NEPA Vital Signs - Summer Fall 2017 - 9

S U M M E R / F A L L 2 017

OF PAP
are uniformly distributed on the slide,
and the slide is more easily screened. This
method of obtaining and processing the
specimen resulted in better detection of
precancerous lesions, and it has since been
universally utilized.
The third advance has been a method
for detection of high-risk human papilloma virus (HPV) in these preserved cells.
Human papilloma virus exists as two main
types. "Low risk" types are associated
with genital warts. The "high risk" types
are associated with precancerous cervical
lesions (also known as "dysplasias"). It
is now known that essentially 100% of
serious dysplasias are associated with high
risk human papilloma virus. If a cervical
Pap test result is "atypical" but cannot be
assigned one of the definitive interpretive
categories, the high-risk HPV test can be
performed on the remaining cells in the
preservative solution. The DNA from the
cells is checked for high-risk HPV virus,
and if detected, the gynecologist can
proceed with a biopsy. The combination
of cervical Pap test screening with the
high-risk human papilloma virus test is
the current method of choice for detecting
the precancerous lesions of the cervix.
Finally, modern technology has been
developed to assist the cytotechnologist in screening cervical Pap tests.
Cytotechnologists can screen up to 100
cervical Pap tests in one day, and despite
the improvements in processing the
specimen and making the slide, false

Normal cervical cells (400x)

Abnormal cervical cells consistent
with low grade squamous
intraepithelial lesion (400x)

Some weaknesses of the test are:

1.
2.
3.

It is still a screening test, and biopsies are still required
to establish a definitive diagnosis.
The false negative rate, while low, is not 0%.
Therefore, repeat Pap tests over time are required
to properly screen for cervical cancer.

The test does a good job in detecting precancerous
lesions of the cervix, but other cancers (such as
endometrial cancers) are NOT reliably detected
by this method.

Nevertheless, the cervical Pap test is one of the true
triumphs of medicine and has greatly reduced the incidence
and number of women who will die of cervical cancer.
negative tests still occur. Most large labs
screen paps by a method called "image
analysis." The Pap test slide is prepared.
A computer analyzes the slide, looking
for abnormal areas. The abnormal areas
are then shown via a special screening
microscope to the cytotechnologist,
who flags the pap as either "negative" or
"atypical." The image-guided method is
used by most larger labs in the United
States and has greatly improved the
sensitivity of detection of precancerous
cervical lesions.
These advances - development of a
unified nomenclature for interpreting

N E PA

9

VITAL SIGNS

the Pap test, development of the "liquid
based" method for obtaining the sample
and making the slide, utilization of the
high-risk HPV test on "atypical" tests,
and the development of computerized
image analysis for screening these tests
- has greatly improved the cervical
Pap test as a means of detecting cervical dysplasia.

MICHAEL YODER, M.D.,
is a pathologist and is the owner
of Pathology Associates of NEPA
in Dunmore.



Table of Contents for the Digital Edition of NEPA Vital Signs - Summer Fall 2017

NEPA Vital Signs - Summer Fall 2017 - 1
NEPA Vital Signs - Summer Fall 2017 - 2
NEPA Vital Signs - Summer Fall 2017 - 3
NEPA Vital Signs - Summer Fall 2017 - 4
NEPA Vital Signs - Summer Fall 2017 - 5
NEPA Vital Signs - Summer Fall 2017 - 6
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NEPA Vital Signs - Summer Fall 2017 - 9
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