Also Known As
巴氏测试
正式名称
巴氏涂片; 宫颈涂片; 宫颈/阴道细胞学
本文最后审核 时间
本文 最后修改 时间
2018/01/14.
快速浏览
为何检测?

筛查宫颈癌和某些阴道或子宫感染。

何时检测?

如果您是一个18岁以上妇女和/或性行为活跃;每年或遵医嘱进行检查。

何种样本?

宫颈细胞。

是否需要作试验前准备?

您可能会被告之,进行巴氏涂片检查前24小时内不要冲洗或浴缸洗澡。您可能还要求在测试前避免性交24至48小时。

检测什么?

宫颈涂片检查是一个用于检测阴道和宫颈的异常或潜在不正常细胞的检查。此检查也用于发现子宫各种细菌、真菌和病毒感染。

测试样本如何采集?

传统方法包括抽样宫颈区域的细胞。使用一种木制的“铲”、棉拭子或刷子得到的标本。相对较新的常规宫颈涂片检查是改良液体法。标本收集如上所述,但不是“涂”上载玻片。相反,将标本放入特殊液体防腐剂中。将该细胞悬液滴于载玻片,染色,并检查。

是否需要进行任何试验前准备以保证样本的质量?

您可能会被告之,进行宫颈涂片检查前24小时内不要冲洗或浴缸洗澡。您可能还要求避免性交24至48小时。

Accordion Title
常见问题
  • 有何用途?

    您的医生或保健医生进行宫颈涂片检查,以寻找癌变或癌前病变的宫颈和/或阴道细胞。置于载玻片上的涂片细胞或细胞悬液,经特殊染色(巴氏染色) ,在显微镜下由技术员或病理学家进行观察。巴氏试验也可用于检测阴道或子宫的感染。这使得能及时治疗感染,从而避免进一步不适或更严重的并发症。当申请进行宫颈涂片检查时,也要求 30岁以上的妇女进行人乳头状瘤病毒DNA检测。

  • 何时检测?

    不同的组织对适合的涂片检查频率有不同意见(见筛查:宫颈癌( 19-29岁) , ( 30-49岁) , (年龄50以上) 。举例来说,美国癌症学会建议, 18岁以上的妇女和/或那些性交频繁的人应每年进行宫颈涂片检查。在以下情况下,可进行宫颈涂片检查:有多位性伴侣,孕妇,或有异常的阴道出血,疼痛,溃疡,流液或瘙痒。宫颈涂片检查连续三年均为正常,或在您的医生认为可以的情况下,适当减少检查的。美国妇产科学院(组委会)在2003年8月提出指南, 30岁或以上的妇女可以同时进行宫颈涂片检查和人乳头状瘤病毒DNA检测。如果全为阴性,则可以减少检测频率。

  • 试验结果的含义?


    宫颈涂片检查阴性表示采集的细胞外观正常,或没有任何可识别的感染。在某些情况下,传统的宫颈涂片检查可能被报告为“不满意”。这可能意味着细胞采集是不够的,或细胞不能明确鉴定。总结其他报告结果如下:

    • 不满意:采样不足或有其他干扰物质。
    • 良性:非癌变细胞,但涂片检查显示感染,增生,或正常的细胞修复。
    • 意义未定的非典型细胞:原因未定的异常鳞状上皮细胞(ASCUS)或腺上皮细胞( AGCUS )。ASCUS试验结果往往需紧接一项DNA测试,以确定存在人类乳头状瘤病毒( HPV )感染的高风险。
    • 低级变化:人类乳头状瘤病毒感染,这在某些情况下可能存在宫颈癌风险。这一测试结果有时需采取后续DNA测试,以确定人类乳头状瘤病毒( HPV )感染的高风险。
    • 高级变化:非常不典型细胞,可能会导致癌症。
    • 鳞状细胞癌:癌症是显而易见的,需要立即引起注意。
  • 还有什么我需要了解的吗?

    巴氏涂片检查,一般用来作为筛选试验。有一小部分妇女在一次子宫颈涂片检查可能不能发现异常,这就是进行定期宫颈涂片检查的重要性。最常见的错误是出现在收集样本时。宫颈涂片代表了阴道区域非常小的一群细胞的标本。即使是经验丰富的医生,有时也可能采样不足而需要重复采样。

    宫颈涂片检查,作为常规检测有很大帮助,可及早发现宫颈癌,如果发现在早期阶段,这是可治疗的。宫颈涂片也被用来监测任何异常或不常见的结果。在许多情况下,这些发现为身体的修复过程的一部分,往往能自愈,无需进一步的治疗。如果您冲洗,在浴缸中洗澡,或使用阴道霜48 - 72小时之内检测,您的测试结果可能是“不能令人满意的”。 其他因素可能改变结果,包括出血(月经)、感染、药物(如洋地黄和四环素),或检查前24小时内性生活会影响检测结果。

