Ayre Spatula Research Articles

Prevalence of abnormal pap smears among Iraqi women attending the Al Zahra'a cervical screening clinic in AL Najaf city

Introduction: The World Health Organization (WHO) reports that in Iraq, there were 2.1 cases of cervical cancer for every 100,000 females of all ages. Moreover, 10.21 million Iraqi women between the ages of 15 and 44 were at risk for developing cancer.Method: At Al Zahra Teaching Hospital in Al Najaf City, a cross-sectional study was carried out over the course of nine months, from January 1 to October 1 2022. Throughout the research period, all female patients who went to the alzahraa cervical screening unit were included (112). At the cytology lab, slides were evaluated using the Bethesda Scoring System, and smears were collected using the Ayre's spatula. Highlighting relationships between cytological results and socio-demographic details using the Chi-square test. Binary logistic regression was used for the significant variables. In our statistical analysis, a significance level of 0.05 was considered to be present.Results: The majority of the sample (91.1%) had normal pap smear results. 8.9% of the remaining women reported abnormal pap smear results. Vaginal discharge (42%), after-coital bleeding (1.8%), and irregular bleeding (25%) were the most frequently reported patient concerns. Cervical cancer in just one case was found. The link between abnormal pap smears and females under the age of 40 was statistically significant (p = 0.047 for both). Smoking increased the risks of having abnormal pap smears [p=0.000; OR=0.011; CI 95% (0,001-0.095)], whereas being 40 years old increased the odds [OR=6.559; CI 95% (.801-53.727)].Conclusions: Ten percent of the sample had abnormal pap smear results, and there was a very significant association between smoking and abnormal pap smear results in females under 40. A successful cervical cancer screening programme must be activated, promoted, and made aware of along with the risk factors that it entails.

Clinical Association and Detection of Cervical Cancer with Pap Smear Screening Test

Aim: To find the clinical association of the cervical cancer with pap smear test. Study Design: Prospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, AJK Medical College Muzaffarbad Azad Kashmir from 1st January 2021 to 30th June 2022. Methodology: Five hundred women were screened who were between 20-55 years of age. Sampling was performed by ecto-cervix through wooden Ayre spatula rotation at 360 degrees. The sample was preserved in a formalin jar and sent for glass slide formation. Cytopathological examination presented lesions as negative intraepithelial neoplasia as well as epithelial-cell abnormalities including squamous in addition to glandular cells. Results: The mean age was 41.5±5.6 years. The epithelial abnormalities were diagnosed in 6% of low grade squamous-intraepithelial lesion cases and 1% in high grade squamous intra-epithelial lesion through pap smear. No case of squamous cell carcinoma was identified while 40% showed inflammation presence Most of the females within 31-40 years were having normal cervical morphology while 36%cases inflammation was noticed in 21-30 years of age. Low grade squamous-intraepithelial lesion was noticed in 63.3% of the women within an age group of 14-50 years while high grade squamous intra-epithelial lesion L was observed within 60% of the similar age women. Majority (148.45%) of the women had white discharge from vaginum followed by cervical erosion seen in 19.21% of the cases Conclusion: Pap smear is a highly specific and efficient test for determining pre-cancerous cervical lesions as well as cervical cancers. Key words: Association, Detection, Cervical cancer Pap smear screening test

