Cervical sampling with the SZALAY CYTO-SPATULA

The possibilities of minimizing the number of false-negative results with the Szalay Cyto-Spatula

The most frequent causes of false negative smears are:

  1. From the clinical specialist's viewpoint: Insufficient cervical sampling (approx. 30% insufficient smears with the cotton swab).

  2. From the cytologist's viewpoint: Negative result (Pap 1 or 2) of a positive case owing to inadequate smear.

  3. From the biological side:
    a) ENDOCERVICAL ABNORMALITIES: The squamo-columnar junction, which plays such a seminal role in the genesis of cervical carcinoma, is often relocated in the canal. Therefore fifteen to twenty per cent of intraepithelial lesions are found in the endocervix. Neither the colposcope, nor the traditional methods of cytologic sampling, ensure their early and accurate detection.

    Traditional cytologic sampling results in smears composed of cells which have exfoliated from the most superficial layer of the epithelium. In some cases of high grade squamous intraepithelial lesion and invasive carcinoma special stains (Krutsay) reveal superficial keratinisation which on occasion may form thick hyperkeratotic plaques. These not only prevent the spontaneous exfoliation of underlying neoplastic cells, but also form impermeable barriers for the cotton-tipped applicator, so that procuring of neoplastic cells becomes impossible. The metabolic exchange and blood supply of the superficial portion of invasive carcinomas are precarious. This results in extensive cellular degeneration and necrosis. The covering necrotic blanket makes the deeper lying neoplastic cells unavailable for examination. Hence the relatively frequent false negative smears in cases of invasive carcinoma (20-25%).

The Sample taking technique using the Szalay-Cyto-Spatula

Print or download the sample taking technique using the SZALAY CYTO-Spatula (PDF file) (short form)

Smear taking technique presentation  (detailed)

A conventional Pap test (Papanicolaou) made with the SZALAY CYTO-SPATULA provides most reliable results, because with correct application always sufficiently well preserved and representative cell material is obtained.

Medical opinion is that the SZALAY-CYTO-SPATULA improves the quality of smears and significantly reduces the number of false negative smears.


Label the slide on the ground-glass side using a pencil (sequence number or name of patient).


After insertion of the speculum the surface of the ectocervix is cleansed with a cotton swab and any mucus and debris removed.


The Spatula with the optimal shape and size is chosen from the series.

4 The 'tongue' of the spatula is introduced into the canal, whilst its 'shoulder' is positioned on the 3 o'clock position of the ectocervix at the beginning of the procedure.

With gentle pressure the spatula is rotated in a clockwise direction (see VideoClip). If the cervical canal is wide the spatula is allowed to wander according to the contour of the cervix during rotation. If after rotation through 360° without bleeding (see important information) it is felt that sampling is inadequate, the procedure may be repeated one or two times.


The cells are spread on the slide always along its long axis, parallel to its edges. If the distribution of the cellular material is uneven, the same spatula may be used for respreading.


The slide is immediately fixed. A distance of about 30 cm should be kept to prevent the cell sample from being blown away.


Once the slide has been fixed, place the slide inside the envelope for dispatch. 

9 The optimal date for taking a smear is in the middle of the menstrual cycle. An unfavourable date for taking a smear may result in unnecessary bleedings.

The Szalay Cyto-Spatulas are discarded after use. They may be burned as they leave no residue.


  1. Endocervical lesions: Abnormal cells taking up a position on the upper portion of the slide are assumed to derive from the tongue of the spatula.

  2. Ectocervical lesions: Abnormal cells which are found on the lower third of the smear represent those obtained by the shoulder of the spatula.

  3. Ecto-endocervical lesions: Even distribution of abnormal cells throughout the slide reflects simultaneous ecto- and endocervical disease.

Use with liquid based methods of analysis

A smear taken with the SZALAY CYTO-SPATULA provides highly reliable results for both conventional (Papanicolaou) and the newer very expensive but not really better liquid-based (Cell Suspension Based Cytologic) methods of analysis.

A conventional Pap test (Papanicolaou) made with the SZALAY CYTO-SPATULA provides most reliable results, because with correct application always sufficiently well preserved and representative cell material is obtained.

Medical opinion is that the SZALAY-CYTO-SPATULA improves the quality of smears and significantly reduces the number of false negative smears.

If the smear is to be further processed with liquid based (Cell Suspension Based Cytologic) methods of analysis, the head of the SZALAY CYTO-SPATULA Plus is removed after cervical sampling (item 5 above) by breaking it off at the visible score line, and sealed in a designated container with the special solution for further processing.


Print or download the range of shape and size of spatula (PDF file)

Real size of the Szalay Cyto-Spatula is: Device-lenght=220mm; Device-width: 5mm


Szalay Cyto-Spatula No. 1
(for a small through medium sized portio)
Szalay Cyto-Spatula No. 2
(for a medium to large sized portio)
Szalay Cyto-Spatula No. 3
(for a very large portio)

Szalay Cyto-Spatula No. 4
a) for a larger cervix with an extended transformation zone, in addition to a cervical smear with a No. 1, No. 2 or No. 3 spatula or in combination with a Cytobrush.
b) for a smear from the outer surface only, in patients with an obliterated cervical canal or one that is too narrow for the passage of a No. 1 spatula. The cytology laboratory must be  informed if this is the case.

The images above are bigger than the actual size of the Szalay-Cyto-Spatula


The smear taking technique is documented in the following small video clip. It can be obtained by download directly or can be ordered on a CD by email to CSM Graf GmbH.

To play the clip, you need Windows Media Player which comes as a standard feature with Windows. You may need to update the version installed on your PC to the latest version. If you are connected to the internet, the update usually takes place automatically as soon as you play the clip.

Downloading the clip as a
.wmv file:
Using the mouse, right-click the right link and store the file on your PC. Then execute it on your PC by double-clicking.

Playing directly from this side:

If you have a high-speed internet connection, you may play the clip directly by double-clicking the right link.

Video Clip on smear technique  
(Windows Media File, ca. 12. MBytes, Version: June 2008)



Important information on the use of the Szalay-Cyto-Spatula

In approximately 2-3% of cases, slight bleeding may occur when taking the cervical sample. This does not affect the colposcopic examination. Slight spotting may occur in that case for one to two days. This should cause no problem if the patient is informed of this possibility. Only very rarely does the blood affect the cytologic assessment. The colposcopic examination may also be conducted prior to taking the cervical sample. 




























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