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Cervical Cytology Specimen Adequacy: Patient Management Guidelines and Optimizing Specimen Collection

Davey, Diane Davis MD1; Cox, J. Thomas MD2; Austin, R. Marshall MD, PhD3; Birdsong, George MD4; Colgan, Terence J. MD5; Howell, Lydia P. MD6; Husain, Mujtaba MD7; Darragh, Teresa M. MD8

Journal of Lower Genital Tract Disease: April 2008 - Volume 12 - Issue 2 - p 71-81
doi: 10.1097/LGT.0b013e3181585b9b

Objective. To provide updated management guidelines according to cervical cytology specimen adequacy and techniques to optimize adequacy based on literature review and expert opinion.

Materials and Methods. Selected members of the American Society for Colposcopy and Cervical Pathology committee and invited experts conducted a literature review and discussed appropriate management and areas for future research emphasis.

Results. The guidelines recommend a repeat Pap test in a short interval of 2 to 4 months for most women when the cytology result is unsatisfactory. The preferred follow-up for women with a negative cytology result lacking an endocervical/transformation zone component or showing other quality indicators is a repeat Pap test in 12 months. Indications for an early repeat Pap test in 6 months are provided, and the influence of human papillomavirus testing results on management is discussed. Techniques for optimizing specimen adequacy are provided in detail.

Conclusion. The specimen adequacy management guidelines will help promote uniform and optimal follow-up of patients receiving cervical cytology screening. The topics for future research emphasis will be helpful in promoting studies in needed areas.

Updated guidelines for managing patients according to cervical cytology specimen adequacy are provided, including techniques for optimizing cytology specimens, and discussion of future research needs.

1Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, 2Student Health Service, University of California, Santa Barbara, CA, 3Department of Pathology, Magee-Womens Hospital of University of Pittsburgh, Pittsburgh, PA, 4Department of Pathology, Grady Health System and Emory University, Atlanta, GA, 5Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada, 6Department of Pathology, University of California-Davis Medical Center, Sacramento, CA, 7Department of Pathology, Detroit Medical Center and Wayne State University, Detroit, MI, and 8Departments of Pathology and Obstetrics/Gynecology, University of California-San Francisco, San Francisco, CA

Correspondence to: Diane Davis Davey, MD, University of Central Florida, College of Medicine, 12201 Research Parkway, Room 307, Orlando, FL 32816-0116. E-mail:

©2008The American Society for Colposcopy and Cervical Pathology