Frequency of Abnormal Pap Smear Cytology in Women with Post-Coital Bleeding

Risk of development of cervical carcinoma has been identified in patients with abnormal cytology on Pap smear. A long duration of prior to development of invasive cervical carcinoma is governed by a precancerous lesion. Consequently, screening and proper treatment reduces the overall risk of cervical carcinoma. Objective: Aim of study was to identify the frequency of abnormal cervical cytology detected by Papanicolaou smear in married child bearing female presenting with bleeding following coitus. Methods: A Descriptive, Cross-sectional study was carried from 15th November 2021 to 31st May 2022 in the Department of Obstetrics and Gynecology, Jinnah Post graduate Medical Centre, Karachi. A total of 218 females of reproductive age group (18-50 years) presenting with post-coital bleeding were included. Patients with previously histo pathological diagnosis, ablative or excisional treatment modalities of cervix and trauma to genital tract were excluded. All cases underwent Pap smear testing with standard technique by utilization of Ayre's spatula and were fixated with 95% ethanol on microscopic slides. Two specimens were prepared for each patient and were assessed for abnormalities. Results: Patients encountered were between 18 to 50 years with mean of 32.20 ± 7.80 years. Majority (139; 67.43%) of the patients were between 18 to 35 years. Mean parity was 3.53 ± 1.51. Mean BMI was 29.12 ± 2.37 kg/m2. Frequency of abnormal cervical cytology was found in 37 (16.97%). Conclusions: This study concluded that Pap smear is an easy, effective and a cheap method for detecting women with cervical pathology.

Clinical Correlation between Cervical Cancer Screening Using Pap Smear Test

Objective: The study's objective is to evaluate the effectiveness of the Pap smear screening procedure for identifying precancerous lesions. Study Design: Prospective study Place and Duration: Department of Pathology, Nishtar Medical University Multan, From 1st October, 2021 to 31 March, 2022. Methods: There were 162 females had age 18-50 years were presented in this study. All of the women were given a complete physical examination, including a speculum exam and a vaginal exam, and their medical histories were recorded. Women's cervical cancer screenings often involved a Pap smear. Using an Ayre spatula, a smear was collected and spread over a labelled glass slide before being stored in 95% ethyl alcohol and delivered to the Pathology Department for cytopathological testing. SPSS 24.0 was used to analyze all data. Results: Among 162 females, 45 (27.8%) had age 18-30 years, 73 (45.1%) were aged between 31-40 years and 44 (27.2%) patients had 41-50 years. Mean BMI of the females was 22.4 ±6.52 kg/m2. Frequency of smokers was 4 (2.5%). Most common complaint was vaginal discharge, followed by irregular menstrual cycle and abdominal pain. We found that 63 (32.7%) cases had no pathology, frequency of inflammatory was 49 (30.2%) cases, atypical squamous cells of undetermined significance (ASUS) was 28 (17.3%), low-grade squamous intraepithelial lesions (LSILs) was 8 (4.9%) and high-grade squamous intraepithelial lesions (HSILs) was 5 (3.1%). As per HPV, low risk and high risk virus was found in 11 (6.8%) cases. Conclusion: The Pap smear is an easy, quick, and inexpensive way to check for cervical epithelial precancerous abnormalities. It has the potential to be employed as a routine screening tool, leading to better treatment outcomes and lower death rates. Increased detection of these lesions is facilitated by the Pap test and the HPV-PCR test. Keywords: Cervical Cancer, Pap smear Test, HPV, Pathology

Analysis of 100 cervical pap smears for screening of cervical cancer at a tertiary care teaching hospital

Cervical cancer is the most common cancer. Pap smear testing can detect cervix precursor lesions early on, reducing the morbidity and mortality associated with cervical cancer. Early detection and treatment can reduce morbidity and mortality. Aim: To study and analyse 100 Papanicolaou smears (PAP smears) taken from women presenting with various gynaecological indications as a screening method to rule out cervical cancer. Method: PAP test with an Ayres spatula on women between the ages of 25 and 70 who went to the gynaecological outpatient department with different gynaecological complaints. SMEAR was reported as per the 2013 Bethesda system. Result: The common presenting complaints of women in our study were abnormal vaginal discharge (p/v 55%), followed by pruritities valvae (09%), intermenstrual bleeding (08%), and postcoital bleeding in 02% of women. On speculum examination of the cervix, 30% had chronic cervicitis. In only 4% of women, the cervix bleeds on touch. Abnormal vaginal discharge is seen in 60% of women. 36% of smears were inflammatory, 5% had low grade squamous intraepithelial lesions, and 2% had high grade squamous intraepithelial lesions. ASCUS and ASC-H were reported in 3% and 1% smears, respectively.

Primary screening of cervical cancer by Pap smear in women of reproductive age group.

