The optimal technique for obtaining a Papanicolaou smear with the Cervex-Brush

Background. The Cervex-Brush (Rovers, The Netherlands; Unimar, Wilton, Conn) is a cervical cytologic sampling device used to simultaneously collect endocervical and ectocervical cells. The optimal method for using this device to collect cervical epithelial cells for a Papanicolaou smear has not been described in the medical literature. Methods. Using the Cervex-Brush, Papanicolaou smears were collected from 516 women in a prospective randomized study to evaluate five different clockwise rotation techniques: 180[degrees] rotation of the brush, 360[degrees], 720[degrees], 1080[degrees], and 1800[degrees]. The Bethesda System of classifying Papanicolaou smears was used to report cytologic results. Endocervical cell presence as an indicator of smear adequacy was quantitated from 0 to 4(+). Results. As the number of rotations was increased, the number of endocervical cells collected also increased (P [greater than] .05). Abnormal cells were found in 22.3% of the smears obtained by rotating the brush 1080[degrees] and 1800[degrees]. This was compared with abnormal cells found in 8.2%, 4.5%, and 11.5% of the smears collected by rotating the brush 180[degrees], 360[degrees], and 720[degrees], respectively (P [greater than] .001). Two smears that identified high-grade squamous intraepithelial lesions were collected using the 1800[degrees] rotation. Unsatisfactory smears were obtained in 39 (7.5%) of the 516 smears. The percentage of slides containing hemorrhagic artifact was greatest (16.4%) in the 1800[degrees] rotation group, but the likelihood of the Papanicolaou smear being considered unsatisfactory was not increased (P [greater than] .05). Conclusions. Using a clockwise 1800[degrees] rotation of the Cervex-Brush to obtain a Papanicolaou smear maximized the collection of endocervical cells, detected the greatest percentage of abnormal cells, and did not statistically exceed the acceptable limit for hemorrhagic artifact. Key words. Papanicolaou smear; cytology; cervix dysplasia; cervix neoplasms. J Fam Pract 1992; 34:276-280.
The purpose of the Papanicolaou smear is to identify premalignant or malignant disease occurring in the transformation zone of the cervix. Adequate sampling of cervical epithelial cells from the transformation [...]