Clinical follow-up of cervical sampling with the Ayre spatula and Zelsmyr cytobrush
B. J. Crouse, B. A. Elliott and N. Nesin
Duluth Family Practice Residency Program, Duluth Family Practice Center, MN 55805.
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.
