Cytology - Cervical cancer screening
The Szalay Cyto-Spatula Pap test
The SZALAY CYTO-SPATULA improves the quality of
Pap tests and significantly minimizes the number of false-negative samples.
The SZALAY CYTO-SPATULA has been developed to increase the quality of
Pap smears and has been
used extensively in Germany, Austria and Switzerland since more than ten years.
The use of the Szalay Cyto-Spatula improves the the quality of Pap smears to
such an extent that almost all cancer cases can be determined in the very early
stages. Following are the advantages
of the Szalay Cyto-Spatula compared to other Pap test taking instruments:
The SZALAY CYTO-SPATULA improves the quality of
Pap tests and significantly minimizes the number of false-negative Pap
smears. If applied carefully, it is faster, cheaper and better
than all other Pap test methods. Although not necessary, the SZALAY-CYTO-SPATULA Plus can easily be
combined with liquid based methods.
The SZALAY CYTO-SPATULA has been developed to obtain the best
quality of Pap smears. It has been used extensively in Germany, Austria and
Switzerland for more than ten years. If used properly, the SZALAY CYTO-SPATULA
improves the quality of Pap smears to such an extent that most cervical
carcinomas can be detected very early.
Order your free samples and check the difference:
- The SZALAY CYTO-SPATULA is an extended-tip spatula and available in
different sizes and shapes to fit the form of the cervix and the size of a
patient’s cervical canal. Thus, no need for different sampling devices to
obtain cells from the different areas.
- There are always enough well- preserved cells from the endocervix,
ectocervix and the endo-ectocervical area contained in a smear made with the
- Compared with other Pap test sampling devices, the SZALAY CYTO-SPATULA scrapes off the
possibly keratinizing superficial cell layers which may cover abnormal
tissue areas. Due to its specially designed surface, cells are also
collected from deeper layers.
- Compared with similar instruments or newer Pap test methods, a SZALAY
CYTO-SPATULA Pap test is cheaper, faster and at least as reliable.
- Although not necessary, the SZALAY-CYTO-SPATULA Plus can easily be
combined with liquid based methods.
- One smear made with the SZALAY-CYTO-SPATULA is up to the standard for
diagnosis in the new BETHESDA SYSTEM (USA 1989).
- The SZALAY-CYTO-SPATULA keeps the sample site identified and thus makes it
possible to identify the site of the lesion for subsequent colposcopy and
||Select the image to make it bigger
The different Szalay Cyto-Spatula's
References and literature
CYTOLOGY OF THE UTERINE L.
Szalay. This book contains more than 700 colored images of smears made with the
GYNÄKOZYTOLOGIE: J. Jenny, Einführung in die gynäkologische
Special Issue on Cervicovaginal
Cytopathology in Honor of George L. Wied on His 70th Birthday: VOL. 35
January-February 1991 of Acta Cytologica
Taking a Pap smear with the Szalay Cyto-Spatula
(Reprint from the book: CYTOLOGY OF THE UTERINE )
The last few decades have not produced an universally
accepted method for taking a smear. This is due to the fact that none of the
implements devised to date allow a l00 % detection rate of cervical carcinoma or
its precursors. In the United States and Western Europe the various spatulas
based on Ayre's spatula are popular. None of the spatulas, however , has
achieved the diagnostic yield desired.
Study of the histopathologic changes in the cervix reveals
those abnormalities and factors which hinder or indeed prevent accurate
The ectocervix is visualized by the gynecologist. Many lesions can be
localized by the colposcope but a large part of the endocervix is out of
colposcopic range. Obtaining of smears with the cotton-tipped applicator from
the endocervix is possible only when the diameter of the external os and
cervical canal allow its passage. During the last two decades the local
destructive therapy of ectocervical intraepithelial lesions has gained a wide
acceptance (electrocoagulation, diathermy , cryo therapy and laser therapy).
Partly as a consequence of this the squamo-columnar junction, which plays such a
seminal role in the genesis of cervical carcinoma, is often relocated in the
canal, as in the postmenopausal woman.
