Comparison of quality parameters in conventional Pap smears made by endocervical brush smear and Ayre spatula

Abstract

Background: Cervical Pap smear is a form of exfoliative cytology and has been widely accepted as a screening tool for cervical cancers. Among the various devices for collecting samples from cervix, wooden Ayre spatula and cytobrush are used commonly. Ayre spatula collects cells from the ectocervix whereas cytobrush from the transformation zone (TZ) and this study compares both techniques.Methods: A retrospective study was done by comparing two conventional Pap smears from all consecutive samples received in the cytopathology section of department of pathology (n=388); one with Ayre spatula and one with endocervical brush.  They were compared for quality parameters like spreading and staining of cells, morphologic preservation, presence of TZ component, degree of inflammation, presence of infection and predominant cell population. Appropriate statistical analysis was performed.Results: The smears made out of Ayre spatula showed better spreading (p≤0.00001) and staining (p=0.00022) as compared with those made using endocervical brush. However, the morphological preservation was equally comparable in both. The TZ component was significantly higher in the endocervical brush smear (p=0.00001). Inflammation was comparable in both (p=0.1916). Infection was detected more in ectocervical smears (p=0.00001). The cytobrush smears showed a significantly higher detection rate of endocervical cells (p≤0.00001).Conclusions: Based on our study, we conclude that the use of both Ayre spatula and endocervical brush together ensures higher efficiency than using a single method.