What is the management approach for a patient with numerous epithelial cells on a wet prep?

Management of Numerous Epithelial Cells on Wet Prep

When numerous epithelial cells are found on a vaginal wet preparation, this typically indicates specimen contamination with upper airway or vaginal secretions and requires repeat sampling to obtain an adequate specimen for accurate diagnosis.

Understanding the Significance of Epithelial Cells on Wet Prep

• The presence of squamous epithelial cells on wet preparation suggests that the specimen is contaminated with upper airway secretions, which compromises the diagnostic accuracy of the sample 1
• Large numbers of bronchial epithelial cells indicate that the sample may not have adequately collected material from the distal airspaces, which is critical for accurate diagnosis 1
• An adequate specimen should contain minimal epithelial cells to ensure proper evaluation of other cellular components 1

Criteria for Specimen Adequacy

• A specimen is considered inadequate or unsatisfactory when it contains more than 1% epithelial cells or more than 10 epithelial cells per low-power field (100x magnification) 1
• Specimens reported as unsatisfactory for evaluation should be obtained again to ensure accurate diagnosis 1
• The presence of large numbers of epithelial cells interferes with the interpretation of other cellular components such as white blood cells, bacteria, and other microorganisms 1

Management Approach

1. Repeat Sample Collection

• When numerous epithelial cells are identified, the specimen should be recollected to obtain an adequate sample 1
• Ensure proper sampling technique to minimize contamination with epithelial cells 1
• For vaginal specimens, proper collection technique involves avoiding contact with the vaginal walls when targeting cervical sampling 1

2. Proper Processing of New Specimen

• Process the specimen within 1 hour if in nutrient-poor media (e.g., saline) or within 2-3 hours if in nutrient-supplemented media 1
• For vaginal specimens, mix natural vaginal fluids with a standardized amount (e.g., 3 mL) of sterile normal saline to enable proper quantification 2
• Use appropriate staining techniques (Wright-Giemsa, May-Grunwald-Giemsa, or Papanicolaou) to enhance visualization of cellular components 1

3. Evaluation of Repeat Specimen

• Assess the new specimen for adequacy before proceeding with diagnostic interpretation 1
• Perform differential cell counts on adequate specimens, noting the presence and relative numbers of white blood cells, bacteria, and other microorganisms 1
• For vaginal specimens, evaluate the concentration of leukocytes, lactobacilli, and the degree of maturation of squamous cells 2

Clinical Implications and Interpretation

• Normal vaginal wet prep typically shows one of three patterns:

  • Abundant lactobacilli, no leukocytes, >50% fully matured squamous cells (51% of normal specimens) 2
  • Low lactobacilli counts, no leukocytes, >50% undermaturated squamous cells (22% of normal specimens) 2
  • Abundant lactobacilli, presence of leukocytes, >50% fully matured squamous cells (12% of normal specimens) 2

• The presence of moderate or many white blood cells (not epithelial cells) may correlate with infections such as Neisseria gonorrhoeae or Chlamydia trachomatis 3

• Clue cells (epithelial cells covered with bacteria) on wet prep are not reliable markers for urinary tract infections 4

Common Pitfalls to Avoid

• Do not interpret results from specimens with excessive epithelial cells, as this leads to inaccurate diagnosis 1
• Avoid confusing normal cyclical variations in vaginal cell populations with pathological findings 5
• Remember that normal vaginal leucocytosis can occur once during each menstrual cycle, which must be considered when evaluating for genital tract infections 5
• Do not rely solely on the presence of clue cells to diagnose concurrent infections like gonorrhea or chlamydia, as this correlation is unreliable 3, 4