Specimen adequacy and the ThinPrep® Pap Test™: The endocervical component

The ThinPrep® Pap Test™ (Cytyc Corp., Boxborough, MA) has proven to be effective in decreasing the number of cervical specimens limited for interpretation by blood/inflammatory exudate as compared to conventional smears. However, its effectiveness in decreasing the number of preparations which lack an endocervical component is less well‐established. The purpose of this 1‐yr study (January 1998–December 1998) was to determine if the collecting instruments used by physicians played a role in the lack of an endocervical component on ThinPrep slides. On implementation of the ThinPrep® Pap Test™ for cervical cytology, the broom‐type sampling device (Papette, Wallach Surgical Devices, Inc., Millford, CT) was the FDA‐approved collecting instrument. Subsequently the combined plastic spatula/Zelsmyr Cytobrush (Medscand, Inc., Hollywood, FL) were approved. A survey was sent to 102 physicians in seven primary care sites and two private obstetrics‐gynecology practices affiliated with the Loyola University Health Care System. One site used the broom only, one site used the spatula/cytobrush, five sites used the broom/cytobrush, and in two sites, two different sets of collecting instruments were utilized. Of the 10,241 ThinPrep samples, 620 (6%) were obtained with the broom only, 432 (4.3%) with the spatula/cytobrush, and 9,189 (89.7%) with the broom/cytobrush. An endocervical component was absent in 24% (range, 13.7–25%) of the cervical samples collected with the broom only, 10% (range, 8.4–12.5%) with the spatula/cytobrush, and 13% (range, 6.2–18.8%) with the broom/cytobrush. The spatula/cytobrush and the broom/cytobrush showed statistical significance (P < 0.001) over the broom alone in the collection of an endocervical component. The results of this study indicate that the collecting instruments used by the physician(s) played a role in the adequacy (endocervical component) of the specimen processed by the ThinPrep method. Diagn. Cytopathol. 23:23–26, 2000. © 2000 Wiley‐Liss, Inc.