A rapid, minimally invasive diagnostic method in which cells obtained from body fluids, brushings, or fine-needle aspiration are spread on a slide, stained, and examined under a microscope.
Indication
- Cervical smear (Pap test) for screening of cervical cancer and precancerous lesions
- Search for malignant cells in pleural, peritoneal, and pericardial fluids
- Urine cytology for screening and follow-up of bladder tumors
- Preliminary diagnosis of salivary gland, thyroid, and lymph node lesions
- Evaluation of pulmonary lesions by bronchial lavage and brushing
- Search for malignant cells or infection in cerebrospinal fluid (CSF)
Preparation
- For Pap smear: avoiding douching, vaginal products, and intercourse for 24 hours before the procedure; scheduling outside of menstruation
- For urine cytology: a fresh urine sample or first-morning, mid-stream urine collected over 3 consecutive days
- Body fluids should be collected in tubes with appropriate anticoagulant
- Bronchial lavage is performed on an empty stomach
How it's performed
- The cell sample is obtained by brushing, fluid aspiration, swab, or needle
- The sample is spread on a slide (conventional) or processed in a special solution with liquid-based cytology
- It is fixed with air drying or alcohol (wet fixation)
- Cytologic stains such as Papanicolaou, May-Grünwald-Giemsa, or H&E are applied
- The cytopathologist evaluates the cells under magnification, analyzing nuclear and cytoplasmic features
- Results are reported using the Bethesda system or a comparable standardized reporting system
Post-procedure
- Pap smear results are typically reported within 3-7 working days
- For atypical or suspicious results, colposcopy, biopsy, or repeat cytology may be recommended
- For negative results, the test is repeated at the routine intervals defined by the national screening program
- In urine cytology, follow-up every 3-6 months is planned for cases requiring surveillance
- Findings on fluid cytology are interpreted together with the clinical picture
Risks
- Insufficient cell sample may require repeating the test
- False negative results (especially due to sampling error) — a limitation of screening
- Anxiety with atypical results; additional invasive tests may be needed
- Mild spotting may occur after a Pap smear
- Local pain or hematoma (limited) at the site of needle aspiration samples
FAQ
How often should a Pap smear be performed?
In the Turkish national screening program, women aged 30-65 are screened every 5 years together with HPV testing. Your physician may recommend a different interval based on your risk profile.
Does cytology replace biopsy?
Cytology is generally used for screening or preliminary diagnosis. A definitive diagnosis is usually confirmed by biopsy (histopathology); the two methods complement each other.
What does an "atypical" cytology result mean?
Atypia does not always mean cancer; it indicates changes that require further investigation. Your physician will plan the appropriate additional tests.
Is there a difference between liquid-based cytology and the conventional method?
Liquid-based cytology produces a cleaner preparation, reduces the rate of inadequate samples, and allows additional molecular testing. The conventional method is still widely used.
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