Cervical Screening Programme
Department of Health
The Government of the Hong Kong Special Administrative Region

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iii.

Equipment for Smear Taking

i. Light source should be adequate and adjustable.
   
ii.

Speculum:

  • Bivalve Cusco's speculum (equal length blades) is commonly used. Other types include single-blade Sims' speculum (for use in clients with posterior prolapse), Graves and Pederson speculum (the latter two have lower blade 1 cm longer than the upper blade for placement in the more distal fornix).
  • Metal speculum should be sterilized properly before re-use. Beware of hot speculum taken out from autoclave. Disposable speculum should be used only once.
  • Choose a speculum of appropriate size according to history such as parity, age, menopausal stage and experience from previous smear taking.
iii. Cervical cell samplers:
  •   [Cervical cell samplers ]
       
    Ayre's spatula: wooden spatula is cheaper but is too porous leading to trapping of cells in the sampler. Both the wooden and plastic samplers can be used in conventional smear but liquid-based cytology requires plastic sampler.
  • Cervex brush: it provides more efficient sampling and reliable cell transfer, hence improving quality and accuracy of the test and reducing unsatisfactory smear but more expensive
  • Cytobrush: obtain good endocervical sample but not ectocervical sample. In pre-menopausal women with an adequate external os, only the spatula or cervical broom is needed. In postmenopausal women and in pre-menopausal women who have previous cervical surgery, endocervical brush should also be used to ensure adequate sampling from the retracted squamo-columnar junction.
iv. Fixative: alcohol aerosol spray or vial containing 95% alcohol.
   
v. Glass slide or vial for liquid based cytology labelled with client's full name and ID number should be ready before sampling. Label the frosted end of glass slide with pencil as ink and paper labels would be washed off during processing in the laboratory.
   
vi. Cytology request form: apart from personal details, clinical information should be included, as it would assist the cytologist in slide interpretation. Details should include client's age, last menstrual period, whether the client is pregnant, postnatal, postmenopausal, using hormone or Intrauterine Contraceptive Device (IUCD). Any risk factors such as prior CIN or treatment, abnormal cervical appearance, or presence of contact or postcoital bleeding should also be written down on the request form.
   
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