title: Improved endocervical sampling with the Cytobrush.
abstract: OBJECTIVE
  To evaluate the effectiveness of the Ayre wooden spatula, the cotton-tipped swab and the Zelsmyr Cytobrush in obtaining endocervical cells.
  
  
  METHODS
  Cross-sectional comparison study.
  
  
  METHODS
  Family practice unit.
  
  
  METHODS
  All postpubertal, nonpregnant women who underwent a routine Papanicolaou smear during a 7-month period.
  
  
  METHODS
  The three devices were used in each patient in a randomized sequence. An experienced cytotechnologist blinded to the device used evaluated the slides for overall epithelial cellularity (graded from 0 [acellular specimen] to 12 [overloaded sample]), density (the number of groups of five or more endocervical cells) and size of cell clusters (5 to 10 cells per cluster [score of 1], 11 to 100 [2] or more than 100 [3]).
  
  
  RESULTS
  Samples from 2 of the 136 women were rejected because of improper labelling of the slides or failure to use all three devices. Seventy-six (57%) of the smears obtained with the spatula and 71 (53%) with the swab had no endocervical cells, as compared with only 14 (10%) obtained with the Cytobrush (p = 0.001). The overall cellularity (and standard deviation [SD]) of the smears obtained with the Cytobrush (5.69 [SD 1.17], p = 0.001) and the spatula (5.70 [SD 1.46], p = 0.001) was significantly greater than the cellularity of those obtained with the swab (4.31 [SD 1.17]). The Cytobrush yielded significantly more groups of endocervical cells (109.84 per slide) than either the spatula (4.17) or the swab (6.25) (p = 0.001). The Cytobrush also produced larger cell clusters (1.56 [SD 0.67], p = 0.001) than either the swab (0.83 [SD 1.70]) or the spatula (0.64 [SD 0.67]).
  
  
  CONCLUSIONS
  The Cytobrush and the spatula should be used instead of the spatula alone or the spatula and the swab for collecting endocervical cells.
authors.affiliation: Department of Pathology, St. Michael's Hospital, Toronto, Ont.
authors.forename: A
authors.initials: A
authors.lastname: Chalvardjian
authors.forename: W G
authors.initials: WG
authors.lastname: De Marchi
authors.forename: V
authors.initials: V
authors.lastname: Bell
authors.forename: R
authors.initials: R
authors.lastname: Nishikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000166:cytology; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D014626:Vaginal Smears / Q000295:instrumentation*