Presence of endocervical cells and number of slides in cervicovaginal smears: differences in performance between gynecologists.

摘要

OBJECTIVE: To study the association of precancerous cervical lesions with the presence of endocervical cells on Pap smears; and to evaluate gynecologists' approaches to the information on smear reports regarding endocervical cell status. STUDY DESIGN: Pap smear reports on 1,637 samples sent by 12 gynecologists were analyzed. The presence of endocervical cells, number of glass slides used per patient, and frequency and distribution of "atypia" and of pathogenetic microorganisms were recorded. Gynecologists' performances were compared, and their reactions to the reported lack of endocervical cells in their smears were evaluated. RESULTS: Atypia was detected significantly more frequently in samples with endocervical cells (1 in 664 versus 31 in 973, P < .01). Likelihood of detecting a pathogenetic microorganism, however, was not affected by the presence or absence of endocervical cells. In samples from certain gynecologists, endocervical cells were present most of the time, and in others they were generally lacking. This pattern did not change over time; specifically, the performance of the latter group of gynecologists did not improve in spite of their receiving information on the absence of endocervical cells in their samples. CONCLUSION: The performance of the "smear taker" is an important component of Pap smear screening practice. Efforts to increase the quality of service should cover not only laboratories but also gynecologists and others who take smears. Screening can only be successful as a system in the presence of good samples.