title: How adequate is adequate for the collection of endocervical specimens for Chlamydia trachomatis testing?
abstract: BACKGROUND
  Endocervical specimen adequacy has been assessed by subjective criteria that are based on arbitrarily chosen thresholds for the presence of target cells observed on microscopic slide examinations.
  
  
  OBJECTIVE
  To assess the relationship of chlamydia test positivity to specimen adequacy with the use of a semi-quantitative cytologic staining method for assessing endocervical specimen collection cellularity.
  
  
  METHODS
  Endocervical specimens for chlamydia testing (PACE 2, GenProbe, San Diego, CA) and for a slide cytologic examination (n = 3,500) were collected in parallel. A semi-quantitative cytologic examination to determine a specimen adequacy (SA) score was performed for every chlamydia-positive result (n = 163) and approximately every fifth negative result (n = 626). The Chi-square test for linear trends was used to assess the relationship between SA scores and chlamydia positivity. The median SA scores for chlamydia-positive and negative slides were compared.
  
  
  RESULTS
  The median SA scores for chlamydia-positive and -negative slides were 27 and 20, respectively (P < 0.001). Chlamydia positivity rates increased with increasing specimen adequacy scores (0-9, 2.7%; 10-19, 15.1%; 20-29, 24.8%; and 30-45, 31.3%; Chi-square for linear trend: P < 0.001).
  
  
  CONCLUSIONS
  These results demonstrate a linear relationship between the numbers of cells observed on an endocervical smear and chlamydia positivity rather than the threshold concept in practice. The semiquantitative cytologic technique offers an objective method for further evaluating specimen adequacy for Chlamydia trachomatis testing.
authors.affiliation: Laboratory and Radiation Services Division, Colorado Department of Public Health and Environment, Denver 80217, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Beebe
authors.forename: K A
authors.initials: KA
authors.lastname: Gershman
authors.forename: J K
authors.initials: JK
authors.lastname: Kelley
authors.forename: D
authors.initials: D
authors.lastname: Hagner
authors.forename: P
authors.initials: P
authors.lastname: Creede
mesh_terms: D002584:Cervix Uteri / Q000382:microbiology*; D002690:Chlamydia Infections / Q000175:diagnosis*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D013048:Specimen Handling / Q000592:standards*; D014626:Vaginal Smears