{"id":268,"date":"2025-06-11T14:53:13","date_gmt":"2025-06-11T14:53:13","guid":{"rendered":"https:\/\/analizesanocare.ro\/?post_type=product&#038;p=268"},"modified":"2025-08-08T13:56:25","modified_gmt":"2025-08-08T13:56:25","slug":"citologie-cervico-vaginala-babes-papanicolaou-in-mediu-lichid","status":"publish","type":"product","link":"https:\/\/analizesanocare.ro\/en\/analiz\u0103\/citologie-cervico-vaginala-babes-papanicolaou-in-mediu-lichid\/","title":{"rendered":"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid"},"content":{"rendered":"<h2><strong>Informa\u0163ii generale \u015fi recomand\u0103ri Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid<\/strong><\/h2>\n<p>Cancerul colului uterin este o problem\u0103 de s\u0103n\u0103tate public\u0103 \u00een \u00eentreaga lume, afect\u00e2nd cu prec\u0103dere femei \u00eentre 35-50 ani aflate \u00een perioada activ\u0103 social\u0103 \u015fi profesional\u0103. Dintre \u0163\u0103rile Uniunii Europene, Rom\u00e2nia prezint\u0103 una dintre cele mai ridicate rate a mortalita\u0163ii prin cancer de col uterin, principalul tip de cancer genital \u015fi a doua cauz\u0103 de deces prin cancer la femeile din \u0163ara noastr\u0103<sup>6<\/sup>.<\/p>\n<p>Depistarea leziunilor colului uterin \u00eentr-o etap\u0103 timpurie a carcinogenezei \u015fi abordarea integrat\u0103 a informa\u0163iilor clinice \u015fi citologice, cu modularea conduitei diagnostice \u015fi terapeutice conform unor protocoale larg acceptate reprezint\u0103 cheia \u00een sc\u0103derea inciden\u0163ei leziunilor de grad \u00eenalt \u015fi a cancerului invaziv. \u00cen \u0163\u0103rile \u00een care se desf\u0103\u015foar\u0103 programe de screening, acestea \u015fi-au dovedit eficien\u0163a, inciden\u0163a cancerului de col uterin sc\u0103z\u00e2nd foarte mult.<\/p>\n<p><a href=\"https:\/\/www.synevo.ro\/shop\/hpv-detectie-tipuri-cu-risc-crescut-genotipare-extinsa\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">HPV<\/a> (human papilloma virus) este considerat cauza major\u0103 a cancerului de col uterin. Transformarea celulelor agresate viral \u00een celule displazice \u015fi apoi \u00een celule canceroase necesit\u0103 \u00eens\u0103 \u015fi existen\u0163a altor factori. Infec\u0163ia cu HPV care este considerat\u0103 o boal\u0103 cu transmitere sexual\u0103, apare mai frecvent \u00een leg\u0103tur\u0103 cu: debutul precoce al vie\u0163ii sexuale, promiscuitate, parteneri multipli, fumat. Exist\u0103 categorii cu risc de a dezvolta o leziune displazic\u0103 \u015fi chiar cancer invaziv \u00een urma infec\u0163iei HPV, respectiv paciente cu nivel sc\u0103zut al imunit\u0103\u0163ii care nu pot elimina virusul sau localiza leziunile determinate de acesta. \u00cen acela\u015fi timp este important \u015fi genotipul viral, deoarece exist\u0103 peste 100 tulpini de <a href=\"https:\/\/www.synevo.ro\/shop\/hpv-detectie-tipuri-cu-risc-crescut-genotipare-extinsa\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">HPV<\/a>, dintre care aproximativ 40 au tropism pentru tractul genital inferior.<\/p>\n<p>Pe criterii epidemiologice acestea au fost clasificate \u00een:<a title=\"\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau.jpg\" rel=\"wpdevart_lightbox lightbox-gallery-e1kwfNND\" data-=\"\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img decoding=\"async\" class=\"alignright size-full wp-image-9648\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"197\" height=\"253\" \/><\/a><\/p>\n<ul>\n<li><strong>cu risc sc\u0103zut (low-risk): 6, 11<\/strong>, 40, 42, 43, 44, 54, 61, 70, 81 \u015fi CP6108, care rareori determin\u0103 leziuni care progreseaz\u0103 spre leziuni de grad \u00eenalt \u015fi cancer;<\/li>\n<li><strong>probabil cu risc crescut:<\/strong> 26, 53, 66;<\/li>\n<li><strong>\u00a0<\/strong><strong>cu risc crescut (high-risk):<\/strong> <strong>16, 18<\/strong>, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 , 68, 73 \u015fi 82.<sup>1<\/sup><\/li>\n<\/ul>\n<p><strong>Fig. 22.1:<\/strong> Istoria natural\u0103 a infec\u0163iei <a href=\"https:\/\/www.synevo.ro\/shop\/hpv-detectie-tipuri-cu-risc-crescut-genotipare-extinsa\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">HPV<\/a>: \u00een urma infec\u0163iei cu <a href=\"https:\/\/www.synevo.ro\/shop\/hpv-detectie-tipuri-cu-risc-crescut-genotipare-extinsa\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">HPV<\/a> apare o leziune acut\u0103, care \u00een func\u0163ie de interven\u0163ia r\u0103spunsului imun al gazdei poate regresa sau poate da o leziune persistent\u0103.<\/p>\n<p>Cea mai eficient\u0103 \u015fi larg utilizat\u0103 metod\u0103, folosit\u0103 \u00een multe \u0163\u0103ri \u00een cadrul programelor de screening pentru cancerul colului uterin, care se poate realiza relativ cu u\u015furin\u0163\u0103 asupra unei popula\u0163ii largi, este reprezentat\u0103 de citologia cervico-vaginal\u0103,.