Cancer cervix is a major health problem responsible for causing a higher mortality rate in women worldwide; the exponential increase in such cases can be reduced by early screening of women. The cytology-based cervical screening had a higher success rate in reducing the incidence of cervical cancer. The present study aimed to evaluate the use of Pap smear screening to find cytological abnormalities and precancerous lesions. Sexually active women over 21 years of age were enrolled for the study. A detailed history was taken on the preformed proforma, and all were subjected to vaginal examination. Samples for Pap smear were taken with the help of Ayre spatula and immediately spread over a marked grease-free glass slide and dipped into 95% ethyl alcohol fixative for cytological examination. Most of the abnormality of the epithelial cells found was in the age range of 31-50 years, and most of them were multiparous. 47.92% of the women had a chief complaint of vaginal discharge, an irregular menstrual cycle in 11.07%, and abdominal pain in 7.83%, while 30.41% were asymptomatic. Women found negative for intraepithelial neoplasia were 82.94%, while 13.36% had an inflammatory smear. 0.92% atypical squamous cells of undetermined significance (ASCUS), 2.78% Low-grade squamous intraepithelial lesion (LSIL) were found, no woman had High-grade squamous intraepithelial lesion (HSIL). Pap smear is a simple, cost-effective, non-invasive, and easy to perform tool for early detection of precancerous lesions, and it is evident that every woman above the age of 25-30 years must be recommended for cervical screening.

Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation

Background: Cervical cancer is a preventable disease of significant public health concern, it is an important cause of mortality in women worldwide. The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions. This prospective study was carried out over 4 month, screening of 86 sexually active women who were more than 25 years of age. A clinical examination, an examination per speculum, and a vaginal examination were performed and a history taken for all women. A Pap smear was used for all women to screen for cervical cancer. The smear was obtained using an Ayre spatula and spread over a marked glass slide, which was place in 95% ethyl alcohol and sent to the Department of Pathology for cytopathological examination. Results: The age of study participant was ranged from 26-65 years with mean of 41.7±9.4 year, most women were in the age range of 30–50 years (67%) and more than half were multiparous (54.8%). There was 24.7% post-menopausal. White vaginal discharge (9.3%) and irregular cycle (9.3%) was the most common symptoms, Pap smear test was negative for malignancy in 29%, and 58.8% had infection or inflammation (17% and 41% for mild and severe inflammation respectively). Atypical squamous cells of undetermined significance (ASCUS) and low‑grade squamous intraepithelial lesion (LSIL), were detected in 12%, and 1%respectively. The abnormal finding was higher in age group 40-60 years, half of women with ASCUS were in age group of 41-50 and 30% in age group of 51-60 years, only one case was diagnosed as LSIL, her age was 52 year. Conclusion: A Pap smear is simple, non-invasive, cost‑effective, and easy to perform for detection of precancerous lesions in a gynaecological patient.

Prevalence and Risk Factors of Cervical Dysplasia among Human Immunodeficiency Virus Sero-Positive Females on Highly Active Antiretroviral Therapy in Enugu, Southeastern, Nigeria.

Objective:Evaluation of prevalence and risk factors of cervical dysplasia among Human Immunodeficiency Virus sero-positive (HIV+ve) females on Highly Active Antiretroviral Therapy (HAART) attending HIV clinic at University of Nigeria Teaching Hospital (UNTH) Enugu, Southeastern, Nigeria. Methods:Structured questionnaire was used to obtain socio-demographic and risk factors data. Cervical specimens were collected from 105 HIV +ve females on HAART and 104 HIV seronegative (HIV–ve) females. Pap smears were collected using cytobrush and Ayre’s spatula in a secluded place. Smears were made on slides and placed in 95% ethyl alcohol for conventional Pap staining and the cytobrush washed into the preservative containers for later Immunocytochemistry staining. Blood samples were used for HIV screening. Immunocytochemistry activity using anti-P16INK4A was carried out on the Pap smears that were positive for cervical dysplasia. Results:Pap staining showed prevalence of cervical dysplasia among HIV+ve on HAART 19.05%, (ASCUS 14.29%, LSIL 3.81%, HSIL 0.95%) whereas HIV-ve was 6.73%, p = 0.008. Only the HSIL 0.95% was positive for P16INK4A. Odds ratios at 95% Confident Interval of the risk factors of cervical dysplasia were thus; HIV+ve, 3.26 (1.31-8.09), education less than secondary school 3.23 (1.25-8.37), polygamy 3.23 (1.25-8.37), smoking 1.36 (0.15-12.10), married 2.08 (0.43-2.31), grand multi gravidity 1.72 (0.72-4.11), grand multi parity 1.54 (0.66-3.61), positive history of sexually transmitted diseases 2.49 (1.06-5.80). Uptake of cervical cancer screening was low in both study groups, 7 (6.7%) among HIV+ve on HAART and 14 (13.5%) among HIV-ve females, P = 0.102. Conclusion:HAART had cytoprotective effect against cervical dysplasia in HIV+ve females, by reducing progression of ASCUS to LSIL, HSIL and cervical cancer. Progression from normal to ASCUS increased which could be due to latency or/and prolonged persistent high risk HPV and HIV infections, of the most sexually active age group before diagnosed of HIV.

