مقایسه کیفیت اسمیر در سه روش نمونه گیری پاپ اسمیر

Background and Aim: Pap smear test is considered the best screening method for cervical disease, especially for malignant lesions. The crucial factor here is obtaining high-quality samples, as poorly-prepared ones cause a great deal of confusion for patients and physicians alike. Attempts to define an ideal sampling technique have been going on for many years, and in this study we compare three different sampling methods to determine which one provides the best quality. Materials and Methods: This interventional study was performed in a private obstetrics-gynecology clinic and involved 600 women who met the criteria for cervical screening. The Pap test was done by three different methods: "Swab spatula", "Cytobrush – spatula" and "Spatula only". Results: Each method was performed on 200 randomly-selected patients. Cytopathologic examination was done by a single pathologist and in a blind fashion. For each specimen, a quality rating was reported as "satisfactory" or "unsatisfactory". Among the 200 samples obtained by the "Swabspatula” method, 150 (75%) were of satisfactory quality and the remaining 50 cases (25%) were rated as unsatisfactory. As for the cytobrush–spatula group, 88 samples (94%) were satisfactory and 12 (6%) were unsatisfactory. Finally, 179 samples (88%) in “Spatula-only” group were satisfactory and 24 (12%) were unsatisfactory. The difference in the proportion of good-quality samples was significant in pairwise comparisons between the three methods: swab-spatula versus spatula-only (P = 0.0013), swab-spatula versus cytobrush-spatula (P = 0.0001) and cytobrush-spatula versus spatula-only (P = 0.036). Conclusion: The study revealed that the cytobrush-spatula sampling method yielded the highest proportion of high-quality samples. Hence, it would be desirable to familiarize physicians, midwives and other health care workers in this country with the technique of cytobrush cervical sampling and its potential advantages. However, financial and cultural aspects must be taken into account before adopting the procedure for routine cervical screening in Iran.