<\/p>\n<p>\u00cen general, Pap testul se recomand\u0103 a fi efectuat periodic la intervale de 3 ani \u00eentre 21 \u015fi 65 ani sau la 3 ani de la \u00eenceputul vie\u0163ii sexuale, deoarece se consider\u0103 c\u0103 majoritatea infec\u0163iilor cu HPV sunt contactate in primii ani de la debutul vie\u0163ii sexuale (18-25 ani)<sup>8<\/sup>.<\/p>\n<p>Citologia cervico-vaginal\u0103 care se realizeaz\u0103 \u00een laboratorul Synevo beneficiaz\u0103 de avantajele tehnologiilor de v\u00e2rf din acest domeniu: recoltare \u00een mediu lichid, \u00eembog\u0103\u0163irea masei celulare cu eliminarea detrisurilor \u015fi a altor elemente ce pot interfera cu rezultatul, colorare automat\u0103, analiz\u0103 computerizat\u0103.<\/p>\n<p>Citologia in mediu lichid (LBC) ajut\u0103 la sc\u0103derea semnificativ\u0103 a cazurilor nesatisf\u0103c\u0103toare fa\u0163a de testele conven\u0163ionale, reduc\u00e2nd astfel nevoia repet\u0103rii nejustificate a prelev\u0103rii.<\/p>\n<p>Prin recoltarea in mediu lichid, \u00eentreaga prob\u0103 recoltat\u0103 este trimis\u0103 la laborator pentru procesare, f\u0103r\u0103 pierderea sau deteriorarea celulelor recoltate.<\/p>\n<p>Procesul de prelucrare realizeaz\u0103 separarea, reducerea detritusurilor (s\u00e2nge, mucus) \u015fi a celulelor inflamatorii, cu conservarea caracteristicilor necesare pentru interpretare, permi\u0163\u00e2nd o vizualizare mai rapid\u0103 \u015fi mai calitativ\u0103 a celulelor relevante clinic.<\/p>\n<p>Procesarea \u015fi colorarea lamelor se realizeaz\u0103 \u00een sistem automat pentru asigurarea unei calit\u0103\u0163i ridicate \u015fi a unor rezultate standardizate.<\/p>\n<p>Sistemul de analiz\u0103 computerizat\u0103 scaneaz\u0103 toate frotiurile \u00een mediu lichid sau conven\u0163ionale \u015fi ajut\u0103 la \u00eembun\u0103t\u0103\u0163irea calit\u0103\u0163ii interpret\u0103rii lor prin direc\u0163ionarea aten\u0163iei patologului asupra c\u00e2mpurilor microscopice care cel mai probabil con\u0163in anomalii, prin clasificarea frotiurilor conform unui sistem de cuantificare a riscului bazat pe m\u0103surarea a sute de parametri celulari.<\/p>\n<p>Prin acest sistem se realizeaz\u0103 o detec\u0163ie crescut\u0103 a cazurilor HSIL-pozitive at\u00e2t pe LBC c\u00e2t si pe preparatul conven\u0163ional, precum \u015fi \u00eembunata\u0163irea detec\u0163iei LSIL pe cele conven\u0163ionale.<\/p>\n<p>Sistemul poate reduce semnificativ timpul de examinare \u015fi, implicit, timpul \u00een care este elaborat diagnosticul final, f\u0103r\u0103 a sc\u0103dea rata de detec\u0163ie a leziunilor importante clinic.<\/p>\n<h2><strong>Preg\u0103tire pacient\u0103 <\/strong><\/h2>\n<p>cu 24-48 ore \u00eenainte de recoltarea probei trebuie s\u0103 fie evitate: raporturile sexuale, lavajul vaginal, alte tratamente intravaginale (geluri, creme, contraceptive, dezinfectante, lubrifian\u0163i) sau alte manevre intravaginale (tampoane intravaginale, explorare vaginal\u0103).<\/p>\n<ul>\n<li>Se recomandat\u0103 recoltarea \u00een afara perioadei menstruale, \u00een perioada de mijloc a ciclului menstrual, iar \u00een cazul infec\u0163iilor, dup\u0103 tratarea acestora.<\/li>\n<li>\u00cen cazul procedurilor medico-chirurgicale, se recomand\u0103 recoltarea \u00eenainte de examinarea manual\u0103, \u00eenainte sau la minim 24 ore postcolposcopie cu aplica\u0163ie de acid acetic, la 3 luni de la recolt\u0103ri anterioare, iar \u00een cazul electrorezec\u0163iilor, polipectomiilor ca \u015fi postpartum ar trebui s\u0103 existe un interval de 1.5-3 luni<sup>4;7<\/sup>.105<\/li>\n<\/ul>\n<p><strong>Specimen recoltat <\/strong>\u2013 celule ale zonei exocervicale, \u00a0endocervicale \u015fi de tranzi\u0163ie dintre acestea (zona de transformare). Zona de transformare reprezint\u0103 sediul cel mai frecvent al leziunilor preneoplazice (turn-over crescut, expus\u0103 microtraumatismelor, sensibilitate crescut\u0103 la ac\u0163iunea HPV), acolo unde epiteliul scuamos al exocolului se continu\u0103 cu cel de tip glandular de la nivel endocervical prin intermediul unei zone de metaplazie scuamoas\u0103.<\/p>\n<p><strong>Recoltare <\/strong>\u2013 se efectueaz\u0103 cu ajutorul periu\u0163ei cervicale cu cap deta\u015fabil. Pentru recoltarea \u00een mediu lichid sunt recomandate dispozitivele din plastic. Dup\u0103 recoltare, partea deta\u015fabil\u0103 a instrumentului este introdus\u0103 \u00een flaconul cu mediu lichid, f\u0103r\u0103 a se efectua alte manevre asupra suprafe\u0163ei care con\u0163ine materialul celular.<\/p>\n<p><a title=\"\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau2.jpg\" rel=\"wpdevart_lightbox lightbox-gallery-e1kwfNND\" data-=\"\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9649\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau2.