Optimal collection technique and devices for a quality pap smear.

BACKGROUND Collection technique is critical in the performance of the Papanicolaou (Pap) smear as an important screening tool for cervical cancer. While superior devices have been established, less effective devices continue to be used for both conventional and liquid-based Pap smears. Our aim is to determine the performance of collection devices currently used in obtaining conventional Pap smears and whether sequence of collection is important for higher quality results. METHODS This prospective, blinded, cohort study used 2 cytology labs to analyze Pap smears done within a 1-year period. Study participants were 128 clinicians who practice in Dane County, Wis, who send their Pap smears to either of the 2 study cytology labs. Participants included advance practice nurses, family physicians, and obstetrician/gynecologists. Logistic regression was utilized for analysis. RESULTS In conventional Pap smears, sequence of collection did not affect any quality indicators. The Cervex-brush (broom) was associated with absent endocervical cells (Odds Ratio = 3.12, P < .001), limited or unsatisfactory results (OR = 1.68, P < .01), and obscuring inflammation (OR = 2.01, P < .01). Of those clinicians who had high levels of absent endocervical cells on their Pap smears (defined as > 3/30 Pap smears), 47% used the broom alone. The Cytobrush optimized quality indicators, and the combination of the Cytobrush for the endocervix and spatula for the ectocervix was superior. Presence of infectious agents also contributed to the absence of endocervical cells (OR = 3.09, P < .001). CONCLUSIONS The combination of the Cytobrush (endocervix) and spatula (ectocervix) is superior for a quality Pap smear. The sequence of collection was not important in conventional Pap smears. The broom alone performs poorly. Presence of infection decreases quality.