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. This anatomic topography is
one of the reasons why cases are always encountered in any practice when in
spite of regular yearly colposcopic, cytologic and gynecologic screening,
cervical carcinomas are discovered late. To evoke rapid tumor transit time as an
explanation is not always plausible, as in such cases the screening of the
endocervical mucus was defective. (Figs 1-3: endocervical carcinoma in situ.
Figs 4-6: endocervical microinvasive and invasive carcinomas)
SUPERFICIAL EPITHELIAL CHANGES WHICH HINDER REPRESENTATIVE SAMPLING
- HyperkeratosisTraditional 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 keratinization 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 (Figs. 7, 9).
- ParakeratosisThe superficial layer in many cases of squamous intraepithelial lesions is
parakeratotic. Although such cells exfoliate, the more deeply situated
neoplastic cells will not appear in the smear (Fig. 8).
- NecrosisThe 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. Adenocarcinoma
is even more prone to rapid autolysis and necrosis than squamous cell
carcinoma. The surface of adenocarcinoma of the cervix which usually arises in
the canal, tends to be necrotic and covered by mucus. Herein lies the
explanation of the relatively infrequent detection of adenocarcinoma in situ
and early invasive adenocarcinoma of the cervix (Fig. 11).
NEOPLASTIC LESIONS COVERED BY NORMAL EPITHELIUM
- The surface epithelium covering cervical polyps may be normal but the
glands underneath may have undergone neoplastic transformation. As a rule,
spontaneously exfoliated cells in such cases are normal (Fig. 10).
- Metastatic and non-epithelial 'tumors (such as sarcomas) can be diagnosed
cytologically only when they invade and breach the covering squamous or
columnar epithelium (Fig. 12)
THE SZALAY CYTO SPATULA
The author of this atlas has also experienced several times the frustrating
false negative smear. This stimulated the development of an improved spatula for
smear taking. The new spatula devised differs in several aspects from its
- The surface area of the ectocervix and the diameter and the length of the
cervical canal differ between the nullipara and parous woman. Therefore a
variety of spatulas were designed from which one of suitable size and shape
may be chosen according to individual requirement.
- Since spontaneously exfoliated cells are not always representative of the
whole lesion, rendering the surface of each spatula roughly allows removal
of parakeratotic, hyperkeratotic and necrotic layers and ensures sampling of
the underlying neoplastic cells.
- The elongated 'tongue' of the spatula ensures adequate scraping of the
OBTAINING A SMEAR WITH A SZALAY CYTO-SPATULA
- After insertion of the speculum the surface of the ectocervix is cleansed
with a cotton swab and any mucus and debris removed (Figs. 13-14).
- The correct spatula is chosen for the individual (Fig. .15).
- 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 (Fig. 16).
- With a light but firm pressure the spatula is rotated in a clockwise
direction. 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 it is felt that sampling is inadequate, the
procedure may be repeated one or two times (Figs. 17-20)
- 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 (Figs. 21-22).
- The slide is immediately fixed (Fig. 23).
LOCATING LESIONS FROM THE SMEAR
- Endocervical lesionsAbnormal cells taking up a position on the upper portion of the
slide are assumed to derive from the tongue of the spatula (Fig. 24).
- Ectocervical lesionsAbnormal cells which are found on the lower third of the smear
represent those obtained by the shoulder of the spatula (fig. 25).
- Ecto-endocervical lesionsEven distribution of abnormal cells throughout the slide reflects
simultaneous ecto- and endocervical disease (Fig. 26).
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Correct use of the spatula and even spreading of the smear enables the
cytologist to pin-point lesions as ecto- or endocervical from the distribution
of the abnormal cells on the slide with surprising accuracy, even in the absence
of clinical information. This is especially important for ectocervical lesions,
as in such cases COLPOSCOPIC examination is negative. Consequently the
cytologist can provide valuable information to the clinician as to the type of
biopsy required for definitive diagnosis.
Using the SZALAY-CYTO-SPATULA, only a single invasive endocervical carcinoma
went undetected among 150.000 smears taken (Figs. 713-718).
DISADVANTAGES 0F SPATULA-TAKEN SMEARS
- Contact bleeding in 2-3% of cases may interfere with subsequent
colposcopic examination. However, blood cells in the sample are no problem
for the cytologist.
- If the patient is duly forewarned, mild spotting for 1-2 days will not be
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