Cervical cytology

Author: Mikael Häggström

Adequacy

Adequacy should always be stated, either as "Satisfactory" or "Unsatisfactory". For estimating the number of cells, determine the following:

• The area of your field of view at high power (see the Evaluation chapter)
• The total size of the relevant area on the microscope slide.
• Look at 10 representative high power fields (HPFs) within that area, and calculate the average number of cells per high power field.

Total number of cells = Average number of cells per HPF *

Total size of area HPF area

Eventually you will be able to tell when most cases are adequate or inadequate without performing a detailed calculation.

Also state whether the endocervical/transformation zone is present or absent. Count an endocervical component as present if there are 10 or more endocervical or squamous metaplastic cells.

Very common findings

• Bacterial flora (usually rod-shaped Lactobacilli), does not need reporting
  Bacterial flora (usually rod-shaped Lactobacilli), does not need reporting
• A clue cell, covered in bacteria, as compared to an unremarkable squamous cell at bottom left, and a neutrophil at bottom center. Pap stain. A significant amount of clue cells can be reported as "Shift in vaginal flora suggestive of bacterial vaginosis".]]
  A clue cell, covered in bacteria, as compared to an unremarkable squamous cell at bottom left, and a neutrophil at bottom center. Pap stain. A significant amount of clue cells can be reported as "Shift in vaginal flora suggestive of bacterial vaginosis".]]

Main conditions to exclude or confirm

Squamous atypia, seen mainly as cells with increased nucleus/cytoplasm ratio, nuclear hyperchromasia and irregular nuclear outline.

• Atypical squamous cells of undetermined significance (ASCUS), with only few slightly atypical cells
  Atypical squamous cells of undetermined significance (ASCUS), with only few slightly atypical cells
• Low-grade squamous intraepithelial lesion (LSIL)
  Low-grade squamous intraepithelial lesion (LSIL)
• 
  High-grade squamous intraepithelial lesion (HSIL)

Main page

• Main page of Patholines