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Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing

Sarah Feldman, MD, MPH
Christopher P Crum, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Cervical cancer screening detects preinvasive neoplasia, thereby making treatment possible before the disease becomes invasive; invasive disease may also be detected. Screening is performed using cervical cytology (Pap test) or a human papillomavirus (HPV) test, or a combination of the two tests.

Techniques for obtaining specimens for cervical cytology and HPV testing are reviewed here. Screening strategies and interpretation of the cervical cytology report are discussed separately. (See "Screening for cervical cancer" and "Cervical and vaginal cytology: Interpretation of results (Pap test report)".)


Cell samples for cervical cytology and human papillomavirus (HPV) testing are obtained during the speculum examination. With certain types of Pap tests, the same specimen can be used for both tests; alternatively, separate specimens can be obtained.

Specimens for cytology — There are two methods for preparing a specimen for cervical cytology: the conventional Pap smear and the liquid-based, thin layer preparation.

For both methods, cells are obtained from the external surface of the cervix (ectocervix) and the cervical canal (endocervix) to evaluate the transformation zone (squamocolumnar junction), the area at greatest risk for neoplasia.

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Literature review current through: Nov 2017. | This topic last updated: Apr 14, 2017.
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  1. Marchand L, Mundt M, Klein G, Agarwal SC. Optimal collection technique and devices for a quality pap smear. WMJ 2005; 104:51.
  2. Martin-Hirsch P, Jarvis G, Kitchener H, Lilford R. Collection devices for obtaining cervical cytology samples. Cochrane Database Syst Rev 2000; :CD001036.
  3. Arbyn M, Herbert A, Schenck U, et al. European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid-based cytology. Cytopathology 2007; 18:133.
  4. Harrison DD, Hernandez E, Dunton CJ. Endocervical brush versus cotton swab for obtaining cervical smears at a clinic. A cost comparison. J Reprod Med 1993; 38:285.
  5. Vooijs GP, van der Graaf Y, Elias AG. Cellular composition of cervical smears in relation to the day of the menstrual cycle and the method of contraception. Acta Cytol 1987; 31:417.
  6. Saslow D, Runowicz CD, Solomon D, et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002; 52:342.
  7. http://www.thinprep.com/hcp/specimen_collection/brush_spatula.html (Accessed on April 25, 2012).
  8. Gage JC, Sadorra M, Lamere BJ, et al. Comparison of the cobas Human Papillomavirus (HPV) test with the hybrid capture 2 and linear array HPV DNA tests. J Clin Microbiol 2012; 50:61.
  9. FDA approves first human papillomavirus test for primary cervical cancer screening. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm394773.htm (Accessed on November 24, 2014).
  10. http://www.thehpvtest.com/~/media/5C4BD0982BED4E3788F65B36AF829AAD.ashx (Accessed on April 30, 2012).
  11. Pathak N, Dodds J, Zamora J, Khan K. Accuracy of urinary human papillomavirus testing for presence of cervical HPV: systematic review and meta-analysis. BMJ 2014; 349:g5264.
  12. Kitchener HC, Owens GL. Urine testing for HPV. BMJ 2014; 349:g5542.
  13. Hildesheim A, Bratti MC, Edwards RP, et al. Collection of cervical secretions does not adversely affect Pap smears taken immediately afterward. Clin Diagn Lab Immunol 1998; 5:491.
  14. Partridge EE, Abu-Rustum NR, Campos SM, et al. Cervical cancer screening. J Natl Compr Canc Netw 2010; 8:1358.
  15. Stoler MH, Schiffman M, Atypical Squamous Cells of Undetermined Significance-Low-grade Squamous Intraepithelial Lesion Triage Study (ALTS) Group. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study. JAMA 2001; 285:1500.
  16. Lozano R. Comparison of computer-assisted and manual screening of cervical cytology. Gynecol Oncol 2007; 104:134.
  17. Davey E, d'Assuncao J, Irwig L, et al. Accuracy of reading liquid based cytology slides using the ThinPrep Imager compared with conventional cytology: prospective study. BMJ 2007; 335:31.
  18. Willis BH, Barton P, Pearmain P, et al. Cervical screening programmes: can automation help? Evidence from systematic reviews, an economic analysis and a simulation modelling exercise applied to the UK. Health Technol Assess 2005; 9:1.