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"121\" height=\"197\" \/><\/a>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<a title=\"\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau1.jpg\" rel=\"wpdevart_lightbox lightbox-gallery-e1kwfNND\" data-=\"\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9650\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau1.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"123\" height=\"198\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0\u00a0\u00a0 Fig.22.2:<\/strong> Periu\u0163a Cervex-Brush<sup>10<\/sup>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0 <strong>Fig. 22.3:<\/strong> Flacon fixare \u015fi transport<sup>10<\/sup><\/p>\n<p><strong>Instruc\u0163iuni de recoltare<\/strong> \u2013 Dup\u0103 vizualizarea colului uterin se inser\u0103 partea central\u0103 a periu\u0163ei \u00een canalul endocervical astfel \u00eenc\u00e2t marginile mai scurte s\u0103 vin\u0103 \u00een contact cu exocervixul. De obicei nu se recomand\u0103 \u015ftergerea colului uterin \u00eenainte de recoltare, dar la nevoie se poate tampona u\u015for cu un tifon<sup>7<\/sup>. Cu partea central\u0103 fix\u0103, se rote\u015fte complet periu\u0163a <strong>\u00een sensul acelor de ceasornic de cinci ori<\/strong> <sup>5<\/sup>.<\/p>\n<p>Proba astfel recoltat\u0103 trebuie imediat fixat\u0103 pentru a se evita deteriorarea probei. \u00cen acest scop se deta\u015feaz\u0103 cap\u0103tul periu\u0163ei care con\u0163ine materialul recoltat \u015fi se introduce \u00een recipientul cu mediu lichid.<\/p>\n<p><strong>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><strong><a class=\"shutterset_9500 cboxElement\" title=\"Citologie cervico-vaginal\u0103 Babe\u015f\u2013Papanicolaou \u00een mediu lichid\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau31.jpg\" rel=\"wpdevart_lightbox lightbox[9500]\" data-rel=\"lightbox-gallery-XNozpYig\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9652\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau31.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"132\" height=\"197\" \/><\/a><\/strong><\/p>\n<p><strong>Fig.22.4:<\/strong>\u00a0Deta\u015fare cap\u0103t recoltare<sup>10<\/sup><\/p>\n<p>Se acoper\u0103 flaconul cu capacul, se \u00een\u015furubeaz\u0103 pentru a nu se varsa lichidul, se eticheteaz\u0103 imediat (sau \u00eenaintea recolt\u0103rii probei) \u015fi se transport\u0103 la laborator \u00eempreun\u0103 cu fi\u015fa de \u00eenso\u0163ire a pacientei \u00een vederea prelucr\u0103rii.<\/p>\n<p><strong>Dup\u0103 recoltarea cu periu\u0163a nu este necesar\u0103 efectuarea altor manevre (de desc\u0103rcare) asupra cap\u0103tului de recoltare. La laborator este trimis flaconul \u00een care se g\u0103sesc: lichidul fixator \u015fi cap\u0103tul deta\u015fabil al periu\u0163ei.<\/strong><\/p>\n<p>Este foarte important ca, pe l\u00e2ng\u0103 corectitudinea recolt\u0103rii, proba s\u0103 fie \u00eenso\u0163it\u0103 \u015fi de datele clinice c\u00e2t mai complete ale pacientei: v\u00e2rsta, data ultimei menstrua\u0163ii, data recolt\u0103rii, antecedente medicale, tratamente, metode de contracep\u0163ie, rezultate anterioare ale Pap testului etc<sup>3;8<\/sup>.<\/p>\n<p><strong>Stabilitate prob\u0103 <\/strong>\u2013 termenul de p\u0103strare a mediului lichid f\u0103r\u0103 proba recoltat\u0103 este de 36 luni de la data fabrica\u0163iei la temperatura camerei (15-30\u00b0C). Dup\u0103 recoltare, proba cu materialul celular se poate p\u0103stra 6 luni la 2-10\u00b0C sau 4 s\u0103pt\u0103m\u00e2ni la temperatura camerei (15-30\u00b0C)<sup>5<\/sup>.<\/p>\n<p><strong>Metod\u0103 <\/strong>\u2013 citologie \u00een mediu lichid, colora\u0163ie Papanicolaou. Prelucrarea \u015fi colorarea LBC se realizeaz\u0103 \u00een mod automat. Lamele sunt scanate \u015fi analizate prin sistemul computerizat care asist\u0103 medicul \u00een elaborarea rezultatului.<\/p>\n<p><strong>Avantajele LBC:<\/strong><\/p>\n<ul>\n<li>recoltare facil\u0103 \u015fi rapid\u0103, f\u0103r\u0103 riscul distrugerii sau deterior\u0103rii celulelor;<strong>\u00a0<\/strong><\/li>\n<li>100% din celulele epiteliale diagnostice recoltate sunt transferate la laborator;<\/li>\n<li>fixare mai eficient\u0103 \u00een mediul de transport;<\/li>\n<li>\u00eenl\u0103turarea majorit\u0103\u0163ii factorilor de obscurare \u015fi realizarea unui frotiu alc\u0103tuit dintr-un singur strat de celule uniform distribuit, concentrat \u00eentr-o zon\u0103 mic\u0103, facilit\u00e2nd interpretarea \u015fi \u00eendeplinirea condi\u0163iilor de acceptabilitate;<\/li>\n<li>sc\u0103derea num\u0103rului de\u00a0 probe ce trebuie repetate \u00een urma raport\u0103rii ca fiind nesatisf\u0103c\u0103toare;<\/li>\n<li>compatibil cu sistemul automat de \u00eembog\u0103\u0163ire celular\u0103, colorare \u015fi interpretare asistat\u0103 de calculator.