ORDER OF ENDOCERVICAL AND ECTOCERVICAL CYTOLOGIC SAMPLING AND THE QUALITY OF THE PAPANICOLAOU SMEAR

Objective: To determine whether the order of cell collection, endocerv ical or ectocervical cells first, has an effect on the quality of the Papanicolaou smear. Methods: One thousand smears were obtained using a n Ayre spatula and an endocervical brush. Tn 500 cases the endocervica l brush was used first, and in 500 cases the spatula was used first. A ll Papanicolaou smears were collected by resident physicians in our un iversity hospital gynecologic clinics. A smear was considered limited for interpretation for the following reasons: 1) lack of endocervical component, 2) obscured by blood, 3) obscured by inflammation, 4) dryin g artifact, and 5) too thick. Results: The brush-first group had 405 ( 81%) adequate smears compared with 410 (82%) adequate smears in the sp atula-first group. More smears were obscured by blood when the brush w as used first (22 or 4.4% compared with three or 0.6%, P < .001). No e ndocervical component tie, metaplastic cells, endocervical cells, or m ucus) was found in 29 (5.8%) smears from the brush-first group compare d viith 45 (9.0%) of the spatula-first group, an insignificant differe nce. More squamous intraepithelial lesions were found when the spatula was used first (55 or 11% compared with 35 or 7.0%, P < .05). Conclus ion: The quality of the Papanicolaou smear can be improved by using th e Ayre spatula first followed by the endocervical brush. Fewer smears will be obscured by blood, which could result in more squamous intraep ithelial lesions being detected. (C) 1997 by The American College of O bstetricians and Gynecologists.