Use of a modified ayre spatula in cervical cytology - Revista Brasileira de Ginecologia e Obstetrícia

Purpose: the authors modified the original Ayre spatula aiming at optimizing endocervical collection. The study verified if the capacity of the modified spatula in collecting endocervical cells is similar to that obtained by the combination brush-Ayre spatula and better than the Ayre spatula alone. Methods: a diagnostic and single-blind simple study was performed. The patients were randomly assigned to one of three collection groups (Ayre spatula, combination of brush-Ayre spatula and modified spatula). After excluding data of 25 patients, 276 smears were evaluated with attention to the presence of squamous, metaplastic, and columnar endocervical cells and their combination. In order to compare methods, the chi² test with corrected Yates values and the exact Fisher test were used. Results: the combination brush-Ayre spatula presented the best performance in the production of columnar endocervical cells. When compared to the combination of brush-Ayre spatula, the modified spatula produced less bleeding in the smears (chi² = 7.98; p = 0.004) and it was not statistically inferior in obtaining metaplastic cells (chi² = 2.97; p = 0.08). When compared to the Ayre spatula, it was statistically superior in obtaining columnar endocervical cells (chi² = 21.37; p = 0.000004) and presented a greater percentage of smears presenting squamous cells accompanied by metaplastic and/or columnar endocervical cells (chi² = 10.97; p = 0.0009). Conclusions: it was concluded that the modified spatula improved the quality of the sample obtained with the Ayre spatula alone, being able to be used in populations where the use of the brush was impossible.