    在这些情况下,重复宫颈涂片检查可能是必要的,但并不一定意味着有很大的问题。在某些情况下,使用液体为基础的技术可以消除干扰物质(血和黏液),这些干扰物质有可能防碍宫颈细胞的清晰而有分散地显示 。第二个优势是,如果需要,相同的标本可被用来进行别的测试,如人乳头状瘤病毒检测。

  • 宫颈癌的危险因素有哪些

      高危因素包括性交开始的年龄(越早风险越高) ,性伴侣的数量(越多,风险越高) ,宫颈涂片检查次数少,吸烟,己烯雌酚暴露史、存在性传播疾病(例子是人类乳头状瘤病毒[HPV] ,疱疹,艾滋病毒)

  • 是否不正常的宫颈涂片检查总是意味着癌症?

      一次的“异常”宫颈涂片检查,并不一定表明有癌症。宫颈内膜不断变化和修复。这种情况下虽然可能没有必要治疗,但应该密切监测。每三至六个月需要重复宫颈涂片检查,直至情况得到解决。

  • 如果我得了宫颈癌,有哪些治疗方法?

      宫颈癌是一个缓慢的,渐进的疾病,并可能需要数年时间在宫颈内进展。事实是,提供定期妇科检查能在早期检测到这种类型的癌症。治疗包括微创手术治疗宫颈(您的医生可能会使用的高频电波刀,锥切术,冷刀,或冷冻治疗) ,切除癌前或非常早期的肿瘤组织。进展期宫颈癌,需要行子宫切除术。细胞扩散到其他组织(转移),可能需要放射治疗,而且在某些情况下,可能需要额外的手术。

Pap Test Terminology

In 2014, a task force updated the classification system for reporting Pap test or smear results, called the Bethesda System. The Bethesda System terminology was originally developed in 1988. The 2014 review of the system incorporated minimal changes to the earlier version but refined some positions and content.

Bethesda System Terminology: 
Important Sections of the Report and the New Terminology

Specimen Adequacy: Each laboratory must report if the cervical sample obtained for the test was adequate and if the quality of the smear was satisfactory for examining under the microscope. Before looking at the results, one should always check to see if the smear has been marked "Satisfactory." If "unsatisfactory," the reasons will be given and the smear will have to be repeated in 2 or 3 months.

Interpretation/Results: This is the section where the important findings from looking at the cells are reported. There are four different sections:

  • Negative for intraepithelial lesion or malignancy
  • Other: Endometrial cells present in a woman age 40 or more
  • Epithelial Cell Abnormalities
  • Other Malignancies

Negative for intraepithelial lesion or malignancy:
This is the desired result and where a "normal" result is reported. There are two important subcategories, where abnormal findings not related to the risk of cancer are reported. These are:

  • ORGANISMS: This is where evidence of trichomonas, a fungal (yeast) infection, herpes, or some other infection is reported.
  • OTHER NON-NEOPLASTIC FINDINGS: This is where evidence of injury and response to injury, previously termed "Benign Cellular Changes," is reported.

Other: Endometrial cells present in a woman age 40 or more:
This section is used to alert the health practitioner that endometrial cells (cells from the lining of the uterus) are present when they normally should not be. This is a check on the status of the uterus and endometrium and not the cervix. When a woman is having monthly periods, endometrial cells are often present near the time of a period. After menopause, however, they should not be present. If you are still having periods even though you are over age 40, you and your healthcare provider can disregard this part of the report.

Epithelial Cell Abnormality:
This section is where abnormalities that are associated with the risk of developing cancer are reported. The abnormalities range from changes that are only slightly abnormal to definite cancer. There is a spectrum of change. There are two types of epithelial cells in the cervix (squamous and glandular) and changes in each are listed.

Squamous Abnormalities (cells that cover most of the external part of the cervix)

  • Atypical Squamous Cells: Unknown Significance (ASC-US) or Cannot exclude HSIL or high-grade changes (ASC-H)
  • Low Grade Squamous Intraepithelial Lesion (LSIL)
  • High Grade Squamous Intraepithelial Lesion (HSIL); one subcategory: "with features suspicious for malignancy"
  • Squamous Cell Carcinoma

The potential for malignancy increases as you move down the list to the last diagnosis of Squamous Cell Carcinoma, which is an invasive cancer.

Note: There are over 50 million Pap smears done in the U.S. each year and approximately 4,000 new cancers are reported. The odds of a positive Pap smear for cancer are quite small.

