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Normal cells / non-neoplastic findings

Unsatisfactory specimen

Reviewer: Farnaz Hasteh, M.D., UCSD Medical Center (see Reviewers page)
Revised: 6 May 2014, last major update March 2011
Copyright: (c) 2006-2011, PathologyOutlines.com, Inc.


● Unsatisfactory if more than 75% of specimen is obscured by blood or inflammation
● Also due to scant cellularity, or if specimen is rejected, not processed, or unsatisfactory for evaluation due to another reason
● An adequate conventional Pap test should have 8,000 to 12,000 squamous cells
● An adequate liquid-based Preparation (LBP) should have at least 5,000 squamous cells (review at least 10 microscopic fields at 40x)


Examples of sample reports for unsatisfactory cases:
● Unsatisfactory because of obscuring inflammation
● Unsatisfactory because of insufficient squamous cellularity
● Unsatisfactory because of obscuring blood

Clinical features

● May be due to atrophy
● For Thin Prep, reprocessing of unsatisfactory slides is useful (Am J Clin Path 2002; 117:457)
● May be fewer unsatisfactory specimens with liquid based cytology (Eur J Gynecol Oncol 2005;26:646, Expert Rev Mol Diagn 2005;5:857, Gynecol Oncol 2005;99:597)
● A lower number of cells may be acceptable in vaginal smears (post hysterectomy) or with severe atrophy (The Bethesda System for Reporting Cervical Cytology:2004
● Presence of endometrial cells does not convert a specimen from unsatisfactory to satisfactory
● Unsatisfactory cases are more often from high risk patients, which may exhibit SIL on follow-up (Cancer Cytopathology 1997; 81:139-143)

Cytology images

Various images

Contributed by Dr. Marilin Rosa, University of Florida (USA)

End of Cervix-cytology > Normal cells / non-neoplastic findings > Unsatisfactory specimen

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