Comparison of two Papanicolaou smear techniques in a family practice setting.

Papanicolaou smear adequacy is directly dependent upon endocervical cell recovery. Ineffective physician sampling techniques and advancing patient age are responsible for most inadequate smears. Two thousand four hundred seventy-eight routine Papanicolaou smears were reviewed from the Department of Family Practice and the Department of Gynecology for the presence of these cells. A retrospective review showed approximately 25 percent cell recovery in women aged over 45 years from both departments. Recovery on the family practice service, however, was 19.4 percent greater than recovery on the gynecology service for younger women (57 percent vs 37.6 percent). Two prospective interventions were introduced in family practice in an attempt to improve these rates. A combined spatula-saline swab technique did not improve cell recovery in either age group. A combined spatula-Cytobrush cell collector technique, however, dramatically improved endocervical cell recovery by 200 percent in older women and by 57 percent in younger women. This method significantly improves endocervical cell recovery and may therefore improve the value of the Papanicolaou smear as a cancer screening test.