The significance of documenting clinical appearance of the uterine cervix in the cervical cytology form

OBJECTIVE: To determine whether or not the Pap smear taker is reporting the clinical appearance of the cervix on the cytology request form, and if cytologist / smear taker are giving any importance to this information prior to issuing advice on subsequent follow-up. Finally, to evaluate the clinicians' response to normal Pap smear report in the absence of the clinical comment on the cervix.

METHODS: A retrospective study, for a total of 1196 random smear results performed between 1999 and 2000 at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia with its relevant charts were evaluated. The samples were divided into 2 main groups. Group I, the Pap smears sent with the absence of clinical description of the cervix, and group II, was sent with the clinical description of the cervix. Cytologist follow up recommendations and the clinicians' response were evaluated.

RESULTS: A total of 1196 Pap smears were reviewed. Of the total 510 (42.6%) smears represented group I. Vast majority 506/510 (99.2%) were reported to be normal. A 12 months follow up was given for 505/506 (99.8%) smears. Only 4/510 (0.8%) Pap smears were abnormal and relevant cytologist's recommendations were given. Clinicians reassessed the uterine cervix for only 7.7% of the patients in the group. A total of 686/1196 (57.4%) smears represented group II. The vast majority 630 (91.8%) were with normal cervical appearance, 627/630 (99.5%) had normal cytology and only 3/630 (0.5%) had significant intraepithelial lesion. Relevant recommendations were given by the cytologist and were accepted by clinicians. A total of 56/686 (8.2%) had abnormal cervical appearance and 45/56 (80.4%) had normal cytology. A 12 months follow up was recommended for all except 7/45 (15.6%). Clinicians have followed these recommendations for all except 5/45 (11.1%). Eleven out of 56 (19.6%) smears were abnormal, relevant recommendations were given by the cytologist and all were followed by the clinicians.

CONCLUSION: High proportion of cervical smears request did not report clinical appearance of uterine cervix (42.6%). In patients whose cervical smear was reported abnormal (8.2%), 19.6% of them were found with significant intra-epithelial lesion. The clinical appearance of the cervix should be documented on the Pap smear request. Follow up recommendation for Pap smears carried out without clinical appearance description should be left to the clinician.