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a class=\"shutterset_9500 cboxElement\" title=\"Citologie cervico-vaginal\u0103 Babe\u015f\u2013Papanicolaou \u00een mediu lichid\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau101.jpg\" rel=\"wpdevart_lightbox lightbox[9500]\" data-rel=\"lightbox-gallery-XNozpYig\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9674\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau101.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"592\" height=\"195\" \/><\/a><\/p>\n<p><strong>\u00a0 Fig.22.5:<\/strong>\u00a0Frotiu conven\u0163ional\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0<strong>Fig.22.6<\/strong>: LBC<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Limite \u015fi interferen\u0163e:<\/strong><\/p>\n<p>\u2013 factori care \u0163in de calitatea tehnic\u0103: nerespectarea condi\u0163iilor privitoare la preg\u0103tirea pacientelor sau la momentul recolt\u0103rii. Ex: recoltare \u00een perioada menstrual\u0103, folosire de lubrifiante intravaginale \u00eenaintea\/\u00een timpul recolt\u0103rii etc.<\/p>\n<p>\u2013 factori fiziologici sau patologici care \u0163in de paciente: sarcin\u0103, lehuzie, postpartum (interval de 6-8 s\u0103pt\u0103m\u00e2ni), atrofie (se poate recomanda terapie trofic\u0103 local\u0103 cu estrogeni), radioterapie.<\/p>\n<p>\u2013 celularitatea sc\u0103zut\u0103 a frotiului poate limita posibilitatea elabor\u0103rii unui diagnostic (criteriul acceptabilit\u0103\u0163ii). Totu\u015fi, preparatele se vor examina pentru a determina cauzele probabile ale acestei deficien\u0163e, care \u00een anumite condi\u0163ii poate fi normal\u0103, sau pentru prezen\u0163a celulelor atipice, caz \u00een care se precizeaz\u0103 \u00een buletinul de analiz\u0103 c\u0103 preparatul are celularitate la limit\u0103 sau sc\u0103zut\u0103. LBC \u015fi sistemul de \u201eimboga\u0163ire celular\u0103\u201d ajut\u0103 la \u00eendeplinirea acestui criteriu, dar exist\u0103 un minim necesar de 5000 de celule<sup>3<\/sup>.<\/p>\n<p>\u2013 absen\u0163a celulelor endocervicale sau metaplaziate semnific\u0103 e\u015fantionarea inadecvat\u0103 a zonei endocervicale, iar aceasta se specific\u0103 \u00een buletinul de raportare.<\/p>\n<p>\u2013 factorii de obscurare pot interfera cu interpretarea atunci cand afecteaz\u0103 &gt;75% (nesatisf\u0103c\u0103tor) sau 50-75% dintre celule (satisf\u0103c\u0103tor, dar par\u0163ial obscurat). Cea mai mare parte a acestor inconveniente sunt \u00eenl\u0103turate prin recoltarea \u00een mediu lichid<sup>3<\/sup>.<\/p>\n<p>\u2013 calitatea celulelor importante pentru diagnostic poate fi influen\u0163at\u0103 de manevre medico-chirurgicale locale practicate anterior recolt\u0103rii: examinare manual\u0103, aplica\u0163ie lugol\/acid acetic, recolt\u0103ri anterioare, electrorezec\u0163ii etc.<\/p>\n<p>\u2013 Pap testul reprezint\u0103 un instrument foarte util de screening folosit \u00een depistarea precoce sau \u00een stadii incipiente ale cancerului cervical, dar trebuie urmat \u00eentotdeauna de alte investiga\u0163ii \u00eenainte de a se lua o decizie terapeutic\u0103. Pap testul triaz\u0103 eficient pacientele care vor efectua investiga\u0163ii suplimentare (colposcopie) \u00een vederea stabilirii de c\u0103tre medicul clinician a atitudinii terapeutice.<\/p>\n<p><strong>Cauze de respingere a probei<\/strong><\/p>\n<p>\u2013 prob\u0103 necorespunz\u0103toare: flacon deteriorat, mediu de transport absent\/insuficient, absen\u0163a din flacon a cap\u0103tului de recoltare al periu\u0163ei;<\/p>\n<p>\u2013 prob\u0103 neetichetat\u0103, fi\u015f\u0103 incomplet\u0103 f\u0103r\u0103 datele clinice \u015fi de identificare complete ale pacientei.<\/p>\n<h2><strong>Rezultate, elaborarea diagnosticului<\/strong><\/h2>\n<p>\u00cen urma prelucr\u0103rii \u015fi examin\u0103rii probei, rezultatul se elaboreaz\u0103 conform Sistemului de raportare a citologiei colului uterin Bethesda 2001<sup>3<\/sup>.<\/p>\n<p><strong>Termeni utiliza\u0163i:<\/strong><\/p>\n<p>\u2013 acceptabilitatea specimenului;<\/p>\n<p>\u2013 modific\u0103ri non-neoplazice \u2013 NILM;<\/p>\n<p>\u2013 anomalii ale celulelor epiteliale scuamoase: ASC-US, ASC-H, LSIL, HSIL, SCC;<\/p>\n<p>\u2013 anomalii ale celulelor glandulare-AGC, AIS, adenocarcinom.<\/p>\n<p><strong>1.<\/strong> Acceptabilitatea specimenului: criteriile necesare a fi \u00eendeplinite de un preparat pentru a fi raportat ca fiind satisfac\u0103tor pentru interpretare sunt:<\/p>\n<ul>\n<li><strong>de celularitate minim\u0103:<\/strong> chiar dac\u0103 metoda LBC \u00eenl\u0103tur\u0103 cea mai mare parte dintre inconvenientele frotiurilor conven\u0163onale, asigur\u00e2nd ajungerea \u00een laborator a 100% din materialul recoltat \u015fi selectarea masei celulare importante pentru diagnostic, exist\u0103 un minim necesar de celule scuamoase bine conservate \u015fi u\u015for de vizualizat pentru elaborarea diagnosticului (5000)<sup>3;<\/sup><\/li>\n<li><strong>prezen\u0163a celulelor endocervicale sau din zona de transformare:<\/strong> indic\u0103 recoltarea corespunz\u0103toare a frotiului