  19. Tabbara SO, Sidawy MK. Evaluation of the 10% rescreen of negative gynecologic smears as a quality assurance measure. Diagn Cytopathol 1996; 14:84.
  20. The 1988 Bethesda System for reporting cervical/vaginal cytological diagnoses. National Cancer Institute Workshop. JAMA 1989; 262:931.
  21. Solomon D, Davey D, Kurman R, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002; 287:2114.
  22. Castle PE, Solomon D, Schiffman M, Wheeler CM. Human papillomavirus type 16 infections and 2-year absolute risk of cervical precancer in women with equivocal or mild cytologic abnormalities. J Natl Cancer Inst 2005; 97:1066.
  23. Khan MJ, Castle PE, Lorincz AT, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst 2005; 97:1072.
  24. Carozzi FM, Del Mistro A, Confortini M, et al. Reproducibility of HPV DNA Testing by Hybrid Capture 2 in a Screening Setting. Am J Clin Pathol 2005; 124:716.
  25. Crum CP, Beach KJ, Hedley ML, et al. Dynamics of human papillomavirus infection between biopsy and excision of cervical intraepithelial neoplasia: results from the ZYC101a protocol. J Infect Dis 2004; 189:1348.
  26. del Pino M, Rodriguez-Carunchio L, Alonso I, et al. Clinical, colposcopic and pathological characteristics of cervical and vaginal high-grade lesions negative for HPV by Hybrid Capture 2. Gynecol Oncol 2011; 122:515.
  27. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htm (Accessed on April 25, 2012).
  28. Olsson SE, Kjaer SK, Sigurdsson K, et al. Evaluation of quadrivalent HPV 6/11/16/18 vaccine efficacy against cervical and anogenital disease in subjects with serological evidence of prior vaccine type HPV infection. Hum Vaccin 2009; 5:696.
  29. Doorbar J. Molecular biology of human papillomavirus infection and cervical cancer. Clin Sci (Lond) 2006; 110:525.
  30. Kotaska AJ, Matisic JP. Cervical cleaning improves Pap smear quality. CMAJ 2003; 169:666.
  31. Hans N, Cave AJ, Szafran O, et al. Papanicolaou smears: to swab or not to swab. Can Fam Physician 2007; 53:1328.
  32. Bernstein SJ, Sanchez-Ramos L, Ndubisi B. Liquid-based cervical cytologic smear study and conventional Papanicolaou smears: a metaanalysis of prospective studies comparing cytologic diagnosis and sample adequacy. Am J Obstet Gynecol 2001; 185:308.
  33. Sherman ME, Carreon JD, Schiffman M. Performance of cytology and human papillomavirus testing in relation to the menstrual cycle. Br J Cancer 2006; 94:1690.
  34. Schmeink CE, Massuger LF, Lenselink CH, et al. Effect of the menstrual cycle and hormonal contraceptives on human papillomavirus detection in young, unscreened women. Obstet Gynecol 2010; 116:67.
  35. Bishop JW, Hartinger JS, Pawlick GF. Time interval effect on repeat cervical smear results. Acta Cytol 1997; 41:269.
  36. Jeronimo J, Khan MJ, Schiffman M, et al. Does the interval between papanicolaou tests influence the quality of cytology? Cancer 2005; 105:133.
  38. Griffith WF, Stuart GS, Gluck KL, Heartwell SF. Vaginal speculum lubrication and its effects on cervical cytology and microbiology. Contraception 2005; 72:60.
  39. Amies AM, Miller L, Lee SK, Koutsky L. The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis. Obstet Gynecol 2002; 100:889.
  40. Hathaway JK, Pathak PK, Maney R. Is liquid-based pap testing affected by water-based lubricant? Obstet Gynecol 2006; 107:66.
  41. Harer WB, Valenzuela G Jr, Lebo D. Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears. Obstet Gynecol 2002; 100:887.
  42. Tavernier LA, Connor PD, Gates D. Water vs gel lubricant for cervical cytology specimens. J Fam Pract 2003; 52:701.
  43. Poindexter AN 3rd, Levine H, Sangi-Haghpeykar H, et al. Comparison of spermicides on vulvar, vaginal, and cervical mucosa. Contraception 1996; 53:147.
  44. Halpern V, Rountree W, Raymond EG, Law M. The effects of spermicides containing nonoxynol-9 on cervical cytology. Contraception 2008; 77:191.
  45. Auborn KJ, Carter TH. Treatment of human papillomavirus gynecologic infections. Clin Lab Med 2000; 20:407.
  46. Marais D, Carrara H, Kay P, et al. The impact of the use of COL-1492, a nonoxynol-9 vaginal gel, on the presence of cervical human papillomavirus in female sex workers. Virus Res 2006; 121:220.
  47. Harper DM, Longacre MR, Noll WW, et al. Factors affecting the detection rate of human papillomavirus. Ann Fam Med 2003; 1:221.
  48. Chen FC, Shaw SW, Cheng PJ, et al. Diagnosis of human papillomavirus infection by abnormal cervical cytology is highly reproducible after vaginal douching. Taiwan J Obstet Gynecol 2008; 47:412.