Terminology and specimen adequacy in cervicovaginal cytology. The College of American Pathologists Interlaboratory...

The 600 participants in the College of American Pathologists 1991 Interlaboratory Comparison Program in Cervicovaginal Cytology were surveyed by mailed questionnaire in March 1991. The total annual gynecologic specimen volume of the 362 respondents was over 7 million. Nearly all participants (94%) used a descriptive diagnosis for cases not within normal limits. Most (87%) have implemented or plan to implement the Bethesda System. A Papanicolaou class system was not used by 66%. Terminology for reporting squamous lesions with premalignant potential was variable, with many laboratories using two or more sets of terms. Specimen adequacy was routinely reported by 66% of participants. Median rates of unsatisfactory and "less than optimal" specimens reported by participants in 1990 were 0.5% to 0.9% (range, 0% to greater than 20%) and 3.0% to 4.9% (range, 0% to greater than 40%), respectively. Leading reasons for both unsatisfactory and less than optimal smears included scant cellularity, obscuring inflammation, obscuring blood or menses, and poor preservation. Absent endocervical component was also a leading reason for less than optimal specimens. The largest number of respondents required endocervical columnar cells and/or metaplastic cells as the criteria for an endocervical component. In conclusion, nearly all laboratories use descriptive terminology for smears that are abnormal, and most laboratories routinely report specimen adequacy. Frequency and criteria for unsatisfactory and less than optimal smears vary significantly, supporting the need for consensus definitions of specimen adequacy.