Comparison of Papanicolaou Smear Quality with the Anatomical Spatula and the Cytobrush-Spatula: A Single-Blind Clinical Trial.

Background:The Papanicolaou (Pap) smear is a standard test for cervical cancer screening; however, the most important challenge is high false-negative results due to inadequate sampling using the Ayres spatula. The cytobrush has been used in combination with the Ayres spatula (cytobrush–spatula) in an attempt to improve the quality of smears with additional costs. The aim of this study was to compare the Pap smear quality with the anatomical spatula (with extended tip) and the cytobrush–spatula.Materials and Methods:This was a prospective single-bind clinical trial. One hundred and ten sexually active women aged between 22 and 65 years were randomized into groups, each having two smears at the same time: one with a cytobrush–spatula and another with an anatomical spatula. Fifty-five patients were randomized to have the anatomical spatula first to obtain their smears and 55 were randomized to have the cytobrush–spatula first to obtain their smears. Slides were assessed by a pathologist.Results:There was no significant difference in the quality of the smears using the two devices with respect to cellular adequacy (P = 0.3532), absent blood staining (P = 0.7766), presence of endocervical cells (P = 0.3502), and evidence of transformation zone sampling using the Bethesda criteria (0.4028). Kappa analysis shows moderate inter-rater agreement between the two devices by ability to show evidence of transformation zone using British Society for Clinical Cytology and Bethesda criteria.Conclusions:There was no significant difference in the quality of smears obtained using the two different methods. The anatomical spatula can be used as a single device in conventional cytology in place of the cytobrush–spatula with the aim of improving the quality of smears without necessarily increasing the cost.

Cervical Screening by Pap Test and Visual Inspection Enabling Same-Day Biopsy in Low-Resource, High-Risk Communities.

To develop an effective, low-cost, single-visit cervical screening strategy incorporating a modified Pap test and visual inspection with acetic acid and Lugol's iodine for low-income settings. We conducted a prospective cohort trial. Two low-income Muslim Uyghur communities in China's far western Kashi Prefecture served as pilot and validation study sites, respectively, and 4,049 women (aged 30-59 years) were screened. The conventional Pap test was modified using a cotton swab to collect cervical cells without scraping the cervix using an Ayre spatula, allowing visual inspection with acetic acid (and visual inspection with Lugol's iodine if visual inspection with acetic acid was negative) to be performed in a single visit. Results from both tests were available within 1-2 hours. Women positive for either or both underwent same-day biopsy that was shipped by a courier service to a central pathology laboratory. Single-visit screening incorporating both a modified Pap test and visual inspection achieved a sensitivity of 96.0% (95% CI 91.6-100), which was superior to Pap testing (76%, 95% CI 66.3-85.7; P<.001) or visual inspection with acetic acid-visual inspection with Lugol's iodine (48%, 95% CI 36.7-59.3; P<.001) alone in detecting cervical intraepithelial neoplasia (CIN) 2 or worse lesions. Rapid interpretation of both diagnostic procedures facilitated efficient same-day biopsy that achieved a negative predictive value of 98.2% in detecting CIN 2 or worse lesions. The increased sensitivity and minimized loss of follow-up allowed this approach to identify an extremely high prevalence of CIN 1 (2,741/100,000, 95% CI 2,238-3,245/100,000), CIN 2 or 3 (1,457/100,000, 95% CI 1,088-1,826/100,000), and cervical cancer (395/100,000, 95% CI 202-589/100,000) among these underscreened, at-risk women. Single-visit cervical screening with both a modified Pap test and visual inspection has greater sensitivity to detect high-grade CINs, reduces loss of follow-up, and could be an efficient low-cost strategy for low-resource settings.

