We are not able to provide tangible explanation for this difference, although, it was not statistically significant. The picking of a higher proportion of abnormal smears at the repeat screen at cross-over did attract the attention. The intention to have the same woman as case and control apparently failed since the loss of sample size was significantly high for the return visit for cross-over component of the study. Population based study would have been better, but the constraints of manpower and other logistics limited the study to hospital visiting women. The present study by virtue of single gynecologist taking all the smears and a single cytopathologist screening the reports removes the bias due to technique and observer variations from the interpretation. The report that atypia was more likely to be present in limited smears than satisfactory smears should not be the argument used to defend inadequacy of smears. The present study showed that the incidence of contact bleeding due to the procedure was significantly less ( P = 0.001) when a smooth surfaced plastic Szalay spatula was used. Use of wooden spatula for collection of smear may abrade the surface because of inherent roughness when compared to plastic spatula.
However, there is very limited data on this aspect. It has been demonstrated that coexisting red blood cells compete with squamous cells to be retrieved on the filter that transfer the cells to the slides. The presence of red blood cells may obscure study of squamous cells in the smear rendering it unsatisfactory. The present cross-over study to evaluate the efficacy of long tipped plastic spatula in comparison with traditional wooden Ayre spatula for collection of cervical smear found that the former yielded significantly higher adequate smears for evaluation.
There have been concerns expressed about the inclusion of endocervical component to define adequacy of the smear. Meta-analyses have shown that compared with other collection devices, the Ayre spatula is an ineffective device for collecting endocervical cells. Hence, their presence or absence was given weightage in reporting smear in Bethesda system. The presence of cells from endocervix and TZ, the site where premalignant change arises in the uterine cervix can be logically considered to be reflective of adequacy of the smear. The Pap test picked up all these 4 cases. In addition, micro-invasive carcinoma of the cervix in 3 and endocervical adenocarcinoma in 1 case was detected.
Histopathological examination reported cervical intraepithelial neoplasia in 10, squamous metaplasia in 3, and chronic cervicitis in 6 cases. None of these VIA positive cases showed any cytological abnormality. There were 22 cases (2.2%) with dense aceto-white areas, which were graded as VIA positive.Ĭervical biopsies were taken from 32 cases that included 15 cervices, which were VIA positive. Visual inspection of the cervix after 1 min of application of 4% acetic acid for visual inspection with acetic acid (VIA) was carried out in all the 1000 cases while obtaining initial smear. The repeat smears with the same collective device had apparently higher abnormality detection rate for Ayre (3.7 and 1.8% χ 2 = 2.26, P = 0.13) as well as when Szalay was used (3.7 and 1.6% χ 2 = 2.57, P = 0.10) although the difference was not significant. There were a total of 17 abnormal Pap tests (1.7%) and the detection rates were similar depending on the type of collecting device (1.8 and 1.6% for Ayre and Szalay devices, respectively χ 2 = 0.06, P = 0.80). Plastic made Szalay spatula with its smooth surfaces resulted in significantly less contact bleeding (99 of 500 with Szalay vs.
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