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Comparative yield of endocervical and metaplastic cells. Two sampling techniques: wooden spatula and cytology brush
Objective:
To compare two sampling techniques in their ability to obtain endocervical and metaplastic cells from the Papanicolaou smear.
Design:
Prospective clinical trial comparing the criterion standard of a wooden spatula to a cytology brush.
Setting:
Community-based family medicine clinic in London, Ont.
Patients:
Consecutive sample of 102 women aged 15 to 58 years requiring a Pap smear between October 1992 and October 1993 who presented to the office of their family physician and were assessed by one resident or one faculty physician.
Interventions:
A Pap smear was obtained from each participant using first the wooden spatula and then the cytology brush.
Main Outcome Measures:
The number of Pap smears done in the study population that contained endocervical or metaplastic cells.
Results:
Endocervical cell yield was significantly greater using the cytology brush (93.1%) than using the spatula (61.8%) (P < 0.001). There was no significant difference in metaplastic cell yield between the cytology brush (71.6%) and the spatula (63.7%). At least one of these cell types was identified on 95.1% of cytology brush samples and on 79.4% of spatula samples (P < 0.001). The resident and faculty physician were not significantly different in their rate of detecting endocervical or metaplastic cells.
Conclusions:
Adding a cytology brush sample to the Pap smear resulted in a significant increase in the rate of Pap smears that detected cells. The cytology brush was significantly better than the spatula for detecting endocervical cells (P < 0.001), but not significantly better for detecting metaplastic cells.