cu e\u015fantionarea zonei de transformare (minim 10 celule endocervicale sau metaplaziate bine conservate, izolate sau grupate). Precizarea prezen\u0163ei\/ absen\u0163ei celulelor endocervicale\/metaplaziate nu este necesar\u0103 \u00een leziunile de grad \u00eenalt sau invazive<sup>3;<\/sup><\/li>\n<li><strong>factori de obscurare: <\/strong>s\u00e2nge, mucus etc. Se consider\u0103 c\u0103 un frotiu este nesatisf\u0103c\u0103tor atunci c\u00e2nd &gt;75% dintre celulele scuamoase sunt acoperite \u015fi par\u0163ial obscurat dar satisf\u0103c\u0103tor pentru interpretare dac\u0103 50-75 % dintre celule sunt obscurate, cu condi\u0163ia ca pe frotiu s\u0103 nu fi fost identificate celule atipice. LBC are avantajul c\u0103 \u00eenl\u0103tur\u0103 cei mai mul\u0163i dintre ace\u015fti factori<sup>3;<\/sup><\/li>\n<\/ul>\n<p>*ASCCP 2007 recomand\u0103 \u00een caz de teste nesatisf\u0103c\u0103toare repetarea la 2-4 luni, repetare la 12 luni pentru cele c\u0103rora le lipse\u015fte componenta endocervical\u0103 sau par\u0163ial obscurate<sup>7.<\/sup><\/p>\n<p><strong>2.\u00a0<\/strong>NILM \u2013 frotiu negativ pentru leziuni intraepiteliale sau maligne<\/p>\n<ul>\n<li><strong>microorganisme<\/strong>: parazi\u0163i (Trichomonas vaginalis), organisme fungice compatibile cu Candida, modific\u0103ri ale florei vaginale compatibile cu diagnosticul de vaginoz\u0103, bacterii sugestive pentru genul Actinomyces, modific\u0103ri celulare sugestive pentru infec\u0163ia cu Virus Herpes Simplex (HSV);<\/li>\n<li><strong>alte modific\u0103ri non-neoplazice:<\/strong> modific\u0103ri celulare reactive asociate cu: inflama\u0163ia, iradierea, dispozitive contraceptive intrauterine; prezen\u0163a de celule glandulare (status posthisterectomie), atrofie.<\/li>\n<\/ul>\n<p><strong>3. <\/strong>Altele \u2013 celule endometriale la femei \u00a0&gt;40 ani<\/p>\n<p><strong>4. <\/strong>Anomalii ale celulelor epiteliale:<\/p>\n<p><strong>Scuamoase:<\/strong><\/p>\n<ul>\n<li>\n<div>Celule scuamoase atipice: \u2013 cu semnifica\u0163ie nedeterminat\u0103 <strong>(ASC-US)<\/strong><\/div>\n<div>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 nu se poate exclude HSIL <strong>(ASC-H)<\/strong><\/div>\n<\/li>\n<\/ul>\n<ul>\n<li>Leziuni scuamoase intraepiteliale de grad sc\u0103zut<strong> (LSIL) <\/strong>\u2013 includ modific\u0103ri induse de <a href=\"https:\/\/www.synevo.ro\/shop\/hpv-detectie-tipuri-cu-risc-crescut-genotipare-extinsa\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">HPV<\/a>; displazia u\u015foar\u0103; CIN1<\/li>\n<li>Leziuni scuamoase intraepiteliale de grad \u00eenalt<strong> (HSIL) <\/strong>\u2013 includ leziunile: CIN2 (displazia moderat\u0103)\u00a0 \u015fi CIN3 ( displazia sever\u0103 \u015fi carcinomul in situ)<\/li>\n<li>Carcinom cu celule scuamoase<\/li>\n<\/ul>\n<p><strong>Glandulare:<\/strong><\/p>\n<ul>\n<li>Celule\u00a0glandulare atipice (endocervicale, endometriale, glandulare) cu semnifica\u0163ie neprecizat\u0103 <strong>(AGC-NOS).<\/strong><\/li>\n<li>Celule glandulare atipice (endocervicale, glandulare) sugestive pentru neoplazie <strong>(FN).<\/strong><\/li>\n<li>Adenocarcinom endocervical in situ <strong>(AIS).<\/strong><\/li>\n<li>Adenocarcinom endocervical, endometrial, extrauterin, cu semnifica\u0163ie neprecizat\u0103 <strong>(NOS)<\/strong>.<\/li>\n<\/ul>\n<p><strong>5.\u00a0 Alte leziuni maligne<\/strong><\/p>\n<h2><strong>Interpretarea rezultatelor, recomand\u0103ri<\/strong><\/h2>\n<p>Rezultatul Pap testului trebuie interpretat prin corelarea cu datele clinice ale pacientelor precum \u015fi cu alte investiga\u0163ii efectuate. Astfel, \u00een func\u0163ie de suspiciunea ridicat\u0103 \u00een urma Pap testului, prin integrarea \u00een contextul clinic de c\u0103tre medicul curant, se pot formula recomand\u0103rile privitoare la conduita terapeutic\u0103 \u015fi diagnostic\u0103 ce trebuie urmat\u0103. Asocia\u0163iile profesionale medicale din domeniu au elaborat o serie de recomand\u0103ri asupra atitudinii de urmat \u00een func\u0163ie de rezultatele Pap testului<sup>1;2;6<\/sup>.<\/p>\n<ul>\n<li><strong>NILM <\/strong>\u2013 semnific\u0103 absen\u0163a leziunilor intraepiteliale sau a malignit\u0103\u0163ii. Aceast\u0103 categorie este folosit\u0103 \u015fi pentru a raporta prezen\u0163a coloniz\u0103rii cu microorganisme, dar \u015fi a leziunilor reactive sau reparatorii ale celulelor ca r\u0103spuns la infec\u0163ii, iradiere, DIU etc. Raportarea celulelor glandulare benigne posthisterectomie poate semnifica: adenoz\u0103, prolaps salpingian, metaplazie etc. Tot \u00een categoria NILM sunt incluse \u015fi modific\u0103rile induse de atrofie.