Composition of cervical smears in patients with and without a cervical ectropion.

Abstract

Aims-To test the hypothesis that absence of squamous cells in cervical smears obtained by an endocervical sampling technique is more prominent in patients with a cervical ectropion. Methods-Prospective study exploring the relation between the composition of cervical smears obtained using an endocervical cotton swab in patients with (n = 188) and without (n = 341) a cervical ectropion. Subjects were 529 consecutive patients from whom a cervical smear was prepared at a university gynaecological clinic. Results-In 7% of the endocervical samples no squamous cells were found. There was no correlation, however, between the presence or the size of an ectropion and the absence of squamous cells in those samples. Conclusions-It was confirmed that endocervical sampling alone is insufficient to obtain good quality cervical smears. The presence of an ectropion proved to be an unreliable predictor of the absence of squamous cells. (J Clin Pathol 1995;48:408-409) Keywords: Cervical screening, quality assurance. Department of MethodsThe study is based on 529 consecutive cervical smears prepared by three staff members of the gynaecological clinic of the University hospital of Maastricht, The Netherlands. For each patient a paired sample, using firstly a cotton swab and secondly an extended tip spatula, was produced. The age of the patient and the occurrence and degree of any cervical ectropion were registered during consultation. The presence of squamous and endocervical cells, respectively, was recorded for each sample by the university's cytology department.The screening personnel in the cytology department were not aware of the aim of the study.For each sampling method the relationship between the presence and the size of any ectropion and the presence of squamous and endocervical cells was examined. For statistical analysis the x' test and Fisher's exact test for independent proportions were used. The x2 test for trend was used in analysing the relationship between the size of the cervical ectropion and the presence of the studied cell types. The McNemar test for paired samples was used to examine the significance of the relationship between the presence in the smear of both cell types and the sampling method employed.A sample size computation was made before the start of the study, and updated whenever new data became available. Accepting a possible type I error of 5% and a type II error of 10%, 531 smears would be sufficient to detect a difference of at least 10% in the number of samples lacking squamous cells between the groups with or without a cervical ectropion. ResultsThere was a strong relationship between the sampling method (spatula or cotton swab) and the presence of both endocervical and squamous cells, the spatula performing better for both cell types (p<0_001; X2). SQUAMOUS CELLSSquamous cells were lacking in 36/529 (7%) of the cotton swab samples. In the presence of an ectropion these cells were absent in 4% of all cotton swab samples. Without an ectropion, they were absent in 8%. The difference w...

Uterine cervical ectopy during reproductive age: Cytological and microbiological findings

“…HPV, especially the oncogenic type, and morphological HPV‐induced lesions (squamous intraepithelial lesion) have been associated with ectopy in some studies . Buntinx et al suggested that the adequacy of a Pap smear could be affected.…”