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

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.

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+.

As the number of rotations was increased, the number of endocervical cells collected also increased (P less than .05). Abnormal epithelial 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 less 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 less than .05).

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.