Volume: 7 Issue: 3
Year: 2019, Page: 103-110,
Background: Papanicolaou (Pap) smear is a very important screening tool for cervical cancer. The challenge for Pap smear is a high rate of false-negative results. Of the several factors compounding this problem the most important one is the incorrect sampling method and sampling tool limitations. We in the present study tried to evaluate the quality of Pap smear samples obtained by two methods Ayres Spatula and Ayres spatula plus cytobrush combination.
Methods: This cross-sectional study was conducted in the Department of Obstetrics and gynecology, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar. The patients were selected from those who were attending the OPD of the Department of gynecology. A total of n=155 women who were sexually active in reproductive age or menopausal were included in the study. Two samples were taken first using Ayres spatula and then the cytobrush.
Results: With cytobrush and Ayres spatula n=135(87.09%) of smear were satisfactory compared to the n=98(63.22%) with Ayres spatula alone the p values were found the <0.01 which is considered as significant. Inadequate smear quality due to absent endocervical cells was found in n=12 (7.74%) of the combination and n=80(51.61%) in Ayres spatula alone the p values were also found to be significant. Blood obscuring the slide was found in n=1(0.64%) of spatula and n=3(1.93%) of the combinationA comparison of cytological results by two methods showed n=1(0.6%) of spatula smear versus n=2(1.29%) of combined cytobrush-spatula smears showed atypical squamous cells of undetermined significance. Low-grade Squamous Intraepithelial Lesions were found in n=3(1.93%) of spatula versus n=10(6.45%) of combined smears. High - grade Squamous Intraepithelial Lesions were found in n=1(0.6%) of spatula smear versus n=3(1.93%) of the combined smear.
Conclusion: that the ability of Ayres spatula and cytobrush combination was more effective in obtaining adequate specimens and it has a better ability to obtain the endocervical cells. The added advantage of the cervical brush is it could be easily used in postmenopausal women who tend to have stenoticos. Therefore this method must be used for screening programs.
Keywords: Ayre's Spatula, cytobrush, Pap smears
1. Albert SO, Oguntayo OA, Samaila MA. Reducing deaths from cervical cancer, examining the prevention paradigms. ObstetGynecolClin North Am. 2012;54:599–11.
2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CACancer J Clin. 2015;65:87–08.
3. Parkin DM, Nguyen-Dinh X, Day NE. The impact of screening on the incidence of cervical cancer in England and Wales. British journal of obstetrics and gynecology. 1985; 92(2):150–57.
4. Duguid HL, Duncan ID, Currie J. Screening for cervical intraepithelial neoplasia in Dundee and Angus 1962–81 and its relation with invasive cervical cancer. Lancet. 1985; 2(8463):1053–56.
5. Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Annals of internal medicine. 2000; 132(10):810–19.
6. Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programs for cervical cancer in low- and middle-income developing countries. Bulletin of the World Health Organization. 2001; 79 (10):954–62.
7. Martin-Hirsch P, Jarvis G, Kitchener H, Lilford R. Collection devices for obtaining cervical cytology samples. The Cochrane database of systematic reviews 2000;(3): CD001036.
8. Allingham JD, King A. Patient characteristics and endocervical cell recovery on Papanicolaou smears.The Journal of family practice. 1985; 20(2):185, 8–90.
9. Buntinx F, Knottnerus JA, Crebolder HF, Seegers T, Essed GG, Schouten H. Does feedback improve the quality of cervical smears? A randomized controlled trial. The British journal of general practice: the journal of the Royal College of General Practitioners. 1993; 43(370):194–98.
10. Harrison DD, Hernandez E, Dunton CJ. Endocervical brush versus cotton swab for obtaining cervical smears at a clinic. A cost comparison. The Journal of reproductive medicine. 1993; 38(4):285–88.
11. Hoda RS, Loukeris K, Abdul-Karim FW. Gynecologic cytology on conventional and liquidbased preparations: a comprehensive review of similarities and differences. Diagnostic cytopathology. 2013; 41(3):257–78.
12. Lee KR, Ashfaq R, Birdsong GG, Corkill ME, McIntosh KM, Inhorn SL. Comparison of conventional Papanicolaou smears and a fluid-based, thin-layer system for cervical cancer screening. Obstetrics and gynecology. 1997; 90(2):278–84.
13. Germain M, Heaton R, Erickson D, Henry M, Nash J, O'Connor D. A comparison of the three mostcommon Papanicolaou smear collection techniques. Obstetrics and gynecology. 1994; 84(2):168–73.
14. Kothari A, Karim SZ, Gordon A, Raslan F, Abdalla M, George S. A comparative study of two devices used for cervical cell sampling raises some doubts about liquid-based cytology. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society. 2006; 16(4):1579–86.
15. Sundari N. Cervical Cancer Screening, Pap smear. In: Gunasheela S, ed – Practical Management of Gynecological Problems, 1stedn. New Delhi, India: Jaypee Publication; 2002:197-205.
16. Krishna Murthy. Cancer cervix (Forward). Journal of Indian Medical Association 2000;98(2):38.
17. Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002; 52:342-62.
18. D Solomon, D Davey, R Kurman, Dennis O'Connor, M Prey, S Raab, et al. The 2001 Bethesda System Terminology for Reporting Results of Cervical Cytology. JAMA 2002; 287(16):2114-19.
19. Van der Graff Y, Voojis PG. The false-negative rate in cervical cytology. J ClinPathol 1987; 40:438-42.
20. Buntinx F, Brouwers M. Relation between sampling device and detection of abnormality in cervical smears - a meta-analysis of randomized and quasi-randomized studies. BMJ 1996; 313:1285-90.
21. Tewari R and Satyanarayan S. Adequacy of Cervical Smears. Acomparative study using Ayre's spatula and endocervical brush. J Cyto 2005;22(3):114-17.
22. Rammou-Kinia R, Anagnostopoulou I, Gomousa M.Comparison of spatula and nonspatula methods for cervical sampling. Acta cytological 1989; 35:69-75.
23. Boon M, de Graff JC, Rietveld WJ. Analysis of five Sampling for the preparation of cervical smears. Acta cytological 1989;33:843-48.
24. Kuramoto H, Banno M, Hori M, Miyagawa J, Iida M, Kawaguchi M. Optimal sampling devices for liquid based procedure in screening for cervical cancer: comparison between cotton stick/Cytobrush and Cervex-Brush. Actacytologica. 2013; 57(2):153–58.
25. Kohlberger PD, Stani J, Gitsch G, Kieback DG, Breitenecker G. Comparative evaluation of seven cellcollection devices for cervical smears. Actacytologica. 1999; 43(6):1023–26.
R Meghana.Assessment of Pap Smear Quality by Ayre's Spatula Versus Ayre's spatula plus Cytobrush Combination - Analysis in a Tertiary Care Hospital. Perspectives in Medical Research 2019; 7(3): 103-110