Glandular Abnormalities (cover the lining of the uterus opening and canal)

  • Atypical cells, not otherwise specified
  • Atypical cells, favor neoplastic
  • Adenocarcinoma in situ
  • Adenocarcinoma (can be endometrial (uterus), endocervical (cervix), extrauterine (origin from outside uterus and cervix), or the site of the malignancy cannot be determined based on the Pap smear))

Glandular abnormalities are much less common than squamous abnormalities. The list above is arranged so that the potential for malignancy increases as you move down the list. A diagnosis like adenocarcinoma in situ (a cancer limited to the surface that has not invaded) is one of the rarest diagnoses made on a Pap smear and frequently requires consultation among pathologists.

Other Malignancies:
Malignant tumors other than primary squamous carcinoma and glandular adenocarcinoma are occasionally seen on a Pap smear and they are reported here.

Reminder

It is important that if you do not understand your Pap smear results, you ask your healthcare provider for clarification. Ninety-nine percent of the abnormal findings reported on a Pap smear are either completely benign or completely reversible and treatable. However, annual Pap smear testing remains important to ensure that any potentially serious problems are detected promptly.

Article Source

Ritu Nayar, MD and David C. Wilbur, MD. The Pap test and Bethesda 2014. Article first published online: 1 MAY 2015. Cancer Cytopathology Volume 123, Issue 5, Pp. 271–281. Available online at http://onlinelibrary.wiley.com/doi/10.1002/cncy.21521/full through http://onlinelibrary.wiley.com. Accessed August 2015.

参考文献

Sources Used in Current Review

(Updated 2009 January 22). Frequently Asked Questions, Pap Test. Womenshealth.gov [On-line information]. Available online at http://womenshealth.gov/faq/pap-test.cfm through http://womenshealth.gov. Accessed February 2009.

(Updated 2009 January 7). Making Progress against Cervical Cancer. CDC [On-line information]. Available online at http://www.cdc.gov/Features/CervicalCancer/ through http://www.cdc.gov. Accessed February 2009.

(Reviewed 2009 February 2). Pap Test. National Cancer Institute Fact Sheet [On-line information]. Available online at http://www.cancer.gov/cancertopics/factsheet/Detection/Pap-test through http://www.coancer.gov. Accessed February 2009.

(2005 January 28). Understanding Cervical Changes: A Health Guide for Women. National Cancer Institute Fact Sheet [On-line information]. Available online at http://www.cancer.gov/cancertopics/understandingcervicalchanges through http://www.cancer.gov. Accessed February 2009.

(Updated 2008 April). Pap Smear, What is a Pap Smear? Familydoctor.org [On-line information]. Available online at http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html through http://familydoctor.org. Accessed February 2009.

Dr. D. Van Niekirk, Director, Cervical Cancer Screening Laboratory, British Columbia Cancer Agency, Vancouver, BC, Canada.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Robert Krum, MD. Director of Cytology, Kaiser Permanente; Adjunct Assistant Professor of Pathology, Oregon Health & Science University.

Communication from Kenneth Sims, M.D. based on Dr. John Bishops' topic "Pap Smear" in Evaluating Abnormal Test Results, http://UPCMD.com developed by the University Pathology Consortium, LLC.

Cindy Steele, SCT(ASCP (IAC). Cytopathology Supervisor, SUNY Upstate Medical University, Syracuse, NY.

Teri Somrak, JD, CT (ASCP). Director of Educational Planning, ASCP.

(2004 Copyright). Human Papilloma Virus (HPV). American Cancer Society [On-line information]. Available online through http://www.cancer.org.

Bren, L. (2004 January February). Cervical Cancer Screening. FDA Consumer Magazine [On-line article]. Available online at http://www.fda.gov/fdac/features/2004/104_cancer.html through http://www.fda.gov.

(2004 Copyright). Human Papillomavirus (HPV). ARUP's Guide to Clinical Laboratory Testing [On-line testing information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_302a.jsp#3465668 through http://www.arup-lab.com.

(2004 May 4). Revised Cervical Cancer Screening Guidelines Require Reeducation of Women and Physicians. ACOG [On-line news release]. Available online at http://www.acog.org/from_home/publications/press_releases/nr05-04-04-1.cfm through http://www.acog.org.

(2004 Copyright). The High-Risk HPV Test: A Breakthrough in Cervical Cancer Screening. The HPVtest.com [On-line information from Digene Corportaion]. Available online at http://www.thehpvtest.com/factsheet.html through http://www.thehpvtest.com.

Pagana K, Pagana T. (2006). Mosby's Manual of Diagnostic and Laboratory Tests. 3rd edition. St. Louis: Mosby Elsevier. Pages 690-693.