Outcome of three consecutive inadequate cervical smears

Area of Science:

• Gynecologic Oncology
• Cervical Cytology
• Diagnostic Pathology

Background:

• Three consecutive inadequate cervical smears pose a challenge in routine cervical cancer screening.
• Identifying reasons for inadequate smears is crucial for improving screening effectiveness.
• Previous studies highlight the need for standardized follow-up protocols for persistent inadequate samples.

Purpose of the Study:

• To audit the outcomes of women with three consecutive inadequate cervical smears.
• To identify common reasons for inadequate cervical smears.
• To assess the detection rate of abnormalities following persistent inadequate smears.

Main Methods:

• Retrospective audit of cervical smear records from 1998-1999 at Birmingham Heartlands Hospital.
• Analysis of reasons for inadequate smears, including polymorphs and sparse cellularity.
• Review of colposcopy and histological assessment rates and findings in the audited cohort.

Main Results:

• The most frequent reasons for inadequate smears were obscured by polymorphs (34.5%) and sparse cellularity (28.9%).
• 73% of women underwent colposcopy, and 22.1% had histological assessment.
• 15.9% of women had an abnormality detected, with 10.6% showing abnormal histology and 5.3% only a cytological abnormality.

Conclusions:

• No specific cytological criterion could reliably differentiate women with or without abnormalities on follow-up.
• All women with three consecutive inadequate cervical smears should receive adequate follow-up.
• Increased demand on colposcopy services is anticipated with universal follow-up for inadequate smears.