Specimen Adequacy in Cervicovaginal Cytology
Dina R. Mody, MD
George G. Birdsong, MD
 Conventional Pap smears at 4x were taken to access squamous cellularity. (A) Pap demonstrates ˜ 75 cells. If all fields have this level of cellularity, then the specimen is deemed unsatisfactory. (B) Pap contains ˜ 150 cells. If all fields have this level of cellularity, the specimen will meet minimum cellularity for adequacy by a small margin. (C) Pap shows ˜ 500 cells. A minimum of 16 fields with similar (or greater) cellularity is needed to call this specimen adequate. (D) Pap shows ˜ 1,000 cells. A minimum of 8 fields with similar (or greater) cellularity is needed for an adequate specimen. (Courtesy G. Birdsong, MD.) |
ADEQUACY REPORTING CATEGORIES
Satisfactory
Presence or absence of endocervical/transformation zone component should be mentioned
Other quality indicators, such as partially obscuring inflammation, blood, and foreign material, should be mentioned
Unsatisfactory
Specimen rejected or not processed
Provide reason, e.g., broken slide, no patient identifiers, empty vial
Specimen prepared and evaluated but unsatisfactory
Provide reason, e.g., scant squamous cellularity, inflammation, blood, or foreign material that obscures > 75% of cells
If any epithelial cell abnormalities are noted, then specimen is considered adequate and reported accordingly
Presence of organisms or endometrial cells can be reported in an unsatisfactory specimen
SQUAMOUS CELLULARITY CRITERIA
Conventional Pap Smear
8,000-12,000 well-visualized, well-preserved squamous epithelial cells are required
This range is an estimate and not a cell count
Endocervical cells and obscured squamous cells should be excluded from this estimate
Metaplastic and parabasal cells are considered
Squamous cellular threshold is lower for postmenopausal or hysterectomized women
Reference images can be used for comparison to estimate cellularity
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