<\/li>\n<li><strong>Celulele endometriale la femei cu v\u00e2rste peste 40 ani <\/strong>\u2013\u00a0pot sugera riscul unei patologii endometriale care pentru femeile \u00een premenopauza este mic (\u00een general patologie benign\u0103: polipi, hiperplazie simpl\u0103), \u00een timp ce la femeile \u00een postmenopauz\u0103 ele pot indica necesitatea investig\u0103rii endometrului prin corelarea cu semnele \u015fi simptomele clinice, terapii hormonale etc. Prezen\u0163a celulelor endometriale este normal\u0103 pe specimenele menstruale sau din timpul fazei proliferative a ciclului menstrual.<\/li>\n<li><strong>Celule scuamoase atipice:<\/strong><\/li>\n<\/ul>\n<p><strong>ASC-US: <\/strong>\u2013 semnific\u0103 prezen\u0163a de celule epiteliale atipice a c\u0103ror semnifica\u0163ie nu poate fi precizat\u0103. Modific\u0103rile celulelor epiteliale sunt mai importante dec\u00e2t cele din procesele inflamatorii, dar nu suficiente pentru interpretarea ca leziune intraepitelial\u0103.<\/p>\n<p>\u2013 prezint\u0103 un risc pentru o leziune de grad \u00eenalt de 10-20%<sup>9<\/sup>.<\/p>\n<p>\u2013 \u00een general exist\u0103 trei recomand\u0103ri: 1. repetare la 4-6 luni<\/p>\n<p>2. testare HPV \u2013 cu risc \u00eenalt<\/p>\n<p>3. colposcopie<\/p>\n<p>* La adolescente (&lt;20 ani) se repet\u0103 citologia anual timp de doi ani, iar \u00een cazul unor rezultate pozitive repetate pentru ASC-US, se recurge la colposcopie cu biopsie<\/p>\n<p><strong>ASC-H: <\/strong>\u2013 sugereaz\u0103 prezen\u0163a unor celule epiteliale atipice sugestive pentru leziuni intraepiteliale de grad \u00eenalt<strong>, <\/strong>dar care nu \u00eentrunesc pe deplin criteriile cantitative sau calitative pentru calificarea ca HSIL.<\/p>\n<p>\u2013 50% din citologiile cu ASC-H ascund riscul unei leziuni de grad inalt<sup>9<\/sup>;<\/p>\n<p>\u2013 din aceste motive, ghidurile interna\u0163ionale recomand\u0103 efectuarea colposcopiei cu biopsia ariilor suspecte<sup>2,6<\/sup>.<\/p>\n<p><strong>LSIL: <\/strong>\u2013 sugereaz\u0103 modific\u0103ri ale celulelor epiteliale scuamoase compatibile cu o leziune intraepitelial\u0103 de grad sc\u0103zut. Termenul de leziune intraepitelial\u0103 se refer\u0103 la faptul c\u0103 modific\u0103rile celulare sunt strict localizate la nivelul epiteliului de acoperire al colului uterin, f\u0103r\u0103 a dep\u0103\u015fi membrana bazal\u0103, deci f\u0103r\u0103 poten\u0163ial invaziv. \u00centr-o leziune de grad sc\u0103zut modific\u0103rile atipice sunt prezente doar la unele dintre celulele scuamoase.<\/p>\n<p>\u2013 \u00een aceast\u0103 categorie sunt \u00eencadrate modific\u0103rile celulare induse de <a href=\"https:\/\/www.synevo.ro\/shop\/hpv-detectie-tipuri-cu-risc-crescut-genotipare-extinsa\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">HPV<\/a> \u015fi CIN1 (displazia u\u015foar\u0103);<\/p>\n<p>\u2013 reprezint\u0103 indica\u0163ie pentru colposcopie cu biopsia leziunilor suspecte.<\/p>\n<p>*femei \u00een postmenopauz\u0103: unele paciente pot prezenta celule atipice (atipie de menopauz\u0103) care nu necesit\u0103 tratament.<\/p>\n<p>**adolescente (&lt;20 ani): este preferat\u0103 urm\u0103rirea clinic\u0103 prin repetare la 12 luni a citologiei timp de 2 ani. Atitudinea de expectativ\u0103 este justificat\u0103 de faptul c\u0103 la adolescente, datorit\u0103 sistemului imun competent, majoritatea leziunilor dispar de la sine, fa\u0163\u0103 de o rat\u0103 de regresie spontan\u0103 mai sc\u0103zut\u0103 la femeile adulte.<\/p>\n<p>***femei \u00eens\u0103rcinate: colposcopie \u00eenainte (pentru excluderea unei leziuni invazive) \u015fi dup\u0103 na\u015ftere.<\/p>\n<p><strong>HSIL: <\/strong>\u2013 sugereaz\u0103 prezen\u0163a unei leziuni intraepiteliale de grad \u00eenalt \u00een care atipiile celulare sunt mai mari \u015fi afecteaz\u0103 o propor\u0163ie mai mare din celulele epiteliale, dar sunt \u00eenc\u0103 limitate la epiteliul de acoperire al colului uterin f\u0103r\u0103 a dep\u0103\u015fi membrana bazal\u0103.<\/p>\n<p>\u2013 apare ca urmare a persisten\u0163ei \u015fi evolu\u0163iei unei leziuni de etiologie HPV.<\/p>\n<p><strong>\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>\u2013 include modific\u0103ri CIN2 (displazia moderat\u0103) \u015fi CIN3 (displazia sever\u0103 \u015fi CIS).<\/p>\n<p>\u2013 conform recomand\u0103rilor, necesit\u0103 confirmare imediat\u0103 prin colposcopie \u015fi biopsie.<\/p>\n<p>*la femeile \u00eens\u0103rcinate, colposcopia poate exclude o leziune invaziv\u0103.<\/p>\n<p>**la adolescente este recomandat\u0103 colposcopia \u015fi biopsia zonelor suspecte. \u00cen caz de biopsie pozitiv\u0103 cu displazie moderat\u0103, atitudinea recomandat\u0103 este de urm\u0103rire colposcopic\u0103 \u015fi prin citologie la 6 luni timp de 2 ani, cu repetarea biopsiei dac\u0103 leziunea persist\u0103, caz \u00een care este indicat\u0103 electrorezec\u0163ia. \u00cen caz de displazie sever\u0103 pe biopsie se impune excizia leziunii.<\/p>\n<p><strong>SCC: <\/strong>\u2013 indic\u0103 prezen\u0163a unei leziuni neoplazice invazive care a dep\u0103\u015fit stadiul de leziune intraepitelial\u0103 prin extensia dincolo de membrana bazal\u0103.