Clinical follow-up of cervical sampling with the Ayre spatula and Zelsmyr cytobrush.

OBJECTIVE

To determine if cervical smears obtained with an Ayre spatula and a cytobrush are better detectors of atypia and dysplasia than the modified Ayre spatula alone, as determined by a 2-year clinical follow-up study.

METHOD

Paired cervical samples were obtained, one using a modified Ayre spatula and the other a cytobrush. In those smears with any abnormality, follow-up after 2 years documented subsequent cytologic and/or histologic diagnosis. The statistical relationship between the screening tests and follow-up cytologic diagnosis was investigated.

SETTING

Seven hundred ninety-two women, aged 18 years and older, who presented to a family practice residency clinic for Papanicolaou tests.

RESULTS

The correlation coefficient for the diagnoses obtained using the modified Ayre spatula and the clinical follow-up was .40 (P = .0008), while the correlation coefficient between the cytobrush samples and the clinical follow-up diagnoses was .25 (P = .04). The kappa statistics indicate statistically significant concordance only between the spatula and the follow-up diagnoses.

CONCLUSIONS

Cervical smears obtained with a modified Ayre spatula correlated significantly with the follow-up diagnoses. As cervical sampling tools emerge, they need to be evaluated on the basis of accurate identification of significant clinical disease, not only on the basis of obtaining endocervical cells to avoid unnecessary repetition of screening tests and diagnostic workups.