A two-step quality-improvement intervention to address Pap smear quality at public health facilities in South Africa.

The endocervical component of a Pap smear is an important indicator of sample quality - or 'adequacy'. However, only 6 of 52 districts in South Africa (SA) meet the Department of Health (DoH) performance benchmark: a 70% adequacy rate. We implemented a quality-improvement (QI) intervention to address suboptimal Pap smear quality in Tshwane District, Gauteng Province, SA. To determine whether training with the wooden Ayre spatula (step 1) or introduction of the cytobroom (step 2) resulted in greater improvements in Pap smear adequacy rates. Two Tshwane District health facilities participated in our QI project between May 2016 and February 2017. In step 1, staff received training on the Ayre spatula. In step 2, the spatula was replaced with the cytobroom. Pap smear volumes, adequacy rates and results are reported for the pre-intervention period and after each QI step. We compared adequacy rates using Fisher's exact test, with a significance level of p=0.05. In the pre-intervention period, 304 of 965 Pap smears were deemed adequate (32%; 95% confidence interval (CI) 29 - 35%). After step 1, the proportion increased to 109 of 191 (57%; 95% CI 50 - 64%; p&lt;0.01). Similarly, after step 2, the proportion increased to 155 of 192 (81%; 95% CI 74 - 86%; p&lt;0.01). The proportion of abnormal smears increased from 13% before the QI intervention to 17% after step 1 and 22% after step 2. Although training in Pap smear collection using the Ayre spatula resulted in modest improvements in quality, facilities only achieved the DoH benchmark of a 70% adequacy rate after the introduction of the cytobroom.

A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation

Objective:The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions.Methods:All women who visited the outpatient gynecology clinic of the Department of Obstetrics and Gynaecology at King Georges Medical University, Lucknow, UP, India, over 1 year for different clinical problems were recruited for the study. A total of 1650 women who were sexually active and over 21 years of age were enrolled in the study. A clinical examination, an examination per speculum, and a vaginal examination were performed and a history taken for all women. A Pap smear was used for all women to screen for cervical cancer. The smear was obtained using an Ayre spatula and spread over a marked glass slide, which was placed in 95% ethyl alcohol and sent to the Department of Pathology for cytopathological examination. All data were recorded using a predetermined pro forma. Women who had visible malignant cervical lesions were excluded from the study.Results:Most women were in the age range of 30–50 years and multiparous. Vaginal discharge was the most common complaint, occurring in 36.96% of the women. An irregular menstrual cycle was the complaint of 12.78% and abdominal pain of 25.63% of women, while 15.15% were asymptomatic. The Pap smear test of 93.57% of the women was adequately taken, while 6.42% of the individuals had an inadequate sample. The test was negative for malignancy in 48.84%, and 42.66% had infection or inflammation. Atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL) were detected in 2.90%, 5.09%, and 0.48%, respectively. Women with Pap tests positive for ASCUS, LSIL, and HSIL underwent a colposcopy and guided biopsy.Conclusions:Women with an abnormal Pap test should undergo a colposcopy, and those with abnormal colposcopy findings should be advised to undergo a biopsy. A Pap smear is simple, noninvasive, cost-effective, and easy to perform for detection of precancerous lesions in a gynecological patient.

