Endocervical component: is it a determinant of specimen adequacy?

There is controversy in the literature concerning the presence or absence of an endocervical component as a determinant of the adequacy of cervical cellular samples. The purpose of this retrospective 2-yr study (January 1, 1999-December 31, 2000) was to evaluate the diagnostic accuracy of ThinPrep Pap Tests with the presence or absence of an endocervical component from 151 women with subsequent tissue-verified cervical intraepithelial neoplasia (CIN) II/III. Of the 138 Pap Tests containing an endocervical component, 100 (73%) showed exact cyto/histologic correlation and 38 (27%) were discordant. Of the 13 Pap Tests lacking an endocervical component, 10 (77%) showed exact correlation and 3 (23%) were discordant. Statistical analysis showed no significant difference in the detection of a high-grade squamous intraepithelial lesion (HSIL) in those ThinPreps that contained an endocervical component from those that did not (P > 0.5). Further analysis of the 41 discordant ThinPrep Pap Tests showed no significant difference between negative Pap Tests and discordant, yet abnormal Pap Tests (atypical squamous cells of undetermined significance, or low-grade squamous intraepithelial lesions) and the presence or absence of an endocervical component (P = 0.25). The results of this study seem to indicate that the issue of the lack of an endocervical component as a determinant of cervical specimen adequacy should be revisited.