Exam 2 - Cervical cancer cytology collection and HPV testing

Question 1

What is the general anatomy of the cervix?

Answer 1

Lower fibromuscular portion of uterus, 3-4 cm in length, 2.5 cm in diameter

Question 2

What are the two major tissue types of the cervix?

Answer 2

• Squamous epithelium
• Columnar epithelium

Question 3

Where on the cervix can squamous epithelium be found?

Answer 3

• Covers vagina and ectocervix
• Pink
• Stratified
• Multiple layers of cells

Question 4

Where on the cervix can columnar epithelium be found?

Answer 4

• Lines endocervix and endometrial canal
• Red cells seen around external cervical os in younger women
• Red
• Single layer of cells
• Glandular - secretes mucus

Question 5

What is the squamocolumnar junction (SCJ)?

Answer 5

The point in which squamous and columnar epithelium meet

• More present on the outside (around glandular cells)
• Visible around external os in younger cervix (reproductive age)
• NOT visible and recedes into endocervical canal in advanced age/postmenopausal cervix

Question 6

What is squamous metaplasia?

Answer 6

Glandular columnar epithelium changes to mature squamous epithelium –> creates transformation zone

Question 7

When is squamous metaplasia most active?

Answer 7

During adolescence and first pregnancy d/t influence of estrogen

• Makes cervix more susceptible to HPV infection
• Area where most precancerous or cervical cancer cells change

Question 8

What are the two types of pap tests that are available?

Answer 8

• Conventional cytology (glass slide)
• Liquid based cytology (aka Thin Prep, SurePath)

Question 9

How does using liquid based cytology improve screening accuracy?

Answer 9

• Increases number of cells sampled
• Removes blood, mucous, debris in samples
  
  • Allows more complete removal of cellular material by rinsing sampling devices in liquid medium
• Reduces screening errors

Question 10

Do you screen more or less often when you use liquid based cytology?

Answer 10

Less often because you can add HPV co-test (every 5 years)

Question 11

What other conditions can you screen for using liquid based cytology other than cervical cancer?

Answer 11

Chlamydia, gonorrhea, trichomoniasis

Question 12

When is HPV co-testing recommended for women?

Answer 12

30+ years

Question 13

What two ways can HPV testing be used with cervical cytology?

Answer 13

• Reflex test - added on after abnormal cytology findings are reported
• Co-testing for women ages 30+ years

Question 14

Is genotyping for specific HPV strains also available when performing cervical cytology?

Answer 14

Yes - available for HPV 16 and 18

Question 15

What happens when you get a negative/normal cervical cytology report but a positive HPV 16 or 18 test with genotyping?

Answer 15

Recommend patient to undergo colposcopy

Question 16

What happens when the patient is positive for other high risk strains other than HPV 16 or 18 with genotyping?

Answer 16

Repeat pap in 1 year

Question 17

General techniques used to collect cervical cytology (pap)

Answer 17

• Obtain sample from SCJ
• Complete when menstrual bleeding is NOT present
• Moisten speculum with warm water or small amount of lubricating gel
• DO NOT remove mucus, discharge, blood from cervix prior to testing (may remove significant cellular material)

Question 18

How would the provider use a spatula and brush to collect a cervical cytology sample?

Answer 18

• Use spatula first
• Insert longer end into cervical os, rotate 360 degrees
• Insert endocervical brush into cervix until only bottom fibers are visible
• Vigorously twirl brush and spatula in liquid at least 10 times
• Use spatula to mechanically remove mucous and cells from brush

Question 19

How would the provider use a broom device to collect a cervical cytology sample?

Answer 19

• Insert central bristles into endocervical canal
• Push gently and rotate in clockwise direction 5 times
• Place broom into liquid vial and press firmly to bottom of vial so bristles are forced apart
• Swirl vigorously 10 times

Question 20

How would the provuder perform conventional/glass slide cytology (sampling and preparation)?

Answer 20

• Sample ectocervix by rotating spatula 360 degrees
• Sample endocervix using endocervical brush
• Place spatula sample on glass slide, creating thin layer that covers slide
• Gently roll brush on top of first sample
• Apply fixative immediately to avoid air drying

Question 21

Are separate slides needed when preparing conventional/glass sides?

Answer 21

No, nor is segmenting the slide into sections for ecto vs endocervical samples