Efficacy of cotton-tipped applicators for obtaining cells from the uterine cervix for Papanicolaou smears.

A study was made of the efficacy of two techniques for the preparation of Papanicolaou smears. In one technique ("swab-spatula technique"), a scraping of the endocervix with a saline-moistened cotton-tipped applicator was combined with a scraping of the ectocervix with a plastic spatula. In the second technique ("swab technique"), the endocervix and ectocervix were scraped with only a saline-moistened cotton-tipped applicator. The swab technique produced more inadequate smears with a scanty cellular yield (24/408 = 6%) than did the swab-spatula technique (9/361 = 3%). The swab technique also produced higher false-negative rates (60% for CIN I, 42% for CIN II, 16% for CIN III, 20% for invasive cancer, and 32% overall) as compared with those of the swab-spatula technique (27% for CIN I, 29% for CIN II, 14% for CIN III, 0% for invasive cancer and 18% overall). Because of the higher rates of inadequate samples and false negativity in smears prepared by cotton-tipped applicators alone, it is recommended that the spatula not be omitted in taking cervical samples for the preparation of Papanicolaou smears for the detection of dysplasia or cancer. This study also reflects a poor performance of a cervical cancer detection system in the setting of a major medical school and suggests the need for instruction and periodic evaluation of the performance of the staff taking the smears. This study also substantiates doubt on the value of a second recent smear as a follow-up procedure for cervical dysplasia.