We have fully explained the importance of detecting cervical precancerous lesions – cervical intraepithelial neoplasia (CIN), so let’s learn about the tests through which we can detect it? We have just talked about the HPV carcinogenic process, and there are two links in this long process to detect cervical precancerous lesions: (i) by understanding the morphological changes of cervical epithelial cells, which include: Pap smear and TCT examination. (ii) By detecting the pathogen through HPV virus testing, i.e. etiological testing. The combination of these two components basically brings out the original cervical precancer (CIN)! TCT test is more advanced and accurate than Pap smear High Pap smear and TCT test have the same principle, but what are their differences? 1. Traditional cytology test – Pap smear. The physician uses a columnar brush or small scraper to scrape shed cells (without injury) from the cervix and cervical canal, which are then applied to a glass slide and stained with Pap stain. The cytopathologist then looks at the morphology of the shed cells under a microscope to determine if cervical precancer (CIN) may be present. 2. With the development of filming technology, TCT was introduced, which also involves obtaining cervical shed cells with a columnar brush and then repeatedly swabbing the brush in a collection bottle to allow the cells on the brush head to fall off into the fixative at the bottom of the bottle, and then centrifuging and precipitating the smear to make a determination under the microscope by computerized scanning combined with observation by the cytopathologist. Looking at the filming results of the two smears, it is obvious that the traditional Pap smear has many contaminated cells, while the TCT smear is much clearer and does not have much impurities. The number of cells available for the doctor’s judgment in a Pap smear is only about 20%, while the number of cells available for judgment in a TCT smear is close to 100%, allowing the cytopathologist to easily make a correct diagnosis. HPV test can tell – infection or not and its typing There are two types of HPV tests: HPV-DNA test and HPV typing test. ①HPV-DNA test: detects the presence of HPV infection and the load of HPV in the body (the higher the load indicates a greater likelihood of cervical lesions). ②HPV typing test: HPV typing test is more accurate and can detect high-risk HPV and low-risk HPV to find high-risk HPV that causes cervical precancer and cervical cancer. low-risk HPV: 6, 11, 41, 42, 43, 44, associated with acromegaly of the genital tract; high-risk HPV: 16, 18, 31, 33, 35, 56, 58, associated with cervical epithelial CIN and cervical cancer. Does a positive TCT test and HPV test indicate cervical precancerous lesions? Of course not, TCT and HPV tests are only screening tests, and colposcopy and cervical biopsy are required for definitive diagnosis. This is what we call the “three-step” procedure to diagnose cervical precancer and cervical cancer: ① Screening: cervical cytology (Pap smear, TCT) + HPV test; ② Helpful diagnosis: we will do colposcopy if there is an abnormality in the screening test. Colposcopy is performed by staining the cervix with acetic acid and iodine and microscopically observing the cervix for suspicious lesions; ③Confirmation of diagnosis: If suspicious lesions are found under colposcopy, a biopsy of the area will be taken for final confirmation of the diagnosis. The cure rate of cervical precancerous lesions (CIN) is almost 100%, so what kind of treatment can we do after finding cervical precancerous lesions? CIN I and CIN II patients are commonly treated with loop electrode excision, which is often referred to as LEEP knife conization, while CIN III patients can undergo cold knife cervical conization. Cervical conization has both therapeutic and diagnostic value. First of all, the excised tissues are sent for pathological examination to clarify the nature of the lesion and to see if the cut edges are clean (normal tissue at the cut edges means that the excision is clean). In addition, it is possible to find out whether there is microinvasive cancer, etc. Secondly, the cervical lesion is removed and at the same time it is treated. We won’t go into details about the treatment method, but you should know that after treatment, the cure rate of cervical precancerous lesions (CIN) is almost 100%! The recurrence rate is also less than 1%, and even if the lesion recurs, it can be treated again to control the development of the lesion as long as it is reviewed regularly.