vaginal tampons and creams which may introduce artifacts on the slides examined. Clinical information on the last menstrual period, use of hormonal contra‐ ception, intrauterine contraceptive devices, any form of immunosuppression and previous history of abnormal smears are important to the pathologist in accurate interpretation of

A pathologist and trained personnel in the collection of the specimen is an important ingredient in conducting the investigation. Other items needed are 95% alcohol for fixing of slides, and a

Over the years various sampling items have been introduced. The traditional wooden Ayrles spatula was initially used but has some limitations as the failure of accessing the endocervix, which is the point of origin of 20% of adenocarcinomas of the cervix. Specimen collections devices include the broom and the endocervical bush (cytobrush) with both having the ability to access the endocervix more than the traditional spatula. The plastic spatula is preferable to the wooden variety because the collected samples are more adherent to the wooden spatula

Following appropriate counseling of the patient and obtaining informed consent for the procedure, the patient is put in lithotomy position with the cervix exposed using a bivalve speculum. A soft cotton is used to remove any mucous material from the external cervical Os, while taking care not to contact the cervix, a tenaculum is used to grasp the anterior lip of the cervix.The collecting device which could be a spatula is introduced into the internal Os and

fixed in 95% alcohol. A four quadrant pap smear of the vaginal walls is advised in patients with history of exposure to diethylstibesterol who are at risk of developing adenosquamous

The specimen can be categorized as satisfactory or non-satisfactory according to the Bethesda system of reporting of adequacy of smears collected. A satisfactory PAP specimen is that in which the sample collected has a adequate number of squamous epithelial cell, endocervical and representative amount of the transformation zone cell components while an unsatisfactory smear has paucity of epithelial cells poorly preserved or cellular or inflammatory cell that

Atypical squamous cells of undermined significance, low grade squamous intraepithelial lesions (CIN1) and high grade intra epithelial lesions which include carcinoma in-situ, CIN2

degree once. The samples collected are smeared on already labeled slide and

and may be discarded with the spatula after use (Goodman, Hutchinson, 1996.)

smears.

**5. Material needed**

130 Contemporary Gynecologic Practice

jar to contain the specimen.

**5.1. Procedure**

rotated in 3600

vaginal cancer (Sarina et al 2004)

**5.2. Interpretation of results of PAP smear after analysis**

obscure the film.Epithelial cell abnormalities can be classified as:

and CIN3.Other abnormalities include squamous cell abnormalities and glandular cell abnormalities. (Solomom D et al, 2001)

#### **5.3. Limitations of PAP smear**

The impact of this screening method has being felt over the years and had contributed to reducing cervical cancer related morbidities, however limitations exist which has affected its utilization. The primary need for a trained pathologist has hampered its utilization especially in the third world with scarcity of trained personnel. Even in the presence of trained personnel the interpretation of morphological alterations in the histological pattern of cervical dysplasia is highly subjective and in the presence of large pool of samples likely to be subject to observer fatigue.The sensitivity of the screening method to identify cervical intraepithelial neoplasia is 51% with a specificity of 98% with increase of sensitivity if interval of screening is made 1-3 years
