166 research article What sampling device is the most appropriate for vaginal vault cytology in gynaecological cancer follow up? Del Pup Lino1, Canzonieri Vincenzo2, Serraino Diego3, Campagnutta Elio1 1 Gynaecology Oncology Department, 2 Pathology Department and 3 Epidemiology Unit, National Cancer Institute CRO, Aviano, PN, Italy Radiol Oncol 2012; 46(2): 166-169. Received 1 August 2011 Accepted 8 February 2012 Correspondence to: Del Pup Lino, Oncologia Ginecologica, Istituto Nazionale Tumori, Centro di Riferimento Oncologico, Aviano, Pordenone, Via F. Gallini 2, Aviano, Pordenone, Italy, Phone: +39 0434 659051; Fax: +39 0434 659439; ldelpup@cro.it Disclosure: No potential conflicts of interest were disclosed. Background. In women with cancer-related hysterectomy, the vaginal vault cytology has a low efficacy - when performed by conventional methods – for the early detection of vaginal recurrence. The amount of exfoliated cells collected is generally low because of atrophy, and the vaginal vault corners can be so narrow that the commonly used Ayres spatula cannot often penetrate deeply into them. This prospective study aimed at identifying the advan- tages obtained in specimens collection using the cytobrush, as compared to the Ayres’s spatula. Patients and methods. 141 gynaecologic cancer patients were studied to compare samplings collected with Ayre’s spatula or with cytobrush. In a pilot setting of 15 patients, vaginal cytology samples obtained by both Ayre’s spatula and cytobrush were placed at the opposite sites of a single slide for quali-quantitative evaluation. Thereafter, the remaining 126 consecutive women were assigned to either group A (spatula) or B (cytobrush) according to the order of entry. The same gynaecologist performed all the procedures. Results. In all 15 pilot cases, the cytobrush seemed to collect a higher quantity of material. The comparative analysis of the two complete groups indicated that the cytobrush technique was more effective than the spatula one. The odds ratio (OR) for an optimal cytology using the cytobrush was 2.8 (95% confidence interval -C.I. 1.3-6.2; chi-square test, p=0.008). Conclusions. Vaginal vault cytology with cytobrush turned out to better perform than the traditional Ayre’s spatula to obtain an adequate sampling in gynecological cancer patients. Key words: Ayre’s spatula; cytobrush; female cancer; vaginal cytology Introduction The main aim of post-treatment surveillance in on- cology is to improve the survival through early de- tection of recurrent tumours.1 The cytopathologic examination is a one of the valuable method to de- tect an early recurrence of malignancy or new pri- mary carcinoma during the follow-up of patients after the treatment of a different cancer.2 However, the vaginal vault cytology is considered a surveil- lance method with low efficacy for the early detec- tion of vaginal recurrence in patients with a ma- lignancy-related hysterectomy.3,4 This is partially caused either by cytologic artefacts due to inflam- mation or by vaginal effects of previous chemo- therapy, radiotherapy, or surgery. The amount of exfoliated cells collected is generally low because of atrophy. In addition, the vaginal vault corners can be so narrow that the commonly used Ayres spatula is often unable to penetrate deeply into them. These two latter factors could further reduce the probability of the early detection of a local re- currence, though they can be improved by differ- ent sampling methods. Radiol Oncol 2012; 46(2): 166-169. doi:10.2478/v10019-012-0019-x