Abstract 3744: Office cervicoscopy in the diagnosis of HPV infection

Abstract Introduction: Since the association between certain oncogenic (high-risk) strains of HPV and cervical cancer is well established. Searching for HPV became a basic step in all screening programs. Laboratory HPV testing is costly and unavailable in developing countries. Objective: To compare the diagnostic indices of office cervicoscopy against cytology and punch biopsy for detection of underlying HPV lesions in women with suspicious cervix. Design: An analytic cross-sectional research design Setting: Early cervical cancer Detection Unit of the Women's Health University Hospital. Assiut, Egypt. Patients and methods: A total of 274 non-pregnant women with clinical diagnosis of suspicious cervix were included in this study. After cervical smearing with Ayre's spatula, they were subjected to cervicoscopy utilizing 2.6 mm telescope and a 3.2 mm outer sheath office hysteroscope. Evaluation of the vulva, vagina, ectocervix, endocervical canal and the endometrial cavity were done. The cervix was then painted with saline, acetic acid and Schiller's iodine stains successively as used during colposcopic examination. Abnormal lesions were biopsied using punch biopsy forceps. Cytologic evaluation relied on both classic and non-classic (secondary) criteria for the diagnosis of HPV including "mild koilocytosis," mild dyskeratocytosis," hyperchromatic nuclei, bi- and multinucleation, and cleared cytoplasm. Punch biopsies were taken from every case based on cervicoscopic localization after staining. Results:. The main complaint was abnormal vaginal discharge in 197 cases (71.4%) . Pap smear sampling was negative for HPV in 188 cases (68.6%) and positive in 86 cases (31.4%). Cervicoscopic findings suggestive of HPV infection were positive in 77 cases ( 28.1% ) and negative in 197 cases (71.9% ). Gold stand histopathology diagnosed HPV in 53 cases only (19.3%). All diagnostic indices of cervicoscopy significantly improved after combination with cytology positive results except false positive results.. Conclusions: Cervicoscopy as a simple, cheap and office procedure can be used as a quick screening tool of HPV infection in women with suspicious cervix. It has the advantage of screening of the rest of the genital tract. In the absence of laboratory HPV testing, cervicoscopy in conjunction with cytology screening of high-risk cases should be encouraged. Note: This abstract was not presented at the meeting. Citation Format: Atef Darwish. Office cervicoscopy in the diagnosis of HPV infection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3744. doi:10.1158/1538-7445.AM2017-3744

Occasional Observation of Acanthamoeba in the Pharynx. A Case Report

Acanthamoeba is an opportunistic protozoan free-living widely distributed in nature and is a potential pathogen for Man. It is responsible for pathologies inherent in the CNS, the cornea , the skin, especially in immunocompromised subjects. An adult subject of 70 years old, suffering from acute pharyngitis, was subjected to a cytological sampling of the pharyngeal mucosa by means of the modified Ayre spatula type A from Armone Caruso, to perform either a coloring method according to the May-Grunwald - Giemsa, and observed under the microscope optical with oil immersion at 100 x of fifty fields, that a preparation for observation under the SEM.( Scanning Electron Microscope,). In both observations it was highlighted in the form of trophozoite some rare Acanthamoeba. The subject was observed without that have appeared due to protozoan diseases: in practice it was a casual observation. The clinical case, described occasionally, it shows how the distribution in the environment of these amoebae is very extensive and mainly related to water and become of interest about the health, for the human use of the latter for purposes such as hygiene care, bathing, medical and health applications. The objective of this paper is to provide a starting point to discuss the potential pathogenicity associated with the presence of Acanthamoeba in the water ecosystems. This is for raise the awareness the scientific community and promote environmental control initiatives of this pathogen in both outdoor and indoor environments.

