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PAP smear is a non-invasive OPD procedure test which is used for early detection/screening for cervical cancer in females.

Test cost price : Rs 500

Procedure price : Varies with different different gynecologists. Around Rs 500. Our lab receives PAP test sample after collection by gynecologist.

Report Time : 1-2 days (excluding holidays/Sunday)

Reporting is done according to worldwide latest Bethesda Guidelines for PAP smear reporting.

Reporting done by experience MD pathologist doctors.

 

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Helpful features for cytological diagnosis for cytopathologists :

FEATURES TO BE EVALUATED IN A PAP TEST
• Adequacy.
• Presence of abnormal cells.
• Number and distribution of abnormal cells.
• Relationship between cells.
• Cell size and shape.
• Nuclear size and shape.
• Nuclear changes and nucleoli.
• Nuclear-to-cytoplasmic (n:c) ratio.
• Cytoplasmic features.
• Background or diathesis.

FEATURES OF PRENEOPLASTIC AND NEOPLASTIC CELLS
• Abnormality in size and shape of cells.
• Variation in cell size and shape.
• Increase in nuclear size.
• Increase in nuclear membrane irregularity.
• Hyperchromasia.
• Prominence of nucleoli and irregularity in shape thereof.
• Thickening of nuclear membrane.
• Increase in n:c ratio.
• Cytoplasm scanty.
• Mitosis, increased number, and abnormal forms.
• Noncohesiveness.
• Abnormal polarity.

COMMON CAUSES OF FALSE-NEGATIVE PAP TEST
• Atypical endocervical cells.
• Crowded cell aggregates.
• Cytolysis.
• Intermediate cells with nuclear enlargement.
• Keratinized cells.
• Metaplastic-like cells.
• Necrotic debris.
• Artifacts such as obscuring blood, inflammation, or air-drying.

COMMON CAUSES OF FALSE-POSITIVE PAP TEST
• Atrophic smear.
• Atypical endocervical or endometrial cells.
• Multinucleated cells.
• Parakeratosis.
• Perinuclear halo in nonkoilocytes.
• Pseudoparakeratosis.
• Reactive/repair.
• Squamous metaplasia.
• Tubal metaplasia.

DIFFERENTIAL DIAGNOSIS OF CELLS WITH “NAKED” NUCLEI
• Autolysis of cytoplasm in menopause.
• Cytolysis.
• Degeneration, especially of endocervix.
• Reserve cells with tamoxifen treatment.

DIFFERENTIAL DIAGNOSIS OF GIANT MULTINUCLEATED CELLS
• Histiocytes.
• Atrophy.
• Folic acid deficiency.
• Tissue repair.
• Viral infection.
• Granuloma.
• Radiation.
• Syncytiotrophoblast.
• Squamous carcinoma.
• Choriocarcinoma.
• Uterine sarcoma.

CYTOLOGICAL FEATURES OF “DARK-CELL CLUSTERS”
• Crowded with piling up of cells.
• Hyperchromatic overlapping nuclei.
• Anisonucleosis.
• Scant cytoplasm.
• Increased n:c ratio.
• Mitosis present.
• Often difficult to determine whether squamous or glandular.

DIFFERENTIAL DIAGNOSIS OF “DARK-CELL CLUSTERS”
• Reactive endocervical cells.
• Tubal metaplasia.
• Atrophy: nuclear membrane smooth.
• Benign endometrial cells.
• Atypical squamous cells cannot exclude high-grade squamous intra-epithelial lesion.
• High-grade squamous intra-epithelial lesion: nuclear membrane irregular.
• Adenocarcinoma in situ.
• Endocervical or endometrial carcinoma.

DIFFERENTIAL DIAGNOSIS OF SMALL CELLS (TABLE 1)
• Lymphocytes in chronic lymphocytic cervicitis.
• Degenerated cells.
• Endometrial cells.
• Histiocytes.
• Reserve cells.
• Tamoxifen cells.
• Smaller cell type of squamous-cell carcinoma.
• Small-cell anaplastic carcinoma.

DIFFERENTIAL DIAGNOSIS
OF CELLS WITH MACRONUCLEOLI
• Repair, regenerative, or reactive squamous cells.
• Reactive endocervical cells.
• Viral inclusions.
• Treatment effect.
• Decidua.
• Adenocarcinoma.
• Metastatic tumor.
• Nonkeratinizing squamous carcinoma.
• Pemphigus.

DIFFERENTIAL DIAGNOSIS OF ADENOCARCINOMA
• Viral infections.
• Endocervical cells, benign and atypical.
• Endometrial cells, benign and atypical.
• Endometritis.
• Histiocytes.
• Metaplasia.
• Vaginal adenosis.
• Intrauterine device.
• Microglandular hyperplasia.
• Metastatic tumor.

CLINICAL INFORMATION NEEDED
FOR OPTIMAL PAP TEST INTERPRETATION
• Patient’s name.
• Age.
• Date of last menstrual period.
• Menopausal status.
• Presence of an intrauterine device.
• Pregnancy.
• Hormone treatment status.
• History of previous cytological abnormalities, cervical biopsies such as cone biopsies, or laser treatment.
• History of malignancy and subsequent chemotherapy and/or radiation therapy.

NOTA BENE
• Morphological expression of cell growth is best seen in the nucleus.
• Variation in cell size within a group of the same cell type is known as “anisonucleosis.”
• Altered vaginal flora may result in multiple vaginal bacterial infection