The technique for obtaining smears is described in an earlier section of this chapter as part of the physical examination (pp. 62 to 64).

Handling Of Specimens

1. Smears should be kept in the fixative (equal parts of ether and 95% ethyl alcohol) for a minimum of one hour to ensure adequate fixation. They may safely remain in the solution for as long as a week to ten days.

2. If the specimens are to be submitted to a local laboratory, they can be hand-delivered in the original fixative bottle.

3. If the specimens are to be mailed, modification of the procedure is necessary since alcohol and ether cannot be legally sent through the United States mail.

Fig. 33. Preparation of vaginal and cervical smears for mailing. After proper fixation in ether alcohol solution, remove the slide, place 1 to 2 drops of glycerin on each smear, and cover with a clean glass slide.

(a) After proper fixation in ether alcohol solution, remove the slides, place 1 to 2 drops of glycerin on each smear, and cover with a clean glass slide (Fig. 33). (The slides can be wet or dry at the time the glycerin is added.)

(b) Clearly label and identify each slide and place in a slide mailing container. If this is not available, wrap slides in wax paper and mail in any suitable crush-proof container.

Common Reasons For Unsatisfactory Specimens

1. Too scanty. The smear may be too scanty as a result of improper collection or smearing on the slide. Occasionally, exfoliated cells may be scanty because the patient has failed to follow instructions and has taken a douche or a tub bath in the twenty-four hours prior to examination.

2. Too thick. The smear may be too thick as a result of overgenerous and improper smearing of the specimen on the slide.

3. Too dry. Failure to deposit the prepared slide immediately in the fixative may allow the exposed smear to dry. Cellular features may be greatly distorted by this flaw in technique.

4. Contamination. This is usually due to the presence of lubricating jelly used to facilitate the insertion of the speculum. If such a lubricant is required, its use should be deferred until after the vaginal and cervical smears have been taken. Occasionally, contamination may result from the recent use of vaginal suppositories or medications by the patient. 5. Distortion. Hormone therapy, radiation therapy, or cauterization can cause cellular abnormalities. Cytologic atypias may also be seen in association with infection, especially that due to Trichomonas.

Information For The Cytologist

It is essential that the cytologist be provided with complete and accurate information regarding certain factors influencing the appearance and hence the interpretation of the smear. Many borderline or equivocal changes assume totally different significance to the cytologist if he has background information on the patient.

The information supplied to the cytologist should include the following:

1. Age of patient.

2. Date of last menstrual period.

3. Menstrual and obstetric history.

4. Any history of hormonal or radiation therapy or of cauterization, with dates.

5. Gynecologic findings, if any. Include statement in regard to Trichomonas infection if suspected.

6. If smears are routine, so state.

7. If previous smears have been taken, so indicate for purposes of comparison.

The Cytologist's Report

Many cytologists use the original Papanicolaou classification as follows:

Other cytologists prefer to describe what they see in a specimen and call it negative, suspicious, or positive for malignant cells.

The clinician would do well to consult in advance with the cytologist regarding his manner of reporting on slides. Thereafter, the physician will be in a better position to interpret and act on the reports provided him. In specific equivocal cases it is often desirable to discuss the individual case with the cytologist.