Tips For Making Good Pap Smears

Ed Uthman, MD

Diplomate, American Board of Pathology

Last updated 13 Jan 2001

The challenge we face in interpreting Pap smears is to facilitate the assignment of smears into either a low-risk category (including "within normal limits" and "benign cellular changes") or a high-risk category (including "squamous intraepithelial lesion" and higher-grade categories). We pathologists, with our partners the cytotechnologists, strive to minimize the number of cases classified as "atypical squamous (or glandular) cells of undetermined significance," as these "ASCUS" or "AGCUS" reports place the patient, clinician, and pathologist into a limbo of uncertainty regarding what should be done for the patient.

It has been my experience that the most frequent preventable cause of "the unnecessary ASCUS" is the suboptimal smear. Accordingly, I have put together a few problems with suggestions for solving them.

In summary...

I can't overemphasize how important it is to develop a close working relationship with your pathologists. Otherwise, we all function like the proverbial blind men examining the elephant. The gynecologist has all the clinical information, the pathologist has all the microscopic morphologic information, and without continuously maintained lines of communication between the two, neither may ever appreciate the complete picture.

HMS Beagle

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