Manual Liquid Based Cytology in Diagnosis of Gynecologic Pathology

Abnormal uterine bleeding (AUB) is a commonly encountered complaint in gynecology department. Endometrial cancer is the fourth most common malignancy in women and the most frequent gynecological cancer in developed countries. With 5,28, 000 new cases every year, cervical cancer is the fourth most common cancer affecting women worldwide, after breast, colorectal, and lung cancers. Though the cytological examination has been the mainstay for early detection of cervical cancer, and found to be useful in detection of endometrial cancer, its widespread use has not been possible in the developing countries due to paucity of resources, man power and other facilities Its sensitivity reduces to less than 50% when there is presence of obscuring blood, inflammation or thick areas of overlapping epithelial cells. Manual Liquid Based Cytology (MLBC) is a cost effective technique that enables cells to be suspended in a monolayer and thus improve detection of precursor lesions and specimen adequacy. The residual sample can be used for other tests like Cell block and immunocytochemistry. <b>Objectives </b>: 1. To improve the diagnosis of gynecological cancers by a method called as Manual Liquid Based Cytology (MLBC). 2. To study a cost effective method of studying both endometrial and cervical cancer with help of ancillary techniques like cellblock, immunocytochemistry 3To compare the findings between conventional pap smear (CPS) and MLBC in detection of gynecological conditions of endometrium and cervix. <b>Methodology </b>: Samples were collected using Ayres spatula by split sample technique from transformation zone of cervix which included outpatients of gynecology dept. The women were aged between 20-60 years, 82 cases with bleeding history were taken to study endometrial pathology, while 100 cases of white discharge per vagina were selected to study the cervix. 60 cases were later subjected to ancillary studies like cellblock with Immunocytochemistry. Histopathological correlation was done for cases wherever possible. <b>Results </b>: The study on endometruim showed MLBC is more sensitive and specific than CPS in diagnosis of malignant lesions. The contingency coefficient for LBC/Histopathology V/s CPS/Histopathology was 0.572 V/s 0.556. It was observed for cervical lesion that increased detection rate was 150% for low grade intraepithelial lesion. The Positive predictive value for diagnosing neoplastic lesions on cell blocks was 75%, while Concordance Rate of CB/HistopathologyVs CPS/Histopathology was 74% vs. 54%. <b>Conclusion </b>: MLBC is a cost effective method for detections of cancerous lesions of endometruim and cervix.

Human papillomavirus genotypes among women with or without HIV infection: an epidemiological study of Moroccan women from the Souss area.

BackgroundData on Human PapillomaVirus (HPV) infection are scarce in Morocco. The objective of the study was to determine the prevalence of HPV and cervical cytology abnormalities in women from the Souss area, Morocco.MethodsTwo hundred and thirty two women who attended the Hassan II hospital (Agadir, Morocco) were recruited in this study. Socio-economic data, sexual activity, reproductive life, history of Pap smear, smoking and HIV status were recorded. Cervical samples were taken using an Ayre spatula. Cytology was reported using the Bethesda system. HPVs were first detected by MY09/11 consensus PCR and then genotyped with INNO-LiPA® assay. Data were analyzed using the logistic regression model.ResultsThe median age of women was 42 years (18–76 years). HIV prevalence was 36.2 %. Any HPV type prevalence was 23.7 % in the study population, lower in HIV-negative women (13.3 %) than in HIV-positive women (39.3 %). HPV16 was the most prevalent type (6.5 %), followed by HPV53 and HPV74 (3.4 % each). Most women had normal cervical smears (82 %), the remaining were diagnosed with LGSIL (13 %) and HGSIL (5 %). HPV was detected in 17.4 % of normal smears, 43.4 % of LGSIL and 75 % of HGSIL. HIV status was the most powerful predictor of high risk (hr) and probable hr (phr) HPV infection (odds ratio 4.16, 95 % confidence interval 1.87–9.24, p = 0.0005) followed by abnormal cytology (OR 3.98, 95 % CI 1.39–11.40, p = 0.01), independently of socio-demographic and behavioral risk factors.ConclusionsIn a Moroccan hospital based-population of the Souss area, HPV infections are frequently detected. In addition, high prevalence of hr and phrHPVs and precancerous lesions among HIV-positive women is likely associated with an increased risk of cervical cancer. This highlights the need for HPV and cervical cancer prevention campaigns in Morocco.

