The influence of the cervix on smear quality. I: Atrophy. An audit of cervical smears taken post-colposcopic management of intraepithelial neoplasia.

Out of 951 smears taken from women attending a hospital cytology clinic, 122 were found to be of poor quality. Twenty-eight percent of these were associated with clinical and/or cytological atrophy, and in 91% of these the main adverse factor affecting smear quality was scantiness. The relative risk of obtaining a scanty smear was found to be 4.8 times greater in women in whom clinical atrophy was identified when compared with those with no atrophy. It is suggested that a reduction in the number of scanty, and hence potentially inadequate, smears in the screening programme may be achieved by the use of more appropriate sampling implements in all women in whom there is clinical evidence of atrophy. Further review of alternative sampling methods is indicated.