Assessment of Pap smear specimens’ adequacy based on Bethesda System-2001 and its association with clinical factors

Document Type : Original Article


1 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University, Karaj Branch, Alborz, Iran.

2 M.Sc. of midwifery, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.

3 Instructor, Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University, Karaj Branch, Alborz, Iran.


Introduction: The efficacy of screening programs in cytology of cervical cancer is dependent on the smear quality. The unsatisfactory smears are confusing to many physicians for deciding and lead to repeat the test. Assessment of the factors which may cause unsatisfactory smears would be useful in identifying the women who are at risk. Therefore, this study was performed with aim to assess the smear’s adequacy and its association with these factors and clinical symptoms.
Methods: This prospective descriptive and analytical study was performed on 1557 women who had referred to gynecology clinic of Alborz Hospital of Karaj to do Pap smear tests from Aug 2011 to Jun 2013. The Pap smear samples were taken with conventional technique and their adequacy was determined based on Bethesda system 2001. The relationship between unsatisfactory smears with age, menopausal status, vaginal infection, cervicitis, and contact bleeding was assessed. Data was analyzed SPSS software (version 13) and Chi-square test and T-test. P < 0.05 was considered significant.
Results: The frequency of unsatisfactory smears was 7.2%. Old age (P= 0.001) and menopause state (P= 0.001) were related to the results of unsatisfactory outcomes. But, there were no significant difference between vaginal infection, cervicitis, and contact bleeding with unsatisfactory Pap smears (P=0.750, P=0.640, and P=0.848, respectively).
Conclusions: Age and menopausal status increase the possibility of unsatisfactory cervical smears. For these cases, the optimal sampling techniques are suggested.  


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