Cytology of the Uter Ine Cervix and Corpus

Cervical cytology is a screening tool that helps to categorize patients for their risk of cervical neoplasm depending on the degree of shift from normal cervical cytology and the amount of the abnormal change seen. Since the cervix is subject to hormonal effects, the clinical context (exogenous estrogens, pregnancy, etc.) should be considered when evaluating cervical cytology specimens. The first cervical cytology screen is recommended for women starting at age 21, or 3 years after the onset of sexual intercourse, whichever comes first. Women under the age of 30 should be screened annually with conventional cytology, or biennially using liquid-based methods. For women over the age of 30, human papillomavirus (HPV) testing can be used in conjunction with cytology, and if both tests are negative, screening can be reduced to every 3 years. After the age of 70, women may choose to stop screening if no abnormal results were found in three or more consecutive cervical cytology specimens over the prior 10 years. Cervical cytology results are reported according to the 2001 Bethesda System (Table 1.1). Cervical cytology screening allows for evaluation of exfoliated cells from the transformation zone, where most cervical cancers arise. Traditionally, cervical cytology samples have been smeared directly onto a slide, fixed with ethanol, and Papanicolaou stained. These conventional smears are rapidly being replaced by liquid-based methods such as ThinPrep and SurePath. For liquid-based preparations, the cervical sample is rinsed directly into a vial of proprietary fixative solution – methanol-based CytoLyt for ThinPrep (Hologic, Bedford, MA) and ethanol-based CytoRich for SurePath (BD Diagnostics, Burlington, NC). Both ThinPrep and SurePath utilize proprietary methods for minimizing obscuring material such as blood, mucus, and debris to produce a thin layer of evenly distributed cells on a slide. Although some studies have shown fewer unsatisfactory specimens with the liquid-based method, Table 1.1 2001 Bethesda System