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Objective: To compare specimen adequacy and detection of disease in conventional cytologic smears and CytoRich monolayer preparations., Study Design: Five hundred sixty pairs of conventional smears and monolayer preparations were compared. The conventional smear was made first, and the remaining cells were rinsed off into a vial containing transport medium. Monolayer slides were then prepared using the CytoRich system., Results: Evaluation of cases for specimen adequacy based on the Bethesda System demonstrated that the CytoRich method eliminated preparations of poor quality, reducing significantly the number of suboptimal specimens (28.3% for conventional vs. 8.4% for CytoRich). The final diagnosis concurred in 82.8% of cases. In 8 cases the CytoRich slide showed a low grade or more severe lesion, while the conventional smear was "atypical" (ASCUS) in 7 cases of squamous intraepithelial lesion and unsatisfactory in 1 case of invasive carcinoma. In three cases the conventional smear showed a low or high grade lesion, while the CytoRich slide was atypical., Conclusion: The CytoRich method significantly reduces suboptimal preparations and the associated ambiguous or inconsistent diagnoses. It detects cervical abnormalities better than does the conventional smear. It may result in cost savings for the community and benefit patients since unnecessary recalls are avoided.