TAILIEUCHUNG - GYNECOLOGIC PROCEDURES AND SURGERY

Exfoliative cytologic examination of specimens from the lower genital tract (Pap smear) is a screening tool that has been so valuable in the detection of premalignant and malignant lesions that it has been almost universally adopted as the primary cancer screening method for cervical cancer, an integral part of the health care of women. This has resulted in a 50% reduction of invasive cancers of the cervix alone. Although cervical cytology may detect endometrial cancer (in 15%–50%), it does not carry the same reliability as a screening tool for endometrial neoplasia. . | GYNECOLOGIC PROCEDURES EXFOLIATIVE CERVICAL CYTOLOGIC STUDY PAPANICOLAOU SMEAR Exfoliative cytologic examination of specimens from the lower genital tract Pap smear is a screening tool that has been so valuable in the detection of premalignant and malignant lesions that it has been almost universally adopted as the primary cancer screening method for cervical cancer an integral part of the health care of women. This has resulted in a 50 reduction of invasive cancers of the cervix alone. Although cervical cytology may detect endometrial cancer in 15 -50 it does not carry the same reliability as a screening tool for endometrial neoplasia. SCREENING GUIDELINES Initial gynecologic screening at age 18 or when the individual becomes sexually active. Women whose initial smear is negative without significant atypia should have a second smear within 1 year to rule out a false-negative smear. High-risk women should be screened annually . those with a history of early sexual activity or those with multiple sexual partners . Low-risk women may be screened every 1-3 years at the discretion of the physician. These are women with late exposure to coitus those with only one sexual partner and women after two successive negative annual smears. Some authorities contend it is too difficult to ascertain low risk and simply recommend annual screening. 841 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. 842 BENSON PERNOLL S HANDBOOK OF OBSTETRICS AND GYNECOLOGY Postmenopausal women should receive annual screening. Women after hysterectomy should have an initial smear following surgery if this is negative cytology should be repeated every 3 years. TECHNIQUE Materials necessary for a Pap smear include a cervical spatula shaped tongue depressor or cotton swab glass slides and a means to identify the slide and patient a speculum warm without lubricant and a jar of fixative 97 ethanol or spray fixative . Pro-Fixx or AquaNet Fig. 31-1 . The objective is to sample .

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