Ch. Sailaja1, B. Rajani Kumari2, Prasad Usha3
Squamous intraepithelial lesions and carcinoma cervix is more commonly seen in the transformation zone (squamocolumnar junction). This zone has to be adequately sampled. Ayre’s spatula has been widely used but is not very effective. Other sampling devices have been developed to improve efficiency, including the Cytobrush. The purpose of this study was to compare the adequacy of cervical smears taken with the Ayre’s spatula as opposed to Cytobrush.
METHODS
A total of 200 cases were studied. The samples were taken first using the Ayre’s spatula and then the Cytobrush, fixed in 90% Isopropyl alcohol and stained with PAP stain. The spatula slides were first interpreted followed by Cytobrush in combination with spatula. Both the methods were compared in terms of adequacy and accuracy of interpretation of various lesions of the cervix.
RESULTS
There was a significant difference in Pap smear quality between the two collection devices. 182 i.e. (91%) of 200 patients had a satisfactory smear when Cytobrush was used as compared to 106 (53%) patients, when spatula was used which was found to be statistically significant (P<0.005). Cytobrush has a better pickup rate of endocervical cells; it can miss ectocervical cells, which can lead to false negative reports. The Cytobrush also has an increased chance of haemorrhage as compared to the Ayre’s spatula. Positive pathology was seen in 9.18% patients in the Cytobrush smears as compared to 3.64% patients in the spatula smears. The difference was found to be statistically significant (P<0.005).
CONCLUSION
The Cytobrush is significantly more efficacious than the Ayre’s spatula in obtaining adequate cervical smears. Current best practice is that the Cytobrush be used together with an Ayre’s spatula to ensure adequate sampling of both the endocervical and ectocervical components of the transformation zone.
