Gavranović Ljiljana, Novak Sanja Rakek, Bolanca Ines Krivak
Merkur University Hospital, Department of Clinical Cytology and Cytogenetics, Division of Gynaecological Cytology and Cytogenetics, Zagreb, Croatia.
Acta Med Croatica. 2011 Sep;65 Suppl 1:115-9.
Inadequate Pap smear by definition is a specimen in which detection of cervical epithelial abnormality is impossible or uncertain. This causes poorer detection of intraepithelial lesions of a mild and more severe grade, including the possible false-negative diagnosis. Sample adequacy is most crucial in the evaluation of the finding, alerting the gynecologist to the limitations of the finding, its possible inaccuracy, and need to repeat the examination in order to obtain as precise results as possible. The aim of the study was to establish the frequency and reasons of unsatisfactory cervicovaginal smear samples in the course of one year, during which 1594 of 12,242 conventionally obtained cervical samples were sorted out as inadequate. These were reassessed with respect to their adequacy. Eight percent of the smears in which the evaluation of cell abnormality failed due to sample inadequacy were identified and these smears were repeated and analyzed for adequacy and presence of abnormality. The most common reasons included insufficient endocervical epithelial cells, excessive smear thickness, cells obscured with numerous inflammatory elements and erythrocytes, and sample inadequacy due to the presence of foreign material, poor fixation or staining. Inadequate equipment, insufficient material for cytologic analysis, and poor preparation technique may lead to failure to observe abnormality and errors in microscopic analysis. This implies each team member's responsibility for the accuracy of the result as well for the assurance of specimen adequacy. Reduction in the frequency of the reasons mentioned above is possible if internal control, performance quality monitoring and continuing education of each team member are conducted on a regular basis. The necessity to repeat sampling adds to the cost of health care with no considerable increase in the detection rate of epithelial abnormalities, inadequate specimens being the most common cause of false-negative cytologic findings.
根据定义，巴氏涂片检查结果不满意是指无法或难以确定是否存在宫颈上皮异常的标本。这会导致对轻度和重度上皮内病变的检测效果较差，包括可能出现假阴性诊断。样本充足性在评估检查结果时至关重要，它能提醒妇科医生注意检查结果的局限性、可能存在的不准确之处，以及为获得尽可能精确的结果而重复检查的必要性。本研究的目的是确定一年内宫颈阴道涂片样本不满意的频率及原因，在此期间，12242例常规获取的宫颈样本中有1594例被归类为样本不充分。对这些样本的充足性进行了重新评估。识别出8%因样本不充分而无法评估细胞异常的涂片，对这些涂片进行了重复检查，并分析其充足性和是否存在异常。最常见的原因包括宫颈管上皮细胞不足、涂片过厚、细胞被大量炎症成分和红细胞遮盖、因存在异物、固定或染色不佳导致样本不充分。设备不足、用于细胞学分析的材料不足以及制片技术不佳可能导致无法观察到异常以及显微镜分析出现错误。这意味着每个团队成员都要对结果的准确性以及样本充足性负责。如果定期进行内部控制、绩效质量监测以及对每个团队成员进行继续教育，上述原因出现的频率是可以降低的。重复采样的必要性增加了医疗保健成本，而上皮异常的检出率并未显著提高，样本不充分是细胞学假阴性结果最常见的原因。
