Look for any obvious abnormality of the cervix. If there are
signs of infection, you may postpone the test until the infection
has been treated. Reassure the woman if her cervix looks normal.
Choose sampling device according to the appearance of the cervix.
A cervical ectropion (often wrongly called cervical erosion)
is a normal area of columnar cells on the ectocervix. Its appearance
is a well-demarcated, red velvety area on the ectocervix. It is
more common in premenopausal women. No treatment is needed. If
it is present, a smear including its border should be obtained
as this represents the upper margin of the transformation zone.
Acceptable smear collection instruments include wooden/plastic
Ayre's spatula, plastic cervical broom (Cervex brush) and endocervical
brush (Cytobrush). Both the conventional and the liquid-based
cytology methods for smear examination are acceptable.
The sampling technique for conventional smears and liquid based
cytology is the same.
Any large mucus plug obscuring the external os should be removed
with dry cotton ball or swab before taking smear.
The transformation zone must be selectively sampled as most
cancers and precancers arise from it.
In postmenopausal women or those with retracted transformation
zone up into the endocervical canal, endocervical brush should
also be used in addition to spatula/Cervex brush. It should not
be used in pregnant women because of the risk of rupturing the
fetal membranes and introducing infection.
Insert the spatula into the cervix through the speculum.
Press the tip onto the ectocervix and rotate 360 degree
in one direction.
If an ectropion is present, sampling of its margin using
the flat end of a spatula is needed.
Insert the Cervex brush into the cervix through the speculum.
Insert the central bristles of the broom into the endocervical
canal deep enough to allow the shorter bristles to fully
contact the ectocervix. Push gently and rotate 360 degree
in one direction for 5 times.
Use the spatula first to avoid the bleeding result from
cytobrush sampling. Use the cytobrush second, as endocervical
cells deteriorate more rapidly than ectocervical cells.
Insert the cytobrush into the cervix until only the bottommost
fibers are exposed outside the os.
Slowly rotate 1/4 to 1/2 turn in one direction, Do NOT
over-rotate as this may lead to trapping of cells in the
bristles, which may not be transferred to the slide.