Controlled evaluation of implementing the Cytobrush technique to improve Papanicolaou smear quality

The effect of introducing the Cytobrush Cell Collector for endocervical sampling on the quality of Papanicolaou smears was evaluated using a quasi-experimental design. Baseline evaluation of the Ayre spatula-cotton swab method in two patient groups showed that only 61.8-61.9% of smears contained endocervical cells. Replacing the cotton swab with the Cytobrush in the intervention group improved endocervical cell yields to 82.0% (P less than .001). This improvement was not due to group differences in patient factors previously related to endocervical cell yields, eg, parity, use of oral contraceptives, pregnancy, previous cervical procedures, and menopausal status. An increase in the proportion of Papanicolaou smears showing dysplasia or cancer (class III or higher) was associated with use of the Cytobrush (P less than .05). Subsequent introduction of the Cytobrush to the control group resulted in a similar significant improvement in cell yields to 82.5% (P less than .001). Greater use of methods such as the Cytobrush Cell Collector in the primary care setting can improve cervical cancer screening by reducing the number of false-negative Papanicolaou smears resulting from inadequate endocervical cell sampling.