Problem: Air-drying
If a cell dries out before it is spray fixed, it enlarges and nuclear detail is lost. This creates problems for interpretation.
Solution: Spray-fix the smear immediately
When a two-step technique (spatula and brush) is used, spray fix the area of the smear prepared first before collecting and smearing the second sample. Spray fix the second sample, using a card to mask the slide area already fixed. It is not necessary to send a separate slide for each specimen.
Problem: Blood and mucus
This obscures and distorts the epithelial cells, making it difficult to determine if they are atypical.
Solution: Remove excess mucus
Before collecting the specimen, gently remove excess mucus. Do not rinse the cervix with saline or a hypocellular smear may result. To reduce the amount of blood on the smear, use the spatula first, then the brush. Finally, routine Pap smears should not be taken while the patient is menstruating.
Problem: Traumatised cells
This may result from excessive manipulation of epithelial cells either during collection or preparation of the smear. Traumatised normal cells may impersonate atypical cells.
Solution:
When using the spatula, scrape in one continuous motion for a rotation of no more than 360 degrees. Spread the material collected on the spatula in a single, smooth, continuous stroke. Use moderate pressure against the slide to avoid producing thick clumps of material.
When using the brush, insert it into the os with gentle pressure and rotate it only 90 to 180 degrees. Roll (do not smear) the brush across the glass slide by twirling the handle. Do not use a brush if the patient is pregnant.
Problem: The smear lacks an endocervical or squamous component
Solution:
Ensure that a representative sample is obtained from both the endocervical and ectocervical areas. Use the combined spatula and cytobrush technique or CERVEX brush to facilitate this. Always ensure you sample the squamo-columnar junction. If there is a large erosion, please take care to sample the periphery of the erosion with the spatula.
Problem: Atrophic patients
Solution:
If possible, postmenopausal women with clinical evidence of cervical or vaginal atrophic changes should have a short course of oestrogen first, usually in the form of vaginal pessaries. This corrects atrophic cellular changes, which may make interpretation difficult.
Problem: Incomplete clinical information
To gain the greatest amount of useful information from a Pap smear, we need clinical information about the patient.
Solution: Fill out the requisitions completely including that on the reverse side of the request form
Age, date of last menstrual period, pregnancy status and the history of previous abnormal Pap smears are essential. Any other pertinent information including, clinical findings are welcome. Please include the patients address on the front of the request form to facilitate the issuing of recall/reminder letters by the laboratory and the SA Back Up Record System.