Del Pup L et al. / Vaginal cytology in gynecological cancer 167 Extended-tip spatulas improve the collection of exfoliated cells, with a nearly 2-fold higher odds ratio (OR) -in comparison with Ayre’s spatula. However, the available data refer to endocervical samples, not to vaginal vault cytology of hysterect- omized cancer patients.5 To evaluate the best spatula for obtaining ad- equate vaginal samplings, we reviewed the availa- ble literature in PubMed using the following strate- gy: (“Vaginal Smears/instrumentation”[MeSH] OR “Vaginal Smears/methods”[MeSH] OR “Vaginal Smears/standards”[MeSH] OR “Vaginal Smears/ utilization”[MeSH]) AND “Genital Neoplasms, Female”[MeSH] AND “Hysterectomy”[MeSH]. Then we searched for indications on the meth- ods in Plumbed with the strategy: “Follow up” AND “Genital Neoplasms, Female”[Mesh] AND “Hysterectomy”[Mesh] as well as in the main guidelines. We could not find adequate rand- omized trials regarding the optimal method to per- form vaginal vault cytology during the follow-up of hysterectomized women. Patients and methods At the Gynaecology Oncology Department of the National Cancer Institute “Centro di Riferimento Oncologico”, Aviano, North East of Italy, 141 gy- naecologic cancer patients in follow-up were in- cluded in prospective study. The study design complied with national regulations and institu- tional policies and the study was carried out ac- cording to the Helsinki Declaration. The survey was conducted in two steps. In a pre- liminary study of 15 patients, we performed vaginal cytology with both Ayres and cytobrush and the cells samples were placed on the same slide, half of the slide area for each device. In order to prevent bias due to the greater amount of cells collected by the first device used, the first sample was obtained initially with Ayres spatula and subsequently with cytobrush. For every subsequent patient this order was changed. Cytobrush samples were placed on the half of the slide far from patient’s identification data. Criteria of adequacy for vaginal vault cytol- ogy consisted in the evaluation of enough cellular- ity of squamous type. However, since the goal of our work was to identify the best method to collect more vaginal cells for smears, some differences in the amount of cells available for comparisons be- tween the two studied methods were expected. This first step of the study aimed to describe the cytology differences between the two sampling A B FIGURE 1. Cytological sample collected from vaginal vault with Ayre’s spatula (A) and cytobrush (B) (Papanicolau; mag. 100X). devices analysing the cells on the same slide. The study continued with a methodology that allowed an improved assessment of the differences. In the second and most important step of the study, 126 consecutive hysterectomized cancer pa- tients who underwent vaginal vault cytology were investigated. Fifty-nine (47%) of them had cervi- cal cancer, 53 (42%) endometrial cancer, nine (8%) had ovarian cancer, four (3%) had vulvar cancer, and one uterine sarcoma. These women were al- ternatively assigned either to group A (i.e., classical Ayres spatula) or B (i.e., cytobrush) according to the order of entry, starting from group A. Vaginal vault cytology collection was performed in group A with the classical Ayres spatula and in group B with cytobrush. The same gynaecologist (DPL) performed all the procedures with exactly the Radiol Oncol 2012; 46(2): 166-169.