<\/p>\n<ul>\n<li><strong>CELULE GLANDULARE ATIPICE:<\/strong><\/li>\n<\/ul>\n<p><strong>AGC: <\/strong>\u2013 aceast\u0103 categorie reune\u015fte modific\u0103rile atipice ale celulelor epiteliului glandular \u00a0superioare celor din leziunile reactive sau reparatorii dar insuficiente pentru neoplazie<\/p>\n<p>\u2013 dac\u0103 este posibil\u0103 identificarea originii, atunci se precizeaz\u0103 \u00een raport, \u00een caz contrar sunt \u00eencadrate \u00een categoria <strong>NOS<\/strong><\/p>\n<p><strong>\u00a0\u00a0\u00a0 <\/strong>\u2013 dac\u0103 modific\u0103rile celulare sunt sugestive pentru prezen\u0163a unei leziuni neoplazice, se precizeaz\u0103 \u00een raport ca fiind sugestive pentru neoplazie. Specifica\u0163ia NOS este folosit\u0103 atunci c\u00e2nd nu este posibil\u0103 precizarea poten\u0163ialului neoplazic al celulelor glandulare atipice<\/p>\n<p><strong>\u00a0\u00a0\u00a0\u00a0<\/strong>\u2013 se recomand\u0103 colposcopie cu biopsia ariilor suspecte \u015fi chiuretaj endocervical \u00a0\u00een cazul celulelor glandulare atipice cu origine endocervical\u0103 sau biopsie endometrial\u0103 pentru cele endometriale<\/p>\n<p>* la femeile &gt;35-40 ani sau &lt;35 ani cu s\u00e2nger\u0103ri anormale este indicat\u0103 investigarea endometrului<\/p>\n<p><strong>AIS: <\/strong>\u2013 semnific\u0103 prezen\u0163a unei leziuni neoplazice limitat\u0103 la epiteliul glandular endocervical f\u0103r\u0103 a dep\u0103\u015fi membrana bazal\u0103<\/p>\n<p>\u2013 este indica\u0163ie de excizie, coniza\u0163ie sau histerectomie \u00een func\u0163ie de caz<\/p>\n<p><strong>Adenocarcinomul endocervical, endometrial sau extrauterin (ovarian, salpingian): <\/strong>este o leziune care a dep\u0103\u015fit epiteliul de suprafa\u0163\u0103 \u015fi are capacitate invaziv\u0103.<\/p>\n<ul>\n<li><strong>Alte neoplasme: <\/strong>\u00een aceast\u0103 categorie sunt incluse tumorile primare rare ale colului uterin (carcinomul cu celule mici, carcinosarcomul, tumori germinative, limfoame etc.), precum \u015fi cele secundare (endometru, rect, vezic\u0103 urinar\u0103) sau de origine metastatic\u0103 (s\u00e2n, melanom etc.).<\/li>\n<\/ul>\n<p><a title=\"\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau4.jpg\" rel=\"wpdevart_lightbox lightbox-gallery-e1kwfNND\" data-=\"\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9657\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau4.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"676\" height=\"366\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Fig.22.7:<\/strong>\u00a0Recomand\u0103ri ASC-US<sup>9<\/sup><\/p>\n<p><strong><a class=\"shutterset_9500 cboxElement\" title=\"Citologie cervico-vaginal\u0103 Babe\u015f\u2013Papanicolaou \u00een mediu lichid\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau5.jpg\" rel=\"wpdevart_lightbox lightbox[9500]\" data-rel=\"lightbox-gallery-XNozpYig\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9658\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau5.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"484\" height=\"253\" \/><\/a>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Fig 22.8:<\/strong>\u00a0Recomand\u0103ri ASC-H<sup>9<\/sup><\/p>\n<p><strong><a class=\"shutterset_9500 cboxElement\" title=\"Citologie cervico-vaginal\u0103 Babe\u015f\u2013Papanicolaou \u00een mediu lichid\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau6.jpg\" rel=\"wpdevart_lightbox lightbox[9500]\" data-rel=\"lightbox-gallery-XNozpYig\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9659\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau6.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"693\" height=\"384\" \/><\/a>\u00a0<\/strong><\/p>\n<p><strong>Fig.22.9:<\/strong>\u00a0Recomand\u0103ri LSIL<sup>9<\/sup><\/p>\n<p><a class=\"shutterset_9500 cboxElement\" title=\"Citologie cervico-vaginal\u0103 Babe\u015f\u2013Papanicolaou \u00een mediu lichid\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau7.jpg\" rel=\"wpdevart_lightbox lightbox[9500]\" data-rel=\"lightbox-gallery-XNozpYig\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9662\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau7.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"413\" height=\"268\" \/><\/a><\/p>\n<p><strong>Fig.22.10:<\/strong>\u00a0Recomand\u0103ri HSIL<sup>9<\/sup><\/p>\n<p><strong><a class=\"shutterset_9500 cboxElement\" title=\"Citologie cervico-vaginal\u0103 Babe\u015f\u2013Papanicolaou \u00een mediu lichid\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau8.jpg\" rel=\"wpdevart_lightbox lightbox[9500]\" data-rel=\"lightbox-gallery-XNozpYig\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9663\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau8.