Indicators of effective cytological sampling of the uterine cervix.

A case-control comparison of adequate and inadequate cervical smears (adequacy being defined as the successful detection of cervical intraepithelial neoplasia and inadequacy as the failure to do so when disease was almost certainly present) was undertaken to determine whether indicators of effective cytological sampling could be identified. The association between inadequate smears and the absence of two types of normal epithelial cells (columnar cells of endocervical origin and immature metaplastic cells) was measured. A significant and substantial association was found between inadequate cervical smears and immature metaplastic cells and between inadequate smears and both types of cell. Endocervical cells alone were less likely to be found in inadequate than in adequate smears, but this association was not statistically significant.