The reliance on the Papanicolaou smear as a screening and diagnostic test for uterine cancer and its precursors infers that appraisal of the specimen's adequacy is based upon a uniform standard of quality. The presence or absence of endocervical cells in cervical samples has been suggested as one measure of a specimen's adequacy. Not all Cytologists are satisfied with the reliability of this criterion, however. On-going studies are indicated to determine those factors which are critical to the evaluation of the adequacy of these specimens.
Pap smear collection devices have been the focus of increasing attention for their perceived role in the reduction of false negative results in Pap smear screening of cervical cancer. New devices are available on the market aimed at improved cellular yield and enhanced cellular preservation. While controversy remains regarding the definition of the "adequate" Pap smear, it has been generally accepted that the adequate Papanicolaou smear consists of a thinly prepared smear which is properly labeled and rapidly fixed. Adequate and relevant patient history should accompany the specimen. The adequate Pap smear should consist of the following: a sufficient number of well preserved epithelial cells that have been collected under direct visualization ' and an endocervical component (defined as either metaplastic cells or endocervical cells) in a premenopausal woman who has a cervix.2Conversely, an unsatisfactory smear is one which does not contain adequate numbers of cells, is poorly preserved or is obscured with inflammatory or hemorrhagic exudate so as to interfere with cytologic interpretation. The Bethesda System format of cervical vaginal cytologic reporting seeks to clearly define what constitutes a satisfactory cervical-vaginal specimen and makes allowances for specimens which may yield valuable information despite problems which may interfere with but not prevent interpreta-Lake City, UT 84117. tion such as air drying artifact, inflammation, or other factors which can be determined by the individual laboratory. The designation "less than optimal" has met with much discussion by the cytologic community and still allows for a great deal of variation between laboratories, a seemingly contradictory goal of the attempt to standardize nomenclature for Pap smear reporting.To date, no one sampling method or collection device has enjoyed universal acceptance or been shown to produce adequate Pap smears in all types of clinical settings and in all patient populations. Previous studies have rated the effectiveness of various sampling devices and made recommendations for decreasing the number of inadequate smears by advocating one particular type of spatula, brush, or other instrument or a combination of devices. MI The cytopathologic interpretation of smears made using the various Pap smear sampling devices requires allowances for artifacts and morphologic changes directly attributable to sampling techniques. Comparative studies and clinical validation must occur as new sampling devices are developed and marketed. Literature accompanying these devices must include details on intended applications, proper use, and contraindications of each sampling device because of the potential for litigation against the manufacturer, the clinician, and the laboratory.This symposium was convened to discuss the following aspects pertaining to Pap smear sampling devices: design rationale, clinical utility, diagnostic and interpretative considerations, and legal implications associated with their use or misuse.The target area of Pap smear sa...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.