Papanicolaou smear: can we make a good test better? Technical and interpretive challenges for the practitioner

The Papanicolaou smear has proven to be an excellent screening test for cervical cancer and has resulted in a significant decrease in mortality from invasive cervical cancer. A relatively high false-negative rate of Pap smears might cause failure to diagnose preinvasive disease, especially when coupled with an increased screening interval. This review focuses on the causes of and methods to reduce the number of false-negative Pap smears. In addition, we address the clinical significance of ambiguous Pap smear diagnoses, such as atypical squamous/glandular cells of undetermined significance, and suggest a scheme for management of patients with these diagnoses. Although efforts to reduce false-negative Pap smears are important, the most effective way of reducing mortality from invasive cervical cancer is universal, organized, population-based screening of all women.