Specimen adequacy and the ThinPrep Pap Test: the endocervical component

The ThinPrep Pap Test (Cyryc Corp., Boxborough, MA) has proven to be effective in decreasing the number of cervical specimens limited for interpretation by blood/inflammatory exudate as compared to conventional smears. However, its effectiveness in decreasing the number of preparations which lack an endocervical component is less well-established. The purpose of this 1-yr study (January 1998-December 1998) was to determine if the collecting instruments used by physicians played a role in the lack of an endocervical component on ThinPrep slides. On implementation of the ThinPrep Pap Test for cervical cytology, the broom-type sampling device (Papette, Wallach Surgical Devices, Inc., Millford, CT) was the FDA-approved collecting instrument. Subsequently the combined plastic spatula/Zelsmyr Cytobrush (Medscand, Inc., Hollywood, FL) were approved. A survey was sent to 102 physicians in seven primarY care sites and two private obstetrics-gynecology practices affiliated with the Loyola University Health Care System. One site used the broom only, one site used the spatula/cytobrush, five sites used the broom/cytobrush, and in two sites, two different sets of collecting instruments were utilized. Of the 10,241 ThinPrep samples, 620 (6%) were obtained with the broom only, 432 (4.3%) with the spatula/cytobrush, and 9,189 (89.7%) with the broom/cytobrush. An endocervical component was absent in 24% (range, 13.7-25%) of the cervical samples collected with the broom only, 10% (range, 8.4-12.5%) with the spatula/cytobrush, and 13% (range, 6.2-18.8%) with the broom/ cytobrush. The spatula/cytobrush and the broom/cytobrush showed statistical significance (P < 0.001) over the broom alone in the collection of an endocervical component. The results of this study indicate that the collecting instruments used by the physician(s) played a role in the adequacy (endocervical component) of the specimen processed by the ThinPrep method. Diagn. Cyto