COMPARACIÓN CITOLÓGICA ENTRE LAS TÉCNICAS DE ESPÁTULA DE AYRE Y CITOESCOBILLA (CYTOBRUSH) EN LA TOMA DE MUESTRAS CERVICOVAGINALES

Objetivo: Comparar la eficacia de los métodos de espátula de Ayre y la citoescobilla ("cytobrush") en la detección de lesiones premalignas y malignas del cérvix uterino. Material y Métodos: Las muestras de raspado de cérvix uterino de 140 pacientes, usando las técnicas de la espátula de Ayre y citoescobilla, fueron extendidas sobre láminas separadas y codificadas, siendo examinadas por dos diferentes patólogos que desconocían el método de recolección de la muestra. Se usó el sistema de Bethesda para el diagnóstico. Resultados: De las muestras obtenidas, 65% vs. 35% tuvieron células endocervicales con el método de la citoescobilla y la espátula de Ayre, respectivamente. Al analizar la cantidad de células endocervicales, las muestras obtenidas por el método de citoescobilla tuvieron más de cinco grupos de células endocervicales, 71,4% vs. 36,4% con la espátula de Ayre. Conclusión: A pesar que el método de la espátula de Ayre es eficiente para la obtención de células endocervicales, el método de la citoescobilla dio mejores resultados en nuestro estudio.

Efficacy of Ayres Spatula with Spatula + Cytobrush Combination in Screening for Cervical Carcinoma

Efficacy of Ayres Spatula with Spatula + Cytobrush Combination in Screening for Cervical Carcinoma

Reliability of Unaided Naked-Eye Examination as a Screening Test for Cervical Lesions in a Developing Country Setup

This study aimed to test the reliability of unaided naked-eye examination (UNEE) of the cervix as a sole cervical cancer screening test in a developing country setup compared with the standard cervical cytology. A total of 3,500 nonpregnant women aged between 25 and 55 years were included. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix. A thorough UNEE of the cervix was done to detect any apparent lesions. Cervical smears were obtained using the long tip of an Ayre spatula. An additional endocervical sample was obtained by cytobrush. Women with abnormal Pap smears or visible cervical lesions by UNEE were scheduled for colposcopic examination. A biopsy specimen was obtained in every abnormal colposcopic examination. Of 3,500 cases, there were 9 (2.57%) preinvasive cervical lesions (cervical intraepithelial neoplasia 1-3) diagnosed with various diagnostic tools used in the study and confirmed by histopathologic examination. Of 3,500 cases, invasive cervical lesions were diagnosed in 6 (1.71%). The sensitivity of UNEE is much better than that of Pap smear (80% vs 60%) but less than that of colposcopy (86.7%). However, the specificity of UNEE (100%) is lower than that of Pap smear (91.16%) and better than that colposcopy (83.12%). The UNEE has a poor positive predictive value (3.75%) when compared with Pap smear (100%) and colposcopy (20%). The negative predictive values of the 3 tests were nearly comparable. Whenever access to Pap smear is limited, UNEE performed by general gynecologists and well-trained nurses is an acceptable alternative for detecting cervical premalignant or malignant lesions especially in low-resource settings.

Plastic spatula with narrow long tip provides higher satisfactory smears for Pap test

Background:Ayre spatula for cervical smear collection is being used despite the suggestion that different modified spatulas provide more satisfactory sampling.Aims:To see whether the cytological pickup improves with the use of long tipped spatula.Setting and Design:Rurally based University Hospital; crossover study.Materials and Methods:Pap smear using Ayre spatula in 500 and with plastic narrow long tip (Szalay) spatula in 500 clinic attending women was taken and analyzed. Crossover smears were taken with modified spatula in 163 and using Ayre spatula in 187 women after 2 weeks of initial smears. The same pathologist made cytological reporting for all smears and was unaware of the type of spatula used.Results:Smears from Ayre spatula had significantly higher reports of inadequate smears (94 of 500 vs. 68 of 500 for Ayre and Szalay, respectively; P = 0.032) and it remained so even after crossover (94 of 187 vs. 70 of 163 for Ayre and Szalay, respectively; P = 0.2). Cellular quality appeared better with smears taken using Szalay spatula, but the overall abnormal smear detection rate remained similar with either collection tool (χ2 = 1.5; P = 0.2).Conclusions:Proportion of satisfactory smears is higher when long tip plastic spatula is used for collection of sample.