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"583\" height=\"130\" \/><\/a>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0Fig.22.11:<\/strong>\u00a0Recomand\u0103ri \u00een AGC<sup>9<\/sup><\/p>\n<p><strong><a class=\"shutterset_9500 cboxElement\" title=\"Citologie cervico-vaginal\u0103 Babe\u015f\u2013Papanicolaou \u00een mediu lichid\" href=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau.9JPG.jpg\" rel=\"wpdevart_lightbox lightbox[9500]\" data-rel=\"lightbox-gallery-XNozpYig\" data-rl_title=\"\" data-rl_caption=\"\" data-wpel-link=\"internal\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9664\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2011\/01\/papanicolau.9JPG.jpg\" alt=\"Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid - Synevo\" width=\"577\" height=\"181\" \/><\/a>\u00a0<\/strong><\/p>\n<p><strong>Fig.22.12:\u00a0<\/strong>Recomand\u0103ri AIS<sup>9<\/sup><\/p>\n<h2><strong>Bibliografie<\/strong><\/h2>\n<p>1. Alexander Meisels, Carol Morin. Modern Uterine Cytopathology. Moving to the Molecular Smear. ASCP Press, Chicago, IL, 2007, 155-162; 369-375.<\/p>\n<p>2. Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. In Journal of Low Genital Tract Disease, 2007.<\/p>\n<p>3. Diane Solomon, Ritu Nayar. Sistemul Bethesda de raportare a citologiei colului uterin, Ed. Medical\u0103 Calisto, 2009.<\/p>\n<p>4. H.F.Nauth, Gynecological Cytology, Georg ThiemeVerlag, 2007, 335-338.<\/p>\n<p>5. Laborator Synevo. Referintele specifice tehnologiei de lucru utilizate. Ref type: Internet Communication.<\/p>\n<p>6. M. Arbyn, A. Anttila, J. Jordan, G. Ronco, U. Schenck, N. Segnan, H. Wiener, A. Herbert &amp; L. von Karsa. European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition\u2014Summary Document, In Annals of Oncology 21, 2010: 448\u2013458<\/p>\n<p>7. M. Arbyn, A. Herbert, U. Schenck, P. Nieminen, J. Jordan, E. Mcgoogan, J. Patnick, C. Bergeron, J-J. Baldauf, P. Klinkhamer, J. Bulten and P. Martin-Hirsch. European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid-based cytology. In Cytopathology 2007, 18, 133\u2013 139.<\/p>\n<p>8. Marluce Bibbo, David C. Wilbur, Comprehensive Cytopathology, Third Edition, Saunders Elsevier 2008.<\/p>\n<p>9. Richard Mac DeMay, The Pap Test, ASCP Press, Chicago, 2005;<\/p>\n<p>10.<a href=\"https:\/\/www.bd.com\/\" target=\"_blank\" rel=\"noopener nofollow external noreferrer\" data-wpel-link=\"external\"> www.bd.com<\/a> .<\/p>\n<p><strong>Abrevieri:<\/strong><\/p>\n<p>AGC \u2013 celule glandulare atipice<\/p>\n<p>AIS \u2013 adenocarcinom in situ<\/p>\n<p>ASC \u2013 celule scuamoase atipice<\/p>\n<p>ASC-US \u2013 celule scuamoase atipice cu semnifica\u0163ie nedeterminat\u0103<\/p>\n<p>ASC-H \u2013 celule scuamoase atipice f\u0103r\u0103 a se putea exclude o leziune de grad \u00eenalt<\/p>\n<p>ASCCP \u2013 American Society of Colposcopy and Cervical Pathology<\/p>\n<p>CIN \u2013 neoplazie cervical\u0103 intraepitelial\u0103<\/p>\n<p>CIS \u2013 carcinom in situ<\/p>\n<p><a href=\"https:\/\/www.synevo.ro\/shop\/hpv-detectie-tipuri-cu-risc-crescut-genotipare-extinsa\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">HPV<\/a> \u2013 virusul papilloma uman<\/p>\n<p>HSIL \u2013 leziune scuamoas\u0103 intraepitelial\u0103 de grad \u00eenalt<\/p>\n<p>LBC \u2013 Liquid Base Cytology \u2013 citologie \u00een mediu lichid<\/p>\n<p>LSIL \u2013 leziune scuamoas\u0103 intraepitelial\u0103 de grad sc\u0103zut<\/p>\n<p>NILM \u2013 negativ pentru leziuni maligne intraepiteliale<\/p>\n<p>NOS \u2013 (no other specifications) f\u0103r\u0103 alte specifica\u0163ii<\/p>\n<p>SCC \u2013 carcinomul scuamocelular<\/p>\n<p>TBS \u2013 The Bethesda System<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Informa\u0163ii generale \u015fi recomand\u0103ri Citologie cervico-vaginal\u0103 Babe\u0219\u2013Papanicolaou \u00een mediu lichid Cancerul colului uterin este o problem\u0103 de s\u0103n\u0103tate public\u0103 \u00een \u00eentreaga lume, afect\u00e2nd cu prec\u0103dere femei \u00eentre 35-50 ani aflate \u00een perioada activ\u0103 social\u0103 \u015fi profesional\u0103. Dintre \u0163\u0103rile Uniunii Europene, Rom\u00e2nia prezint\u0103 una dintre cele mai ridicate rate a mortalita\u0163ii prin cancer de col uterin, [&hellip;]<\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false},"product_brand":[],"product_cat":[49],"product_tag":[],"class_list":["post-268","product","type-product","status-publish","product_cat-citologie-cervico-vaginala","first","instock","shipping-taxable","purchasable","product-type-simple"],"acf":[],"_links":{"self":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product\/268","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/types\/product"}],"wp:attachment":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/media?parent=268"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_brand?post=268"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_cat?post=268"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_tag?post=268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}