VAGINAL SMEARS—A Plea for More Critical Evaluation

To determine whether a conscious effort to reduce the incidence of equivocal (Class III) vaginal cytologic smear readings might have demonstrable clinical value, we have compared a previous study of our predictive efforts with a recent experience in screening a similar number of patients. It was possible to achieve an appreciable reduction in the incidence of Class III smears—from 2.4 per cent to 0.6 per cent. There was a modest increase in the reliability of the Class III smear as an indicator of cancer and a very notable increase in the reliability of the Class IV and V interpretations. While only 66 per cent of the earlier group with Class IV and V smears were shown to have cancer, 86 per cent of the present series with IV and V readings had malignant disease (97 per cent of the Class V group). The ultimate yield of malignancies was similar in the two series, but theoretically the overloading of Classes III, IV and V with women who do not actually have cancer necessarily leads to large numbers of diagnostic surgical procedures that might be avoided. Class III should be used to denote merely a temporary state of inconclusiveness rather than a real suspicion of cancer. With proper collaboration between physician and cytologist, most of the initially confusing situations can be either upgraded or downgraded to the proper rating, and eventually the bulk of patients standing to profit from conization will fall into Classes IV or V.