Liquid-based cytology (PAP test)

The cytological smear, also known as the Pap test or Pap smear (named after its developer, Georgios Papanicolaou), is a screening diagnostic method used to detect precancerous changes and cervical cancer. The test allows identification of atypical cells that may indicate infection, inflammation, dysplasia (a precancerous condition), or malignant changes in cervical epithelial cells. The Pap test is a key component of cervical cancer prevention and early detection.

Why is the Pap test performed?

The primary purpose of the Pap test is to detect abnormal changes in cervical cells at an early stage, when treatment is most effective. Cervical cancer usually develops slowly, and precancerous cellular changes may be detected several years before clinical symptoms appear. Early identification of these changes makes it possible to prevent progression to invasive cancer.

The Pap test may also help identify:

• human papillomavirus (HPV), the main etiological factor in cervical cancer development;
• inflammatory processes affecting the cervix;
• hormonal changes in cervical epithelial cells.

The Pap test is recommended for all women aged 20 years and older, as well as for women who have initiated sexual activity. The screening interval depends on age, previous test results, and individual risk factors:

• women aged 21–29 years are advised to undergo a Pap test every 3 years;
• women aged 30–65 years are advised to have a Pap test every 3 years, or co-testing with Pap test and HPV testing every 5 years;
• women older than 65 years with consistently normal previous results may discontinue screening based on medical advice.

How is the Pap test performed?

The Pap test is a simple and quick procedure performed during a routine gynecological examination. It usually takes only a few minutes and includes the following steps:

1. Examination of the cervix: the physician inserts a speculum into the vagina to visually assess the cervix.
2. Sample collection: using a special brush or spatula, cervical cells are collected from the surface of the cervix. The sample is placed on a glass slide or into a liquid medium for laboratory analysis.
3. Laboratory analysis: the collected cells are examined under a microscope to identify atypical, precancerous, or malignant changes.

Possible Pap test results

Pap test results are generally classified into two main categories:

1. Normal (negative result). No atypical cells, infection, or inflammation are detected. In this case, repeat screening is recommended in 3–5 years, depending on age and risk factors.
2. Abnormal (positive result). The presence of atypical cells does not necessarily indicate cancer but requires further evaluation.

Possible abnormal findings include:

• ASCUS (Atypical Squamous Cells of Undetermined Significance): atypical cells of unclear origin; additional HPV testing may be recommended.
• Low-grade or high-grade squamous intraepithelial lesions (LSIL, HSIL) / CIN 1, CIN 2, CIN 3: precancerous changes that may require observation or treatment.
• AGC (Atypical Glandular Cells): changes that require further investigation due to potential association with malignancy.
• Malignant cells: detection of cancerous cells necessitates additional diagnostic procedures to confirm the diagnosis and plan treatment.

Additional tests and procedures

If abnormal changes are detected on a Pap test, further diagnostic procedures may be recommended:

• HPV testing: identifies high-risk HPV strains associated with cervical cancer; commonly used in combination with the Pap test in women over 30 years of age.
• Colposcopy: a magnified examination of the cervix that allows detailed assessment of abnormal areas and targeted biopsy if needed.
• Biopsy: a small sample of cervical tissue is taken for further examination when suspicious changes are identified.

Advantages of the Pap test

• Early detection of precancerous changes, enabling prevention of cervical cancer;
• Safety and accessibility: the Pap test is a safe, quick, and relatively inexpensive screening method;
• Reduction in cervical cancer incidence and mortality through timely diagnosis and treatment.

The cytological smear (Pap test) is an essential tool in cervical cancer prevention and early detection. Regular screening significantly reduces the risk of developing cervical cancer and ensures timely intervention when precancerous conditions are identified. Women are encouraged to discuss the optimal screening schedule with their healthcare provider to maintain cervical health.