In search of more representative cervical cytology. A preliminary prospective study

Non-representative cervical smears represented 26.5% of the 105,165 smears screened by the cytology laboratory at Tygerberg Hospital during the period 1986 - 1987. This figure varied from 21% to 41% depending on the skill of the performer. In an effort to secure more representative smears a preliminary prospective study was conducted to ascertain the value of a variety of devices (Ayre wooden spatula, saline-soaked cotton-wool swab, Cytobrush). Initially these devices were employed by one specific clinician and subsequently by a variety of medical personnel. This study proved that in the hands of all the personnel endocervical cells were present in all smears taken by the Cytobrush technique, obviating the need for repeat smears. The combination of an ectocervical scrape by an Ayre wooden spatula with an endocervical Cytobrush smear applied to one slide should result in more representative smears at screening. The resultant higher cost should be offset by minimising repeat smears.